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anatomy > Exam 1 - Thorax > Flashcards

Exam 1 - Thorax Flashcards

1
Q

what does the ectoderm make?

A

*skin & NS
- adrenal gland, posterior pituitary, brain, SC, nerves

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2
Q

what does the mesoderm make?

A

*muscles, bone, reproduction, cardiovascular
- kidneys, spleen, heart & vessels, peritoneum, goands, muscles, skeleton

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3
Q

what does the endoderm make?

A

*respiratory, digestive
esophagus, trachea, thyroid, thymus, anterior pituitary, lungs, stomach, liver, pancreas, gall-bladder, duodenum, jejunum, illeum, caecum, appendix, colon, rectum, bladder, prostate

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4
Q

where do afferent neurons go? efferent?

A

afferent = body -> CNS
efferent = CNS -> body

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5
Q

visceral afferent

A

nonsensory & sensory
- CO2, hunger, nausea, cramps
- broad area pair (stomach ache)

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6
Q

somatic afferent

A

touch, taste, burn, kiss (pinpoint sense)
- aware of!

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7
Q

efferent visceral

A

maintains homeostasis
- cardiac & smooth muscle, glands
- sympathetic & parasympathetic

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8
Q

efferent somatic

A

controlling skeletal muscle

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9
Q

what are visceral responses like?

A

internal, slow, diffuse

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10
Q

what are somatic responses like?

A

external, fast, precise

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11
Q

where in the SC do afferent signals come from?

A

dorsal horn

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12
Q

where in the SC do efferent signals come from?

A

visceral efferent = lateral horn (two neurons)
somatic efferent = ventral horn

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13
Q

what are the five layers of the epidermis?

A

stratum corneum (outer)
stratum lucidum
stratum granulosum
stratum spinosum
straum basale

*CLGSB (clare lost grace’s softball)

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14
Q

describe each layer of the epidermis

A

corneum = anucleate, keratin
lucidum = only in thick skin
granulosum = flattened shape, secrete proteins
spinosum = prickle layer
basale = mitotically active, cuboidal

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15
Q

describe the dermis

A
  • dense irregular CT
  • contains hair follicles, sweat glands, sebaceous glands, small vessels
  • melanocytes in hair bulb, contains erector muscles
  • SOMATIC AFFERENT nerve endings
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16
Q

what are the five types of somatic afferent nerves endings of the dermis? describe them

A

pacinian corpuscles = pressure, high vibration
meissner corpuscles = flutter, low vibration
ruffini corpuscles = stretch, warm
merkel endings = texture (light touch)
krause bulb = cold

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17
Q

where are the five different somatic afferent nerve endings of the dermis located at?

A

pacinian = underneath the nerve, low in dermis, light ring
meissner = in the groove of epidermis
ruffini = below grooves, oval shape
merkel = on the hump of groove
krause = bulb shape

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18
Q

describe the hypodermis

A

mainly fat tissue

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19
Q

describe the pathway of sympathetic nerves in the thorax from the SC (visceral efferent)

A

lateral horn -> ventral root -> white rami communicantes
1. goes through sympathetic trunk
2. goes to visceral organs
3. goes through gray rami communicantes (go through dorsal or ventral ramus)

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20
Q

describe the pathway of parasympathetic nerves in the thorax

A

all come from vagus nerve
- comes out of lateral horn

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21
Q

what separates the epaxial muscles from the hypaxial muscles?

A

thoracolumnar fascia

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22
Q

what is the origin of the trapezius?

A

superior nuchal line
external occipital protuberance
ligamentum nuchae
C7-T12

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23
Q

what is the insertion of the trapezius?

A

lateral third of clavicle
acromion
spine of scapula

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24
Q

innervation of trapezius

A

CN 11 (accessory nerve)

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25
Q

what is the action of the trapezius?

A

rotate scapula
- upper fibers elevate
- middle fibers retract
- lower fibers depress

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26
Q

what is the origin and insertion of the serratus posterior superior?

A

O: ligamentum nuchae, C7-T3
I: ribs 2-3

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27
Q

what is the innervation and action of the serratus posterior superior?

A

INN: intercostal nerves (T1-4)
A: elevate ribs

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28
Q

what is the origin and insertion of the serratus posterior inferior?

A

O: T11-L2
I: ribs 9-12

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29
Q

what is the innervation and action of the serratus posterior inferior?

A

INN: intercostal nerves (T9-12)
A: depress ribs

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30
Q

what are the two splenius muscles? where are they?

A

neck
- capitis, cervicis

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31
Q

what is the origin and insertion of the splenius muscles?

A

O: nuchal ligament
I: mastoid process (cap), trans. process C1-3 (cerv)

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32
Q

what is the innervation and action of the splenius muscles?

A

INN: dorsal rami
A: extent, lateral bend, and rotate head

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33
Q

what are the three erector spinae muscles?

A

spinalis (closest to center)
longissimus
lliocostalis

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34
Q

what is the origin and insertion of the erector spinae spinalis?

A

O: inferior spinous process
I: superior spinous process

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35
Q

what is the origin and insertion of the erector spinae longissimus?

A

O: inferior medial transverse process
I: superior lateral transverse process

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36
Q

what is the orgin and insertion of the erector spinae illocostalis?

A

O: illiac crest, sacrum, T11-L5
I: ribs

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37
Q

what is the innervation and action of the erector spinae muscles?

A

INN: dorsal rami
A: lateral flex & extending spine
- iliocostals do unilateral spine flex & bilateral rib depression

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38
Q

what are the three transversospinalis muscles?

A

semispinalis (capitas, cervicis, thoracis)
multifius
rotatores

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39
Q

what is the origin, insertion, and innervation of the transversospinalis muscles?

A

O: transverse process (caudally)
I: spinous process (cranially)
INN: dorsal rami

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40
Q

describe how to tell the difference between cervical, thoracic, and lumbar vertebrae?

A

cervical: short body, containn foramen transversarium, and has a short spinous process
thoracic: has two demifacet pairs for ribs, heart shaped body
lumbar: no facets for ribs, large body

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41
Q

what in the vertebrae has a primary curvature? secondary curvature?

A

primary: thoracic, sacrum (bends away from body)
secondary: cervical, lumbar (bends towards body)

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42
Q

what is the atlas and axis of the spine?

A

C1: atlas
C2: axis

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43
Q

what ligament runs vertical to the vertebral bodies? what ligament runs vertical to the front of the vertebral bodies?

A

ant. longitudinal ligaments = runs vertical to vertebrae bodies
- resists hyperextension (bending backwards)
-
post. longitudinal ligaments = runs vertical to the front of vertebraes
- resists hyperflexion and herniation

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44
Q

what ligament joins the vertebrae inferior to it (below it) on the laminae?

A

ligamenta flava

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45
Q

what ligament is b/w spinous processes of two vertebrae?

A

interspinous ligament

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46
Q

what ligament runs on the tips of the spinous processes?

A

supraspinous ligament

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47
Q

describe the ligamentum nuchae

A

cranial continuation of supraspinous ligament
- holds head up to conserve energy

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48
Q

scolioosis

A

lateral bent spine, YOUNG

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49
Q

kyphosis

A

hunchback, weak ligamenta flava, OLD
- occurs in thoracic spine

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50
Q

ankylosing spondylistis

A

inflammation that leads to fusion of vertebrae
- ossification of disks

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51
Q

spondylolisthesis

A

forward slippage of L5 (next to sacrum) and can lead to a break in spinous process
- due to poor evolution, malformed articular processes, or repeated force

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52
Q

herniated disk

A

nucleus pulposus of intervertebral disk bulges out & compresses nerve roots
- effects all downstream targets

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53
Q

what are dermatomes?

A

skin regions receiving somatic afferents from a specific spinal nerve
- has an inferior offset in thorax / abdomen
- twisted in limbs

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54
Q

describe the arteries of the spinal cord

A

1 anterior spinal artery
2 posterior spinal arteries
- has segmental spinal arteries that branch from intercostal arteries

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55
Q

describe the veins of the spinal cord

A

1 anterior spinal vein
1 posterior spinal vein
- all drain into the venous plexus (inside dura matter)

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56
Q

what is the mediastinum?

A

space b/w pleural sacs, behind manubrium

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57
Q

what is in the sternal angle?

A

at the plan of the manubriosternal joint (T4/5 disc)
-superior limit of pericardium
- bifurcation of trachea
- beginning and ending of aortic arch
- entrance of SVA into pericardium
- superior limit of pulmonary trunk

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58
Q

what does the tubercle of the ribs articulate with?

A

transverse processes

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59
Q

where are there nonsynovial joints?

A

intervertebral symphyses
manubriosternal symphyse
first sternocostal joint

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60
Q

what are the three muscles in the thoracic wall?

A

innermost intercostal
internal intercostal (inferoposterior = run toward middle)
external intercostal (inferanterior = run toward back)

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61
Q

what are the three vessels between each rib?

A

intercostal vein (superior)
intercostal artery
intercostal nerve (inferior)

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62
Q

what are the muscles called that run inside the rib cage on the posterior surface & cross two intercostal spaces?

A

subcostalis muscles

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63
Q

what are the 4-5 short muscles on the anterior side of the body that attach at the xiphoid process / inferior sternum and connect at the upper costal cartilage?

A

transversus thoracis muscles

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64
Q

what gives rise to the posterior intercostal arteries for ribs 3-12?

A

descending aorta

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65
Q

what gives rise to the posterior intercostal arteries for ribs 1-2?

A

supreme intercostal artery
- branches off of subclavian artery

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66
Q

what gives rise to the anterior intercostal arteries for ribs 1-6?

A

internal thoracic artery
- branches off of subclavian artery

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67
Q

what gives rise to the anterior intercostal arteries for ribs 7-9)

A

musculophrenic artery
- branches off of internal thoracic artery at T6/7

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68
Q

what three vessels branch off the aortic trunk? describe what they branch into

A

1: left subclavian -> vertebral artery
2. left carotid -> external & internal carotid
3. brachiocephalic branch -> right subclavian, right carotid (external & internal carotid)

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69
Q

what gives rise to the posterior intercostal veins for the RIGHT ribs 5-11?

A

azygous vein
- branches off of lumbar veins from the IVC

70
Q

what gives rise to the posterior intercostal veins for the RIGHT ribs 2-4?

A

superior intercostal vein
- branches off of the loop of the azygous vein to the SVC (at T4)

71
Q

what gives rise to the posterior intercostal veins for the RIGHT rib 1?

A

supreme intercostal vein
- branches off of SVC directly

72
Q

what gives rise to the posterior intercostal veins for LEFT ribs 9-11?

A

hemiazygous
- branches off of lumbar veins from the IVC

73
Q

what gives rise to the posterior intercostal veins for LEFT ribs 5-8?

A

accessory hemiazygous vein
- branches off of azygous vein at T8

74
Q

what gives rise to the posterior intercostal veins for LEFT ribs 2-4?

A

superior intercostal vein
- branches directly off of SVC

75
Q

what gives rise to to the posterior intercostal veins for the LEFT rib 1?

A

supreme intercostal vein
- branches off of SVC directly

76
Q

what two branches does the SVC have? describe what they branch into

A

brachiocephalic veins
- subclavian & internal jugular veins

*ON BOTH SIDES

77
Q

what is the superior thoracic aperature? what comes out of it?

A

above rib1 and b/w clavicle & rib1
- esophagus, trachea
- cardotid, subclavian, jugular

78
Q

what is thoracic outlet syndrome?

A

compression of brachial plexus of nerves by a band of tissue on cervical rib tip

79
Q

what is the inferior thoracic aperature? what are the three openings and what comes out of them?

A

through the diaphragm
- Caval Opening (T8) = IVC, phrenic nerve (right)
- Esophageal Hiatus (T10) = esophagus, gasrtic vessels (left), lymph channels
- Aortic Hiatus (T12) = aorta, thoracic duct, azygous vein

80
Q

what is the origin and insertion of the diaphragm?

A

O:right and left crus (L1-3)
I: costal cartilage of ribs 7-12, xiphoid process

81
Q

what is the innervation and action/function of the diaphragm?

A

INN: phrenic nerve (C3-5)
A: flattens & retracts lower ribs downward, quiet respiration

82
Q

what attaches the mammary glands to the dermis?

A

suspensory ligaments of Cooper

83
Q

what is peau d’orange?

A

breast carcinoma causes the suspensory ligament to be pulled tight and create pits in the skin
- leads to breast edema due to the occlusion of lymphatics and inability to drain

84
Q

what are mammary glands?

A

modified sweat glands that have no capsule or sheath and contain about 15-20 lobes
- each lobe has a lactiferous sinus that leads to a lactiferous duct

85
Q

what is the nerve supply of the breast?

A

anterior & lateral cutaneous branches of the 4-6 intercostal nerves

86
Q

what are the glands called on the areola?

A

areolar glands / glands of montgomery

87
Q

what is the axillary tail?

A

superolateral extenstion of mammary gland that reaches the armpit
- can swell during menstration & feel like a lump

88
Q

what is the blood supply of the breast?

A

lateral quadrants (outer half)
- lateral mammary arteries
(comes from a branch off of the subclavian artery -> axillary a -> lateral thoracic a)

medial quadrants (inner half)
- medial mammary arteries
(comes from a branch off of the subclavian artery -> internal thoracic a, internal mammary a)

89
Q

describe the lymphatic drainage in the breast

A

subareolar plexus -> anastomoses with contralateral (opposite) breast
- all quadrants drain to axillary nodes
- some medial quadrants also drain into the parasternal nodes

90
Q

describe why breast cancer is very common and spreads fast

A
  • water diffuses out of the blood and is taken up by the lymph system to drain into the veins
  • the breast lymph nodes are close to the subclavian vein
  • which can cause the cancerous cells to be spread all throughout the body
91
Q

what is the most common type of breast cancer? where does it form?

A

ductal cell carcinoma
- in the epithelium of lactiferous ducts

92
Q

describe the three levels of breast cancer

A
  1. lateral to pect. minor
  2. behind pect. minor
  3. medial to pect. minor
93
Q

what is the upper and lower respiratory tracts?

A

upper: nasal -> larynx
lower: trachea -> alveolar sacs

94
Q

what is the conducting zone?

A

nasal -> terminal bronchioles
- cleans, warms, and moistens the air
- known as the dead zone (no gas exchange)

95
Q

what is the respiratory zone?

A

parenchyma (respiratory bronchioles, alveolar ducts, alevoli)

96
Q

where along the vertebral column is the trachea before it bifurcates?

A

C6-T4/5

97
Q

which main bronchus is more likely to have an object lodged in it? (L or R)

A

right
- shorter, wider, and more vertical than left

98
Q

how many primary/main bronchi are there on the left and right sides?

A

1 on each side

99
Q

how many secondary bronchi are there on the left and right sides?

A

3R
2L

100
Q

how many tertiary/segmental bronchi are there on the left and right sides?

A

10R (3 upper, 2 middle, 5 lower)
10L (5 upper, 5 lower)

101
Q

what is the branch called on the right side that contains the upper tertiary bronchi?

A

eparterial bronchus

102
Q

what is the branch called on the right side that contains the middle and lower tertiary bronchi?

A

bronchus intermedius

103
Q

what are the branches called on the left side for the uper and lower tertiary bronchi?

A

upper -> superior
lower -> inferior

104
Q

what occurs during quiet inspiration?

A

volume increases
- diaphragm contracts and is pulled down & out

105
Q

what occurs during quiet expiration?

A

volume decreases
- diaphragm relaxes and elastic recoil of lung forces air out

106
Q

what occurs during vigorous inspiration?

A
  • rib1 is stabilized by scalenes
  • external intercostal muscles pull ribs up & out
    (mediolateral, anterposterior)
107
Q

what occurs during very vigorous inspiration?

A

-sternocleidomastoid and scalenes elevate thorax

108
Q

what occurs during vigorous expiration?

A

internal intercostals & abdominal muscles contract

109
Q

what innervates the intercostal muscles?

A

intercostal nerves

110
Q

what innervates the scalenes?

A

cervical SC

111
Q

what innervates the sternoclediomastoid?

A

CN 11 (accessory)
phrenic nerve (C3-4)

112
Q

where on the spinal cord, if it is cut, leaves the individual breathing on a ventiliator?

A

C3

113
Q

what are bronchopulmonary segments?

A

area of lungs supplied by tertiary bronchi and it’s pulmonary arterial branch
- smallest part of lung that can be surgically removed w/o affecting neighboring regions because they are functionally independent
- 10 segments per lung

114
Q

what blood supplies the parenchyma?

A

pulmonary artery (intrasegmental -> into each segment)
pulmonary vein (intersegmental -> many segments per)

115
Q

what blood supplies the bronchial part of lungs?

A

bronchial artery from the descending aorta

116
Q

how many lobes in each lung? what is the fissure b/w the upper and lower lobes in both lungs? what is the fissure called b/w the upper and middle right lobes called?

A

3R
2L
- upper/lower -> oblique fissure
- upper/middle (R) -> horizontal fissure

117
Q

what is the attachment points of the scalene muscles?

A

transverse processes & ribs 1,2

118
Q

what is the layer on the outside of the pleural cavity? layer on the lungs? what is the pleural cavity filled with inbetween these two layers?

A

parietal pleura (against thoracic wall)
visceral pleura (next to lungs)
serous fluid in b/w (allows for surface tension)

119
Q

what is a penumothorax?

A

air entering the pleural sac causing lungs to collapse inward
- the lungs have sub atmospheric pressure, so when air from the environment enters, it causes the surface tension of the lungs to be destroyed (which is what holds them out)

120
Q

what is a pleural effusion?

A

collection of fluid in the pleural sac
- hemothorax = blood
- chylothorax = lymph

121
Q

where is the fluid drained from during a pleural tap?

A

costodiaphragmatic recess (8th/9th intercostal space which is between rib9/10)

122
Q

what is the muscle that is between the pleural cavity and the ribs?

A

endothoracic fascia

123
Q

what is the innervation of the parietal pleura?

A

somatic afferent
- phrenic nerve -> diaphragmatic & mediastinal pleura
- intercostal nerves -> costal pleura

124
Q

what is the innervation of the lungs?

A

visceral efferent
- parasymp -> vagus -> mucous glands in trachea (cholinergic)
- symp -> T1-5 ventral roots

visceral afferent
- nonsensory go to brain thru vagus nerve
- NO SENSORY

125
Q

what type of reflex does the acini activate?

A

Hering-Breur reflex
- regulates rhythmic ventilation & prevents over inflation / deflation
- uses stretch receptors

126
Q

what type of reflex does the trachea and bronchi activate?

A

cough reflex
- uses chemoreceptors to sense an irritant

127
Q

what does activation of the sympathetic NS on the trachea and bronchi do?

A

releases epi to bind to beta2 receptors
- relaxes smooth muscle
- dilates bronchi

128
Q

what does activation of the sympathetic NS on the pulmonary vasculature do?

A

releases epi to bind to beta2 receptors
- relaxes smooth muscle
- dilates bronchi

129
Q

what does activation of the sympathetic NS on the bronchial arteries?

A

releases epi to bind to beta2 receptors
- constricts vessel to precent the blood from destroying mucosa lining

130
Q

what innervates the lung parenchyma and visceral pleura?

A

posterior and anterior plexuses
- found around the carina and main bronchi
- come from the vagus and cardiac nerves

131
Q

what is the most superior part of the pleura called?

A

cervical pleura

132
Q

what is the most distal part of the pleura called?

A

costal pleura

133
Q

what is the most inferior part of the pleura called?

A

diaphragmatic pleura

134
Q

what is the most medial part of the pleura called?

A

mediastinal pleura

135
Q

what two brain structures regulate breathing?

A

medulla & pons

136
Q

what center in the pons tells the medulla to stop inspiration?

A

pnemotaxic center

137
Q

what center in the pons tells the medulla to go check the breathing and contract muscles?

A

apneustic center

138
Q

what part of the SC deals with inspiration? what about expiration?

A

inspiration = dorsal respiratory group
expiration = ventral respiratory group

139
Q

where does the pons & medulla get its signals from for breathing?

A

gets signals from the aorta (CO2, O2)

140
Q

what is the function of the thymus?

A

primary lymph organ
- gland that screens and allows for a place of T-cell (killer cell) maturation

141
Q

where is the thymus located?

A

mediastinum, above heart, and in front of carina

142
Q

describe the structure of the thymus? what are the pouches called that they arose from?

A

2 lobes (R,L)
- each comprised of individual lobules
- each lobule has two layers (medulla, cortex)
- cortex and fenestrated capillaries, medulla has non-fenestrated capillaries
- come from phrengial pouches

143
Q

what is the blood supply of the thymus?

A

inferior and middle arteries, intercostal arteries

144
Q

describe the blood-thymus barrier

A

made by epithelial cells to ensure T-cells are mature
- negative screening -> autoreactive cells apoptose
- positive screening -> antigen-binindg cells proliferate

145
Q

describe the shape of the thymus in children vs adults

A

children = square, larger
adult = triangular, gets smaller and fattier as we age (run out of T-cells to screen)

146
Q

what is the outer layer of the pericardial cavity?

A

fibrous pericardium (outer)
serous pericardium/parietal layer (inner)

147
Q

what is the inner layer of the pericardial cavity? (closest to the heart)

A

visceral layer

148
Q

what is the space b/w the parietal layer and visceral layer of the heart called?

A

pericardial cavity
- filled with serous fluid

149
Q

whats the importance of the fibrous pericardium?

A

contains phrenic nerves (C3-5) and pericardiacophrenic vessels

150
Q

where is the transverse pericardial sinus?

A

behind ascending aorta & pulmonary trunk, in front of SVC

151
Q

where is the oblique pericardial sinus?

A

behind the posterior wall of left atrium

152
Q

what is cardiac tamponade?

A

compression of the heart due to fluid accumulation w/in pericardium
-caused by kidney malfunction, trauma, inflammation
-makes there be less blood pumped, less blood in the heart, which overall increases bp
- can be solved by drugs or a pericardiocentesis

153
Q

what is the auricle?

A

pouchlike appendage from embryonic development in the atrium’s

154
Q

what is the crista terminalis?

A

ridge that runs from the IVC to the SVC openings in the right atrium

155
Q

what is the fossa ovalis?

A

depression in the interatrial septum
- former site of the foramen ovale

156
Q

what is the trabeculae carneae?

A

irregular ridges of the right venticle myocardium

157
Q

what are papillary muscles?

A

what attaches the cuspid valves to the heart

158
Q

what are chordae tendineae?

A

fibrous cords that connect papillary muscles to valve

159
Q

what is the moderator band?

A

connects anterior papillary muscles to interventricular septum

160
Q

which atrium has a thicker wall, left or right?

A

left atrium

161
Q

what are the two semilunar valves?

A

pulmonary and aortic
- not muscular
- blood LEAVES

162
Q

what are the two cuspid valves?

A

bicuspid (L), tricuspid (R)
- papillary muscles force open
- blood ENTERS

163
Q

what two things are open during fetal development, but eventually close?

A

foramen ovale
ductus arteriosus
- no need to pump blood to lungs in utero (gets O2 from mom)

164
Q

what are common birth defects of the heart?

A

narrow pulmonary trunk
enlarged right ventricle
aorta open to both ventricles
hole in ventricular wall

165
Q

what type of membrane is around each valve in the heart and serves as an electrical insulator to open valves separately?

A

dense fibrous connective tissue
- bound together by trigones

166
Q

what two arteries stem off of the aortic root?

A

coronary arteries (L, R)

167
Q

describe the three sinuses of the aortic root

A

three cavities
- left coronary sinus
- right coronary sinus
- non-coronary sinus

168
Q

what branches does the RIGHT coronary artery give rise to?

A

right marginal artery
posterior inerventricular artery

169
Q

what does the RIGHT coronary artery give blood to?

A

RA, RV, LV

170
Q

what branches does the LEFT coronary artery give rise to? what do these branches give blood to?

A

LAD (LA, LV)
circumflex -> left marginal artery (LV, septum)

171
Q

what are atherosclerotic plaques?

A

common in the RCA and LCA in the tunica intima
- made up of fats, lipids, and debris

172
Q

where are the common occlusion sites for plaques?

A
  1. b/w LAD & circumflex
  2. LAD
  3. RCA
  4. circumflex
  5. posterior interventricular artery

anatomy (4 decks)

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