Exam 2 Flashcards
1
Q
What connects the lower part of the pharynx to the trachea?
A
The Larynx
2
Q
What are the functions of the larynx?
A
- It prevents the passage of food into the airway during swallowing.
- It regulates the flow of air into the lungs.
- It functions in vocalization.
3
Q
How long is the adult larynx?
A
5 cm long
4
Q
What vertebrae does the larynx lie between?
A
C3 and C6
5
Q
What is the thyroid cartilage primarily made of?
A
Hyaline cartilage
6
Q
The thyroid cartilage is a single cartilage which presents what features?
A
- Superior Thyroid Notch
- Inferior Thyroid Notch (less defined)
- Laryngeal Prominence (anterior median elevation)
- Superior Horn (attached to greater horn of hyoid)
- Inferior Horn (articulates with cricoid cartilage)
- Laminae (lateral walls)
- Oblique Line (on external surface of the lamina, provides attachment for inferior constrictor, sternothyroid, and thyrohyoid)
7
Q
What feature of the thyroid cartilage is also known as the “adam’s apple”?
A
Laryngeal Prominence
8
Q
What feature of the thyroid cartilage is more pronounced in males due to a longer vocal cord?
A
Laryngeal Prominence
9
Q
What does the Greek word Krikos mean?
A
Ring
10
Q
What cartilage of the larynx is a single cartilage which is shaped like a signet ring consisting of a narrow anterior arch and a broad, posterior lamina?
A
Cricoid cartilage
11
Q
What is the most inferior of the laryngeal cartilages?
A
Cricoid cartilage
12
Q
What cartilage of the larynx is a single cartilage which is shaped like a spoon and lies behind the root of the tongue and body of the hyoid bone?
A
Epiglottic cartilage
13
Q
What cartilage of the larynx has a lower end that is attached to the back of the laryngeal prominence of the thyroid cartilage by the thyroepiglottic ligament?
A
Epiglottic cartilage
14
Q
What cartilages of the larynx make a cricoarytenoid joint?
A
Arytenoid cartilages
15
Q
What cartilages of the larynx are paired cartilages which are pyramidal in shape?
A
Arytenoid cartilages
16
Q
What cartilages of the larynx have bases that articulate with the cricoid cartilage?
A
Arytenoid cartilages
17
Q
What two features does each arytenoid cartilage present?
A
- Vocal process
2. Muscular process
18
Q
What feature of the arytenoid cartilage gives attachment to the vocal ligament?
A
Vocal process
19
Q
What feature of the arytenoid cartilage gives attachment to intrinsic muscles of the larynx?
A
Muscular process
20
Q
What cartilages of the larynx are paired cartilages which lie on the apices of the arytenoid cartilages and are closed within the aryepiglottic folds?
A
Corniculate cartilages
21
Q
What cartilages of the larynx may ossify in some individuals and look like a fracture when looking at x-ray?
A
Corniculate and Cuneiform cartilages
22
Q
What cartilages are paired cartilages which lie in the aryepiglottic folds anterior to the corniculate cartilages?
A
Cuneiform cartilages
23
Q
What joint of the larynx is a synovial joint between the side of the cricoid cartilage and the inferior horn of the thyroid cartilage and permits rotation of the thyroid cartilage around a horizontal axis?
A
Cricothyroid joint
24
Q
What joint of the larynx is a synovial joint between the upper border of the cricoid cartilage and the base of the arytenoid cartilage and permits gliding and rotation of the arytenoid cartilage on the cricoid cartilage?
A
Cricoarytenoid joint
25
What ligament of the larynx extends from the thyroid cartilage to the hyoid bone and is pierced on each side by the internal laryngeal nerve and the superior laryngeal vessels?
Thyrohyoid Membrane
26
What ligament of the larynx extends from the arch of the cricoid cartilage to the thyroid cartilage?
Median Cricothyroid Ligament
27
What ligament of the larynx extends from the thyroid cartilage in front to the vocal process of the arytenoid cartilage behind?
Vocal Ligament
28
What ligament of the larynx is a fibroelastic membrane which extends upward from the cricoid cartilage to the vocal ligament and has a free edge that is formed by the vocal ligament?
Conus Elasticus (Cricovocal Membrane, Lateral Cricothyroid Ligament)
29
What ligament of the larynx connects the epiglottic cartilage to the arytenoid cartilage on each side?
Quadrangular Membrane
30
What margin of the Quadrangular forms the aryepiglottic ligament within the aryepiglottic fold?
Superior margin
31
Whar margin of the Quadrangular forms the vestibular ligament within the vestibular fold?
Inferior margin
32
What two pairs of folds does that larynx contain?
1. Vestibular Folds (False Vocal Cords)
| 2. Vocal Folds (True Vocal Cords)
33
Which of the two pairs of folds that the larynx contains does not vibrate but is protective in function and initiates the cough reflex?
Vestibular Folds
34
Which of the two pairs of folds that the larynx contains vibrates and is located inferior and medial to the False vocal cords?
Vocal Folds
35
What do vocal folds contain?
The vocal ligament and vocalis muscle
36
What is the space between the vestibular folds termed?
Rima Vestibuli
37
What is the space between the vocal folds and is the narrowest part of the laryngeal cavity?
Rima Glottidis
38
What space is where people usually choke and need assistance?
Rim Glottidis
39
What includes the rima glottidis and vocal folds and is a sound producing apparatus?
Glottis
40
What is the larynx divided into three cavities by?
The vestibular and vocal folds
41
What 3 cavities is the larynx divided into?
1. Laryngeal Vestibule
2. Laryngeal Ventricles
3. Infraglottic Cavity
42
What cavity of of the larynx extends from the laryngeal inlet to the vestibular folds?
Laryngeal Vestibule
43
What cavity of the larynx lies between the vestibular folds and vocal folds?
Laryngeal Ventricles
44
What cavity extends from the vocal folds to the inferior border of the cricoid cartilage and is the lowest cavity of the larynx?
Infraglottic Cavity
45
What is the term used for inflammation of the vocal cords?
Laryngitis
46
What is the small diverticulum within the laryngeal ventricle?
Laryngeal Saccule
47
What contains glands which lubricate the vocal folds and has been called the "oil can" of the vocal folds?
Laryngeal Saccule
48
With hoarseness due to excessive speaking or singing what happens to the lubricant from the saccule?
It is temporarily depleted
49
What muscles are those which move the larynx as a whole?
Extrinsic muscles of the larynx
50
What two groups can extrinsic muscles be divided into?
elevators and depressors
51
Which of the extrinsic muscles of the larynx are elevators?
1. Thyrohyoid
2. Stylohyoid
3. Mylohyoid
4. Digastric
5. Stylopharyngeus
6. Palatopharyngeus
52
Which of the extrinsic muscles of the larynx are depressors?
1. Omohyoid
2. Sternohyoid
3. Sternothyroid
53
What are the names of the intrinsic muscles of the larynx?
1. Cricothyroid
2. Posterior Cricoarytenoid
3. Lateral Cricoarytenoid
4. Transverse Arytenoid
5. Oblique Arytenoid
6. Aryepiglottic
7. Thyroepiglottic
8. Thyroarytenoid
9. Vocalis
54
When contracted, what intrinsic muscle of the larynx increases pitch?
Cricothyroid
55
What muscle originates at the cricoid cartilage and inserts on the inferior horn and lower lamina of the thyroid cartilage?
Cricothyroid
56
What is the innervation of the Cricothyroid muscle?
External Laryngeal Nerve
57
What is the function of the Cricothyroid muscle?
Tilts the thyroid cartilage downward or cricoid cartilage upward thereby tensing the vocal cords
58
What muscle originates at the posterior surface of the lamina of the cricoid cartilage and inserts on the muscular process of the arytenoid cartilage?
Posterior Cricoarytenoid
59
What is the innervation of the Posterior Cricoarytenoid muscle?
Recurrent Laryngeal Nerve
60
What is the function of the Posterior Cricoarytenoid muscle?
Abducts the vocal cords
61
What position of the vocal cords is considered to be neutral and reduces the risk of suffocation?
When they are partially abducted
62
What muscle originates at the arch of the cricoid cartilage and inserts on the muscular process of the arytenoid cartilage?
Lateral Cricoarytenoid
63
What is the innervation of the Lateral Cricoarytenoid muscle?
Recurrent Laryngeal Nerve
64
What is the function of the Lateral Cricoarytenoid muscle?
Adducts the vocal folds
65
What muscle originates at the posterior surface of the arytenoid cartilage and inserts on the posterior surface of the opposite arytenoid cartilage?
Transverse Arytenoid
66
What is the innervation of the Transverse Arytenoid muscle?
Recurrent Laryngeal Nerve
67
What is the function of the Transverse Arytenoid muscle?
Adducts the vocal folds
68
What two muscles act together to perform the action of "coughing"?
1. Transverse Arytenoid
| 2. Oblique Arytenoid
69
What muscle originates at the muscular process of the arytenoid cartilage and inserts at the apex of opposite arytenoid cartilage?
Oblique Arytenoid
70
What is the innervation of the Oblique Arytenoid muscle?
Recurrent Laryngeal Nerve
71
What is the function of the Oblique Arytenoid muscle?
Adducts the vocal folds
72
What muscle originates at the apex of the arytenoid cartilage and inserts on the side of the epiglottic cartilage?
Aryepiglottic
73
What is the innervation of the Aryepiglottic muscle?
Recurrent Laryngeal Nerve
74
What is the function of the Aryepiglottic muscle?
Closes the laryngeal inlet (swallowing)
75
What muscle is a continuation of the Oblique Arytenoid and lies within the aryepiglottic fold?
Aryepiglottic
76
What muscle originates at the inner surface of the thyroid lamina and inserts at the lateral margin of the epiglottis?
Thyroepiglottic
77
What is the innervation of the Thyroepiglottic muscle?
Recurrent Laryngeal Nerve
78
What is the function of the Thyroepiglottic muscle?
Opens the laryngeal inlet (end of swallowing)
79
What muscle originates at the inner surface of the thyroid lamina and inserts at the arytenoid cartilage?
Thyroarytenoid
80
What is the innervation of the Thyroarytenoid muscle?
Recurrent Laryngeal Nerve
81
What is the function of the Thyroarytenoid muscle?
Shortens and relaxes vocal folds by drawing the arytenoid cartilages forward
82
What happens when the Thyroarytenoid muscle takes tension off of the vocal folds?
A lower voice is produced
83
What muscles originates at the inner surface of the thyroid lamina and inserts at the vocal process of the arytenoid cartilage?
Vocalis
84
What is the innervation of the Vocalis muscle?
Recurrent Laryngeal Nerve
85
What is the function of the Vocalis muscle?
Adjusts the tension on the vocal cords during phonation
86
What are important in phonation because they control the stream of air passing through the rima glottidis?
Vocal folds
87
The size and shape of what is altered during phonation and respiration by movements of the arytenoid cartilages?
Rima glottidis
88
The movements of what alters the size and shape of the rima glottidis during phonation and respiration?
Arytenoid cartilages
89
The rima glottidis is ___ during inspiration, and ___ and ___ during expiration and phonation.
- Wide
- Narrow
- Wedge-shaped
90
What aspect of the vocal folds determines the pitch (frequency) of the sound produced?
Degree of Tension
91
To raise the pitch (frequency) of the sound produced, tension is increased by what muscle(s)?
Cricothyroid muscle
92
To lower the pitch (frequency) of the sound produced, tension is decreased by what muscle(s)?
Thyroarytenoid and Vocalis muscles
93
What 3 things is voice dimorphism determined by?
1. Length of the Vocal Cords
2. Size of the Resonating Chamber (Pharynx, Larynx, etc.)
3. Thickness of the Vocal Cords
94
Does the vocal ligament have androgen receptors on it?
Yes
95
What nerves innervate the larynx?
1. Recurrent Laryngeal Nerve
2. Internal Laryngeal Nerve
3. External Laryngeal Nerve
96
What nerve is motor to all of the intrinsic muscles of the larynx except the cricothyroid?
Recurrent Laryngeal Nerve
97
What nerve is sensory to the mucosa of the larynx below the vocal fold?
Recurrent Laryngeal Nerve
98
What nerve(s) is/are a branch of the superior laryngeal nerve?
1. Internal Laryngeal Nerve
| 2. External Laryngeal Nerve
99
What nerve is sensory to the mucosa of the larynx above the vocal folds?
Internal Laryngeal Nerve
100
What nerve pierces the thyrohyoid membrane to enter the larynx along with the superior laryngeal artery?
Internal Laryngeal Nerve
101
What nerve is motor to the cricothyroid and inferior constrictor muscles?
External Laryngeal Nerve
102
What blood vessel supplies blood to the larynx from the superior thyroid artery?
Superior Laryngeal Artery
103
What blood vessel supplies blood to the larynx from the inferior thyroid artery?
Inferior Laryngeal Artery
104
Which of the nerves that innervate the larynx is the most important?
Recurrent Laryngeal Nerve
105
What are the 3 main functions of the lymphatic system?
1. Picks up protein molecules from tissue fluid which are too large to pass through capillaries and transports them to the bloodstream.
2. Returns excess tissue fluid to the bloodstream.
3. It produces lymphocytes.
106
What type of tissue do lymph nodes contain?
Reticular tissue
107
What moves lymph?
Skeletal Muscle Contraction
108
What are examples of lymph being moved by skeletal muscle contraction?
1. Exercise clears toxins from tissues.
| 2. Health benefits of massage.
109
What are swellings found along the lymphatic system called?
Lymph Nodes
110
What are the functions of lymph nodes?
1. Produce lymphocytes.
| 2. Act as filters for the lymph, preventing foreign bodies from entering the bloodstream.
111
What do afferent lymph vessels do?
Drain lymph to a node
112
What do efferent lymph vessels do?
Drain lymph from a node
113
What are the superficial lymph nodes of the head?
1. Occipital
2. Mastoid
3. Parotid
114
What are the superficial lymph nodes of the neck?
1. Submandibular
2. Submental
3. Anterior Cervical
4. Superficial Cervical
115
What superficial node of the neck is located on the external surface of the sternocleidomastoid muscle following the external jugular vein?
Superficial Cervical
116
Where do all lymphatics of the head and neck eventually drain directly or indirectly into?
Deep Cervical Nodes
117
Where are deep cervical nodes located?
Located within the carotid sheath and follows the course of the internal jugular vein
118
What are the two largest deep cervical nodes?
1. Jugulodigastric Node
| 2. Jugulo-omohyoid Node
119
What does the Jugulodigastric Node drain?
The tongue and the palatine tonsils
120
Where is the Jugulodigastric Node found?
Near the posterior belly of the digastric muscle.
121
What node is enlarged by Tonsilitis?
Jugulodigastric Node
122
What does the Jugulo-omohyoid Node drain?
The tongue
123
Where is the Jugulo-omohyoid Node found?
Near the intermediate tendon of the omohyoid
124
What forms the right and left jugular trunks?
Efferents of the deep cervical nodes
125
Where does the right jugular trunk drain into?
The junction between the internal jugular and subclavian veins
126
Where does the left jugular trunk drain into?
The thoracic duct
127
What is very important for tracking the spread of cancer cells?
The lymphatic system
128
Afferents of what nodes drain the central portions of the lower lip, the floor of the mouth, and the tip of the tongue?
Submental Nodes
129
Afferents of what nodes drain the cheek, the side of the nose, the upper lip, the lateral part of the lower lip, the gums, and the margin of the tongue?
Submandibular Nodes
130
What lymphatics are followed by the spread of cancer?
The lymphatics which drain the affected region
131
Will cancer of the central part of the lip follow a different path than cancer of the lateral part of the lip?
Yes
132
Will cancer of the central part of the lip follow the same path than cancer of the lateral part of the lip?
No
133
What term is used to describe the spread of cancer via the lymphatic system?
Lymphogenous Metastasis
134
What is an enlarged supraclavicular node that is usually located on the left side?
Signal (Sentinel) Node
135
What is often the first indication of a visceral tumor of the thorax or abdomen?
Signal (Sentinel) Node
136
What is a primary tumor of the lymph nodes called?
Lymphoma
137
What is Hodgkin's disease a type of?
Lymphoma
138
What is a type of lymphoma that has a poorer prognosis than Hodgkin's disease?
Non-Hodgkin's Lymphoma
139
In diagnosis, what does an enlarged lymph node which is tender or painful indicate?
Infection
140
In diagnosis, what does an enlarged lymph node which is hard and painless indicate?
Cyst development or cancer
141
What is a parasital infection of the lymph nodes consisting of worms?
Filarasis
142
What is an epidermally derived structure that consists of mammary glands, fat, and fibrous tissue?
The breast
143
What does the breast consist of?
1. mammary glands
2. fat
3. fibrous tissue
144
Where is the breast located?
Between the second and sixth ribs and between the sternum and the midaxillary line
145
What is a vertical line dividing the armpit into anterior and posterior halves?
Midaxillary Line
146
Where is the nipple usually located?
At the level of the fourth intercostal space
147
What is the ring of pigmented skin which surrounds the nipple called?
Areola
148
What is the portion of the breast which extends back into the armpit?
Axillary Process (Tail)
149
Is the axillary process (tail) a frequent site for cancer?
Yes
150
What are the strong fibrous septa which support the breast and which run through the breast from the skin to the deep layer of superficial fascia called?
Suspensory Ligaments of the Breast
151
What is a modified sweat gland that is located in the superficial fascia and has 15 to 20 lobes of glandular tissue?
Mammary Gland
152
Where does each lobe of glandular tissue of a mammary gland open onto?
Onto the tip of the nipple through the lactiferous duct
153
What is an expansion of the lactiferous duct which serves as a reservoir for milk during lactation?
Lactiferous Sinus
154
What blood vessels supply blood to the breast?
1. Internal Thoracic Artery
2. Thoracoacromial Artery
3. Lateral Thoracic Artery
4. Intercostal Arteries
155
What are the lobes of glandular tissue made up of?
Histological features called lobules
156
What lymphatic structures drain the breast?
1. Axillary Nodes
2. Parasternal Nodes
3. Nodes of the Opposite Breast
4. Nodes of the Anterior Abdominal Wall
157
Why are there lots of lymphatics around the breasts?
Immune response protecting the infant
158
What is the most important lymphatic that drains the breast?
Axillary Nodes
159
Where are parasternal nodes located?
Inside of the Sternum
160
Seventy-five percent of the lymph from the breast drains to what nodes?
Axillary Nodes
161
What is the most common cancer in women?
Breast Cancer
162
Where does breast cancer spread to first before entering the bloodstream?
Lymphatics
163
Following entrance into the bloodstream where does breast cancer first spread to?
Axilla
164
Where does the posterior intercostal veins brain cancer drain to?
Azygos and Hemiazygos systems
165
Where do connections to the vertebral venous plexus allow the spread of breast cancer to?
The vertebral column and brain
166
What are the 3 clinical signs of breast cancer?
1. Dimpling due to invasion of the suspensory ligament.
2. Inverted nipple (due to invasion of the lactiferous duct).
3. Leathery thickening of skin (like an orange).
167
What is one cause of mid-thoracic back pain in females?
Breast Cancer
168
What is the sternum a major site for?
Red Blood Cell production
169
What is the widest and thickest part of the sternum?
Manubrium
170
What structure's upper border forms the jugular notch?
Manubrium
171
What part of the sternum articulates with the second to seventh costal cartilages?
Body
172
What joint does the costal cartilage of the second rib articulate directly with?
Manubriosternal Joint
173
What part of the sternum is cartilaginous at birth, but slowly ossifies throughout life?
Xiphoid Process
174
Can the Xiphoid process of the sternum be bifid?
Yes
175
What part of the sternum is often broken during CPR?
Xiphoid Process
176
What does the articulation of the manubrium with the body of the sternum form?
The Sternal Angle
177
Where is the sternal angle found at?
The level of the intervertebral disc between T.V.4 and T.V.5
178
What is the superior opening of the thoracic cage called?
Superior Thoracic Aperture (Thoracic Inlet)
179
What is the Superior Thoracic Aperture (Thoracic Inlet) bounded by?
1. Manubrium
2. First Rib
3. First Thoracic Vertebra
180
What may barrel chest suggest?
COPD (Emphysema)
181
What is the inferior opening of the thoracic cage called?
Inferior Thoracic Aperture (Thoracic Outlet)
182
What is the shape of the Inferior Thoracic Aperture (Thoracic Outlet)?
Kidney-shaped
183
What is the Inferior Thoracic Aperture (Thoracic Outlet) bounded by?
1. Xiphoid Process
2. Costal Margin
3. Twelfth Rib
4. Distal End of the Eleventh Rib
5. Twelfth Thoracic Vertebra
184
How many ribs are there?
24 (12 pairs)
185
What two types of ribs are there based on their patterns of articulation?
1. True Ribs
| 2. False Ribs
186
What type of ribs are ribs 1 to 7?
True Ribs
187
What type of ribs articulate with the sternum directly through their own costal cartilages?
True Ribs
188
What ribs are classified as "True Ribs"?
Ribs 1 to 7
189
What types of ribs are ribs 8 to 12?
False Ribs
190
What "False Ribs" articulate with the sternum indirectly by attaching to the costal cartilage of the rib above?
Ribs 8 to 10
191
What "False Ribs" are not connected to the sternum at all and are often referred to as floating ribs?
Ribs 11 & 12
192
What two types of ribs are there based on morphology?
1. Typical Ribs
| 2. Atypical Ribs
193
What ribs are classified as "Typical Ribs"?
Ribs 3 to 9 which share similar morphology
194
What ribs are classified as "Atypical Ribs"?
Ribs 1, 2, 10, 11, and 12, each of which is unique
195
What morphological features are found on a typical rib?
1. Head
2. Neck
3. Tubercle
4. Angle
5. Shaft
6. Costal Groove
196
What are the functions of the thoracic cage?
1. Protection of thoracic and upper abdominal organs.
2. Muscle attachments.
3. Respiration.
197
Do the ribs move with respiration?
Yes
198
What muscle originates at the lower border of ribs 1 to 11 and inserts at the upper border of ribs 2 to 12?
External Intercostal
199
What is the innervation of the external intercostal muscle?
Corresponding intercostal nerve
200
What is the function of the external intercostal muscle?
Elevates the ribs in inspiration
201
Where on the rib do the external intercostal muscles begin and end?
They begin at the tubercle of the rib and end at the costochondral joint
202
What are the external intercostal muscles replaced by at the costochondral joint?
External intercostal membrane
203
What direction do the fibers of the external intercostal muscles run?
Downward and Forward
204
What muscle originates at the upper border of ribs 2 to 12 and inserts at the lower border of ribs 1 to 11?
Internal Intercostal
205
What is the innervation of the internal intercostal muscles?
Corresponding intercostal nerve
206
What is the function of the internal intercostal muscles?
Depresses the ribs in fored expiration
207
Where on the rib do the internal intercostal muscles begin and end?
They begin at the sternum and end at the angle of the ribs
208
What replaces the internal intercostal muscles?
Internal Intercostal Membrane
209
What direction do the fibers of the internal intercostal muscles run?
Downward and Backward
210
What muscle originates at the upper border of ribs 2 to 12 and inserts at the lower border of ribs 1 to 11?
Innermost Intercostal
211
What is the innervation of the Innermost Intercostal muscle?
Corresponding Intercostal Nerve
212
What is the function of the Innermost Intercostal muscle?
Depresses the ribs in forced expiration
213
What direction do the fibers of the innermost intercostal muscles run?
Downward and Backward
214
What do all intercostal muscles function to do?
To prevent the pushing in or drawing out of the intercostal spaces during respiration
215
What muscle originates at the inner surface of ribs near their angles, travels across a rib without inserting, and then inserts into the rib above that?
Subcostalis
216
What is the innervation of the subcostalis muscle?
Intercostal Nerve
217
What is the function of the subcostalis muscle?
Depresses the ribs in forced expiration
218
What muscle originates at the posterior surface of the lower sternal body and xiphoid process and inserts at the inner surface of costal cartilages 2 to 6?
Transversus Thoracis
219
What is the innervation of the transversus thoracis?
Intercostal Nerve
220
What is the function of the transversus thoracis?
Depresses the ribs in forced expiration
221
What do anastomoses allow?
Collateral Articulation
222
What is the anterior aspect of the thoracic wall supplied by?
The Internal Thoracic Artery and its branches
223
What are the branches of the internal thoracic artery (from the subclavian)?
1. Pericardiacophrenic Artery
2. Anterior Intercostal Arteries
3. Musculophrenic Artery
4. Superior Epigastric Artery
224
What branch of the internal thoracic artery accompanies the phrenic nerve and supplies the pleura, pericardium, and diaphragm?
Pericardiacophrenic Artery
225
What branch of the internal thoracic artery supplies the upper 6 intercostal spaces and anastomose with the posterior intercostal arteries?
Anterior Intercostal Arteries
226
What branch of the internal thoracic artery is the lateral terminal branch?
Musculophrenic Artery
227
What branch of the internal thoracic artery is the medial terminal branch?
Superior Epigastric Artery
228
What blood vessels supply the posterior aspect of the thoracic wall?
1. Supreme (Superior) Intercostal Artery
2. Third through Eleventh Posterior Intercostal Arteries
3. Subcostal Artery
229
What side is the thoracic branch of the aorta located on?
Left
230
Where does the Supreme (Superior) Intercostal Artery come from?
Costocervical Trunk
231
What does the Supreme (Superior) Intercostal Artery branch into?
The first and second posterior intercostal arteries
232
Where do the third through eleventh posterior intercostal arteries arise from?
Directly from the thoracic aorta
233
Where does the subcostal artery come from?
Thoracic Aorta
234
Where does the subcostal artery lie?
Below the 12th rib
235
What is the anterior aspect of the thoracic wall drained by?
Internal Thoracic Vein
236
What does the internal thoracic vein drain into?
The brachiocephalic vein
237
What is the posterior aspect of the thoracic wall drained by?
The azygos system of veins
238
Is the Azygos System unpaired and bilaterally asymmetrical?
Yes
239
Is the Azygos System paired and non-bilaterally asymmetrical?
No
240
On the right side, where does the first posterior intercostal vein drain into?
The brachiocephalic vein
241
On the right side, what do the second and third posterior intercostal veins join together to form?
The Superior Intercostal Vein
242
On the right side, what does the superior intercostal vein drain into?
The azygos vein
243
On the right side, what do the fourth through eleventh posterior intercostal veins and the subcostal vein drain into?
The azygos vein
244
On the left side, what does the first posterior intercostal vein drain into?
The Brachiocephalic Vein
245
On the left side, what do the second and third posterior intercostal veins join together to form?
The Superior Intercostal Vein
246
On the left side, what does the superior intercostal vein drain into?
The Left Brachiocephaic Vein
247
On the left side, what do the fourth through eighth posterior intercostal veins join together to form?
The Accessory Hemiazygos Vein
248
On the left side, what does the hemiazygos vein drain into?
The Azygos Vein
249
On the left side, what do the ninth through eleventh posterior intercostal veins join to form?
The Hemiazygos Vein
250
What do the azygos and hemiazygos veins represent?
The thoracic continuation of the right and left ascending lumbar veins
251
What are the anterior primary rami of the first 11 thoracic spinal nerves?
Intercostal Nerves
252
What is the anterior primary ramus of the 12th thoracic spinal nerve?
Subcostal Nerve
253
What is the function of the endothoracic fascia?
To prevent the innermost intercostal muscle from rubbing against the parietal pleura
254
What is the thickening of the fascia over the apex of the lung called?
Suprapleural Membrane
255
What does the typical intercostal space contain?
1. Intercostal Vein
2. Intercostal Artery
3. Intercostal Nerve
256
What structure found in the typical intercostal space hangs below the costal groove and is not protected like its corresponding artery and vein?
Intercostal nerve
257
What structures lie within the costal groove on the lower, internal surface of each rib and are sandwiched between the internal and innermost intercostal muscles?
1. Intercostal Vein
2. Intercostal Artery
3. Intercostal Nerve
258
What three smaller cavities is the thoracic cavity subdivided into?
1. Mediastinum
| 2. 2 Pleural Cavities
259
What is the name of the cavity that surrounds the lung?
Pleural Cavity (2)
260
What is the area between the two pleural cavities which contains the heart, great vessels, trachea, esophagus, etc. called?
Mediastinum
261
What is a thin membrane which lines the inner surface of the thoracic cavity and covers the surface of the lung?
Pleura
262
What two types of pleura are there?
1. Parietal Pleura
| 2. Visceral Pleura
263
What type of pleura lines the inner surface of the thorax?
Parietal Pleura
264
What type of pleura intimately invests the lung?
Visceral Pleura
265
What is a potential space between the parietal and visceral pleurae?
Pleural Cavity
266
What lubricates the pleurae to minimize friction between the parietal and visceral layers, facilitating movement of the lungs?
Pleural Fluid
267
What 4 parts does the parietal pleura consist of?
1. Costal Pleura
2. Mediastinal Pleura
3. Diaphragmatic Pleura
4. Cervical Pleura (portion which overlies the apex of the lung)
268
What are spaces found between two folds of parietal pleura called?
Pleural Recesses
269
What do pleural recesses allow for?
The expansion of the lung during inspiration
270
What is the space formed where the costal and diaphragmatic pleurae meet?
Costodiaphragmatic Recess
271
Where is the costodiaphragmatic recess located?
At the midaxillary line
272
What is the space formed where the costal and mediastinal pleurae meet?
Costomediastinal Recess
273
What tends to accumulate in the costodiaphragmatic recess but can be removed by thoracentesis done at intercostal space 9 during expiration?
Fluid
274
What blood vessel(s) supply the parietal pleura?
1. Intercostal Arteries
2. Internal Thoracic Artery
3. Superior Phrenic Artery
275
What blood vessel(s) supply the visceral pleura?
Bronchial Artery
276
What innervates the parietal pleura?
1. Intercostal Nerves
2. Subcostal Nerve
3. Phrenic Nerve
277
Is the parietal pleura highly sensitive to pain?
Yes
278
Is the visceral pleura highly sensitive to pain?
No
279
Is the parietal pleura insensitive to pain?
No
280
Is the visceral pleura insensitive to pain?
Yes
281
What innervates the visceral pleura?
Nothing. It has no sensory innervation
282
With what condition do the pleural cavities fill with air?
Pneumothorax
283
What are the causes of pneumothorax?
1. Trauma ("sucking chest wound")
2. Disease (Lung tumor, chronic bronchitis, foreign object, etc.)
3. Congenital weak spot (More common in tall people due do a difference in the growing rates)
284
What term is used when discussing a condition of pneumothorax in which air comes from the lung itself through rupture?
Positive Pressure Pneumothorax
285
With what type of pneumothorax would there be a flap instead of a hole present on the visceral pleura allowing the lung to expand, but then it closes with breathe out and pushes against the heart potentially causing collapse?
Tension Pneumothorax
286
What condition is caused when air enters the pleural cavity on inspiration but cannot exit upon expiration?
Pneumothorax
287
With what condition does the pleural cavity inflate like an intertube pushing the mediastinum to the opposite side and compressing the other lung?
Pneumothorax
288
With what condition does the pleural cavity fill with blood?
Hemothorax
289
When both Pneumothorax and Hemothorax are present what is this condition called?
Hemopneumothorax
290
What is the term used interchangeably with lung collapse?
Atelectasis
291
What term is used to describe cancer of the pleura?
Mesothelioma
292
What condition consists of inflammation of the pleurae which leads to adhesions between parietal and visceral pleurae?
Pleuritis
293
What condition is painful due to the sensory innervation of the parietal pleura?
Pleuritis
294
With what condition is pain often referred to the shoulder via the phrenic nerve (C3,4,5)?
Pleuritis
295
With what condition does pain radiate along the distribution of the supraclavicular nerves (C3,4)?
Pleuritis
296
What condition produces a sand known as a pleural friction rub, which can be heard with auscultation?
Pleuritis
297
What is the space between the pleural cavities called?
Mediastinum
298
What space contains all of the structures of the thorax except the lungs and pleurae?
Mediastinum
299
What divides the mediastinum into the superior mediastinum above and the inferior mediastinum below?
An imaginary plane that passes from the sternal angle through the intervertebral disk between T.V. 4 and T.V. 5
300
Topographically, what structures does the sternal angle act as an important landmark to indicate the level of?
1. Boundary between the superior and inferior mediastinum.
2. Articulation of the second rib with the sternum.
3. Aortic arch.
4. Bifurcation of the trachea into the left and right main bronchi.
5. Upper border of the pulmonary trunk.
301
What are the contents of the Superior Mediastinum?
1. Superior Vena Cava
2. Brachiocephalic Veins
3. Arch of the Aorta (and its branches)
4. Thoracic Duct
5. Trachea
6. Esophagus
7. Thymus
8. Vagus Nerve
9. Left recurrent laryngeal nerve
10. Phrenic Nerve
302
What three compartments is the inferior mediastinum further subdivided into?
1. Anterior Mediastinum
2. Middle Mediastinum
3. Posterior Mediastinum
303
Where does the anterior mediastinum lie?
Anterior to the pericadial sac and posterior to the sternum
304
What are the contents of the anterior mediastinum?
1. Thymus
2. Lymph Nodes
3. Sternopericardial Ligaments
305
What is the middle mediastinum bounded by?
The Pericardial Sac
306
What are the contents of the middle mediastinum?
1. Heart
2. Pericardium
3. Roots of the Great Vessels
4. Main Bronchi
5. Phrenic Nerve
307
Where does the posterior mediastinum lie?
Posterior to the pericardial sac and anterior to thoracic vertebrae 5 through 12
308
What are the contents of the posterior mediastinum?
1. Esophagus
2. Thoracic Aorta
3. Azygos Vein
4. Hemiazygos Vein
5. Thoracic Duct
6. Vagus Nerve
7. Splanchnic Nerves (from sympathetic trunk)
309
Where does the trachea begin?
At the inferior border of the cricoid cartilage (C.V.6)
310
How many C-shaped cartilaginous rings does the trachea consist of?
15 to 20
311
Which direction do the C-shaped cartilaginous rings of the trachea open?
Posteriorly
312
What is the function of the C-shaped cartilaginous rings of the trachea?
Prevent the trachea from collapsing
313
What band of smooth muscle spans the posterior gap of the trachea?
Trachealis muscle
314
How long is the trachea?
9 to 15 cm in length
315
At the level of the sternal angle what happens to the trachea?
It bifurcates into the left and right main bronchi
316
What is the prominent ridge located within the trachea at its bifurcation that separates the openings of the right and left main bronchi called?
Carina
317
Where does the trachea lie?
Anterior to the esophagus and posterior to the arch of the aorta
318
In its path, where does the trachea deviate to just before its bifurcation at the sternal angle?
To the Right
319
Which of the main bronchi is shorter, wider and more vertical?
Right Main Bronchus
320
Which of the main bronchi passes under the arch of the azygos vein and gives off the superior lobar bronchus before entering the hilum of the lung?
Right Main Bronchus
321
Which of the main bronchi divides into the middle and inferior lobar bronchi within the hilum?
Right Main Bronchus
322
How many lobar bronchi are there coming from the right main bronchus?
3
323
What do the 3 lobar bronchi of the right main bronchi divide into?
10 segmental bronchi
324
Which of the main bronchi is longer, narrower, and more horizontal?
Left Main Bronchus
325
Which of the main bronchi passes anterior to the esophagus and divides into superior and inferior lobar bronchi within the hilum of the lung?
Left Main Bronchus
326
How many lobar bronchi are there coming from the left main bronchus?
2
327
What do the 2 lobar bronchi of the left main bronchi divide into?
10 segmental bronchi
328
Is it common for a child to aspirate a small object such as a peanut or a button?
Yes
329
During Aspiration, where do foreign objects usually enter due to its wide, short and vertical arrangement?
Right Main Bronchus
330
What is the carina covered with?
Sensitive Mucous Membrane
331
What represents the lowest point in the tracheobronchial tree where the cough reflex is mechanically initieated?
Carina
332
Once the carina is passed, coughing stops and what ensues?
Chemical Bronchitis and Atelectasis
333
What blood vessel(s) supply blood to the trachea?
1. Inferior Thyroid Artery
| 2. Bronchial Arteries
334
What nerve(s) innervate the trachea?
1. Vagus Nerve (parasympathetic and pain fibers)
| 2. Sympathetic Trunk
335
Do both the left and right lungs have an apex and a base?
Yes
336
What surfaces are present on both lungs?
1. Costal
2. Mediastinal
3. Diaphragmatic
337
What borders are present on both lungs?
1. Anterior
2. Posterior
3. Inferior
338
What surface of the lungs is the hilum present on?
Mediastinal Surface
339
What is the opening of the lung through which the vessels, nerves, and bronchi pass?
Hilum
340
What is formed by the structures which pass through the hilum?
Root of the Lung
341
What does the root of the lung connect?
The lung to the heart and trachea
342
What structures form the root of the lung?
1. Bronchi (posterior)
2. Pulmonary Arteries (superior)
3. Pulmonary Veins (anterior and inferior)
4. Bronchial Vessels
5. Nerves
6. Lymphatics
343
What is the root of the lung covered with?
Pleura, which is prolonged downward as a double layered membrane called the pulmonary ligament
344
How many bronchopulmonary segments does each lung have?
10
345
What fissure(s) are present on the right lung?
1. Oblique Fissure
| 2. Horizontal Fissure
346
What lobes are present on the right lung?
1. Superior Lobe
2. Middle Lobe
3. Inferior Lobe
347
Where is the superior lobe of the right lung located?
Above the horizontal fissure
348
Where is the middle lobe of the right lung located?
Between the horizontal and oblique fissures
349
Where is the inferior lobe of the right lung located?
Below the oblique fissure
350
What supplies each lobe?
A corresponding lobar bronchus
351
Following the division of each lobar bronchus into segmental bronchi, what do each of these segmental bronchi supply?
A bronchopulmonary segment
352
What features are characteristic of the right lung?
1. Groove for the Azygos Vein
2. Groove for the Esophagus
3. Cardiac Impression (shallow)
4. Groove for the Superior Vena Cava
5. Groove for the Brachiocephalic Vein
353
What fissure(s) are present on the left lung?
Oblique Fissure
354
What lobes are present on the left lung?
1. Superior Lobe
| 2. Inferior Lobe
355
Where is the superior lobe of the left lung located?
Above the Oblique Fissure
356
Where is the inferior lobe of the left lung located?
Below the Oblique Fissure
357
What features are characteristic of the left lung?
1. Lingula
2. Cardiac Notch
3. Cardiac Impression (deep)
4. Groove for the Aorta
5. Groove for the Left Subclavian Artery
358
What are the functional units of the lung?
Bronchopulmonary Segments
359
What does each bronchopulmonary segment consist of?
1. Segmental Bronchus
2. Branch of the Pulmonary Artery
3. Segment of Lung tissue
4. Surronding Septum
360
What structures are clinically important as they can be surgically removed without affecting the functioning of adjacent structures?
Bronchopulmonary Segments
361
What blood vessels supply the lungs with blood from the thoracic aorta?
Bronchial Arteries
362
What blood vessels of the lungs take blood to the azygos and accessory hemiazygos veins?
Bronchial Veins
363
In order, what structures make up the Tracheobronchial Tree?
1. Trachea
2. Main Bronchi
3. Lobar Bronchi
4. Segmental Bronchi
5. Bronchioles
6. Alveoli
364
What is the primary structure of the trachea?
Cartilaginous Rings
365
What is the primary structure of the main bronchi?
Cartilaginous Rings
366
What is the primary structure of the lobar bronchi?
Cartilaginous Plates
367
What is the primary structure of the segmental bronchi?
Smooth Muscle
368
What is the primary structure of the bronchioles?
Only Smooth Muscle
369
What is the primary structure of the alveoli?
Membrane (Squamous Cells)
370
What does inflammation of the segmental bronchi cause?
Bronchitis
371
What does inflammation of the bronchioles cause?
Bronchiolitis
372
What does inflammation of the alveoli cause?
Pneumonia
373
Where do the anterior and posterior pulmonary plexuses lie?
In front of and behind the root of the lung
374
The anterior and posterior pulmonary plexuses are formed by fibers from where?
1. Vagus Nerve (parasympathetic and sensory)
| 2. Sympathetic Trunk (T2 to T5, sympathetic and sensory)
375
What does sympathetic activation of the lungs produce?
1. Bronchial Dilation
| 2. Vasoconstriction
376
What does parasympathetic activation of the lungs produce?
1. Bronchial Constriction
| 2. Vasodilation
377
Does sympathetic activation decrease glandular secretion?
Yes
378
Does parasympathetic activation decrease glandular secretion?
No
379
Does sympathetic activation increase glandular secretion?
No
380
Does parasympathetic activation increase glandular secretion?
Yes
381
What condition is an obstructive airway disease characterized by coughing, wheezing, and difficulty breathing?
Asthma
382
What condition is caused by spasms of smooth muscle which lie in the segmental bronchi and bronchioles?
Asthma
383
What condition is accompanied by excessive secretion of mucus?
Asthma
384
What are the two types of Asthma?
1. Extrinsic Asthma
| 2. Intrinsic Asthma
385
What type of asthma is triggered by allergens?
Extrinsic Asthma
386
What type of asthma is triggered by non-allergy stimuli such as stress, cold or exercise?
Intrinsic Asthma
387
What have chiropractic clinicians noted about asthma?
Often associated with upper thoracic subluxation
388
What often brings relief to patients with asthma?
Adjustments
389
What does impingement of the sympathetics that originate from T2 to T5 allow?
Parasympathetic activation to dominate
390
What supplies the adrenal medulla, which secretes epinephrine, a potent bronchodilator?
Lower Thoracics (T9 to T11)
391
Smoke damage to the cilia tesults in what?
Smokers cough
392
Where does lymph from the lungs drain into?
The pulmonary and bronchopulmonary nodes located in the hilum
393
Where do the pulmonary and bronchopulmonary nodes located in the hilum drain into?
Tracheobronchial Nodes
394
Is respiratory Epithelium ciliated?
Yes
395
What does mucosiliated clearance move?
Mucus and dirt up and out of the larynx
396
What are the lungs and tracheobronchial tree rich in?
Lymphatics
397
What is a primary tumor of the bronchus?
Bronchogenic Carcinoma
398
What condition is directly related to cigarette smoking and air pollution?
Bronchogenic Carcinoma
399
What condition is highly metastic and spread quickly to the lymph nodes and enters the bloodstream by eroding a venule and traveling via the pulmonary veins to the heart and systemic circulation?
Bronchogenic Carcinoma
400
What condition often causes enlargement of a sentinel node?
Bronchogenic Carcinoma
401
How may lung cancer affect the phrenic nerve?
Results in paralysis of half of the diaphragm
402
How may lung cancer affect the recurrent laryngeal nerve?
Results in the paralysis of half of the larynx
403
Interthoracic disease such as bronchogenic carcinoma or lung infections may refer pain to where?
Upper or Middle Thoracic cord segment
404
Do both sympathetic and vagal branches of the lungs contain sensory fibers?
Yes
405
What seperates the thorax from the abdomen?
Diaphragm
406
What is a fibromuscular dome-shaped structure with right and left domes?
Diaphragm
407
Is the right or left dome of the diaphragm slightly higher?
Right Dome
408
Why is the right dome of the diaphragm slightly higher?
It overlies the liver
409
What two parts does the diaphragm consist of?
1. Muscular Part (lies around the periphery)
| 2 Central Tendon
410
What part of the diaphragm takes origin from a number of bony sources, and inserts into the central tendon?
Muscular Part
411
What are the 3 points of origin of the muscular part of the diaphragm?
1. Sternal
2. Costal
3. Lumbar
412
Where does the sternal point of origin of the muscular part of the diaphragm come from?
The Xiphoid Process
413
Where does the costal point of origin of the muscular part of the diaphragm come from?
The lower 6 costal cartilages
414
Where does the lumbar point of origin of the muscular part of the diaphragm come from?
The bodies of Lumbar vertebrae 1-3 and the medial and lateral arcuate ligaments
415
What are the openings in the diaphragm?
1. Caval Opening (Foramen)
2. Esophageal Hiatus
3. Aortic Hiatus
416
What opening of the diaphragm is located at T.V.8 within the central tendon and transmits the inferior vena cava and the right phrenic nerve?
Caval Opening (Foramen)
417
What opening of the diaphragm is located at T.V.10 and transmits the esophagus and the anterior and posterior vagal trunks?
Esophageal Hiatus
418
What opening of the diaphragm is located at T.V.12 and transmits the aorta, thoracic duct, and azygos vein?
Aortic Hiatus
419
What is the lowest part of the mediastinum?
T.V.12
420
What blood vessels supply blood to the diaphragm?
1. Musculophrenic Artery
2. Pericardiacophrenic Artery
3. Superior Phrenic Artery
4. Inferior Phrenic Artery
421
Where is the musculophrenic artery derived from?
Internal Thoracic Artery
422
Where is the pericardiacophrenic artery derived from?
Interna Thoracic Artery
423
Where is the superior phrenic artery derived from
Aorta
424
Where is the inferior phrenic artery derived from?
Aorta
425
What nerve(s) innervate the diaphragm?
1. Phrenic Nerve (C3,4,5)
| 2. Intercostal Nerves
426
What nerve supplies motor innervation to the diaphragm as a whole and supplies sensory innervation to the central part of the diaphragm?
Phrenic Nerve (C3,4,5)
427
What nerve supplies sensory innervation to the peripheral part of the diaphragm?
Intercostal Nerves
428
What condition is due to weakness in the diaphragmatic wall around the esophageal hiatus?
Hiatal Hernia
429
What condition involves the upper part of the stomach sliding up into the thoracic cavity through an opening?
Hiatal Hernia
430
When does a hiatal hernia usually occur?
After age 50
431
What condition is a major cause of gastroesophageal reflux?
Hiatal Hernia
432
What condition may be involved when the symptoms of a patient include belching and epigastric pain?
Hiatal Hernia
433
What type of chiropractic adjustment may be used in treatment of a hiatal hernia?
S.O.T. technique diagnose with X-ray
434
During what action do three major movements take place within the thorax which result in an increase in intrathoracic volume and a decrease in intrathoracic pressure?
Inspiration
435
What three movements take place within the thorax during inspiration?
1. Piston Movement
2. Bucket Handle Movement
3. Pump Handle Movement
436
During what movement that takes place within the thorax during inspiration, does the diaphragm contract, pulling the domes inferiorly into the abdomen resulting in an increase in the vertical diameter of the thorax?
Piston Movement
437
During what movement that takes place within the thorax during inspiration, does an elevation of the lower ribs (7 to 10) occur about an anteroposterior axis resulting in an increase in the transverse diameter of the thorax?
Bucket Handle Movement
438
During what movement that takes place within the thorax during inspiration, does an elevation of the upper ribs (2 to 6) occur about a transverse axis resulting in an increase in the antero-posterior diameter of the thorax?
Pump Handle Movement
439
What is the elevation of the ribs in both the bucket handle and pump handle movements due to?
Contraction of the external intercostal muscles
440
What do movements of inspiration result in?
A negative pressure within the thoracic cavity and the entrance of air into the lungs
441
During what type of expiration do the diaphragm and external intercostal muscles relax and air is expelled passively?
Normal Expiration
442
During what type of expiration do the internal intercostals, innermost intercostals, and the muscles of the anterior abdominal wall contract?
Forced Expiration
443
During Inspiration what happens to the interthoracic volume and pressure?
- Volume Increases
| - Pressure Decreases
444
During expiration what happens to interthoracic volume and pressure?
- Volume Decreases
| - Pressure Increases
445
Does contraction of the diaphragm during inspiration have the same or opposite effect on the abdomen that it has has on the thorax?
Opposite Effect
446
During inspiration what happens to the intra-abdominal volume and pressure?
- Volume Decreases
| - Pressure Increases
447
What is an important factor in the occurrence of inguinal hernias?
Contraction of the diaphragm during inspiration has the opposite effect on the abdomen that it has on the thorax
448
What are the result of a spasmodic contraction of the diaphragm?
Hiccups
449
What are some morbid underlying causes of hiccups?
1. Brain lesions
2. Pleuritis
3. Pericarditis
4. Peritonitis
450
What is a fibroserous sac that occupies the middle mediastinum and forms its borders and encloses the heart and great vessels?
Pericardium
451
What types of pericardium are found around the hear?
1. Fibrous Pericardium
| 2. Serous Pericardium
452
What is the strong, dense outer part of the pericardium?
Fibrous Pericardium
453
What blends with the central tendon of the diaphragm and with the walls of the great vessels which pierce it?
Fibrous Pericardium
454
What part of the pericardium is continuous with the pretracheal fascia above?
Fibrous Pericardium
455
What is connected to the back of the sternum by two variable fibrous strands called sternopericardial ligaments?
Fibrous Pericardium
456
What are the three parts of the serous pericardium?
1. Parietal Layer
2. Pericardial Cavity
3. Visceral Layer
457
What part of the serous pericardium lines the inner surface of the fibrous pericardium?
Parietal Layer
458
What part of the serous pericardium is a potential space between the parietal and visceral layers of the serous pericardium and contains serous fluid?
Pericardial Cavity
459
What part of the serous pericardium is closely adherent to the outer surface of the heart and is also known as the epicardium?
Visceral Layer
460
What are the 4 layers of the heart?
1. Epicardium
2. Myocardium
3. Endocardium
4. Chambers
461
What part of the heart is equivalent to the visceral layer of the serous pericardium?
Epicardium
462
What part of the heart is composed mainly of cardiac muscle fibers arranged in a spiral?
Myocardium
463
What part of the heart is the smooth endothelium which lines the inside of the heart?
Endocardium
464
How many chambers are there in the human heart?
4
465
With what condition is the fibrous pericardium very unyielding ("tough" or "doesn't stretch well")?
Cardiac Tamponade
466
With what condition, if fluid leaks rapidly into the pericardial cavity (pericardial-effusion), the heart may be compressed and venous return may be impeded because veins are flatter and can be compressed more easily?
Cardiac Tamponade
467
In Cardiac Tamponade, what is particularly vulnerable?
Superior Vena Cava
468
With what condition can the external jugular vein become prominent and eventually all veins of the face and neck can become engorged?
Cardiac Tamponade
469
What are the names of the pericardial sinuses?
1. Transverse Pericardial Sinus
| 2. Oblique Pericardial Sinus
470
Which pericardial sinus is a subdivision of the pericardial sac which lies posterior to the aorta and pulmonary trunk as well as anterior to the superior vena cava and left atrium?
Transverse Pericardial Sinus
471
Which pericardial sinus is a subdivision of the pericardial sac which lies posterior to the heart and is surrounds by the left and right pulmonary veins and the inferior vena cava?
Oblique Pericardial Sinus
472
What blood vessel(s) supply blood to the pericardium?
1. Pericardiacophrenic Artery
2. Bronchial Artery
3. Esophageal Artery
4. Coronary Arteries (supply visceral layer of serous pericardium only)
473
What nerve(s) innervate the pericardium?
1. Phrenic Nerve (Sensory)
2. Sympathetic Trunk (Vasomotor)
3. Vagus Nerve
474
Where does the phrenic nerve pass in relation to the pericardium?
Between the parietal pleura and fibrous pericardium
475
Where is pericardial pain felt diffusely?
Behind the sternum
476
What is less sensitive to pain? (Pericardium or Pleura)
Pericardium
477
What is inflammation of the membrane of the lung which is not serious but painful?
Pleuritis
478
What is inflammation of the pericardium which is serious and can be life-threatening but not really painful?
Pericarditis
479
Describe the Pericardial Friction Rub test.
1. Have patient hold their breath
2. Examine the patient for friction by auscultation
3. Distinguish between pleural friction and pericardial friction
480
During the Pericardial Friction Rub test, if the rubbing stop what is indicated?
Pleural Friction
481
During the Pericardial Friction Rub test, if the rubbing continues what is indicated?
Pericardial Friction
482
Where does the heart lie?
Within the pericardial sac in the middle mediastinum
483
What is the heart divided into left and right halves by?
A Septal Wall
484
What does each half of the heart consist of?
Two Chambers (Atrium & Ventricle)
485
What is the thickest chamber of the heart?
Left Ventricle
486
What is the 2nd thickest chamber of the heart?
Right Ventricle
487
What is the 3rd thickest chamber of the heart?
Left Atrium
488
What is the thinnest chamber of the heart?
Right Atrium
489
In order according to thickness, list the chambers of the heart.
1. Left Ventricle
2. Right Ventricle
3. Left Atrium
4. Right Atrium
490
What are the only arteries to carry de-oxygenated blood?
Pulmonary Arteries
491
What are the only veins to carry oxygenated blood?
Pulmonary Veins
492
How much thicker is the Left Ventricle than the Right Ventricle?
2 to 3 times thicker
493
What condition is an obstruction of a pulmonary artery by a blood clot?
Pulmonary Embolism
494
In relation to a pulmonary embolism, where does the blood clot form?
In the systemic venous system (a leg for example)
495
Describe the pathway of a blood clot to becoming a pulmonary embolism.
1. Forms in the systemic venous system
2. Passes through the inferior or superior venae cavae to the right atrium
3. Passes from the right atrium to the right ventricle
4. Passes from the right ventricle to the pulmonary trunk
4. Passes from the pulmonary trunk into the pulmonary arteries
5. Embolus blocks a pulmonary artery or one of its branches blocking blood to the lung
496
What does a pulmonary embolism result in?
Acute Respiratory Distress
497
What condition leads to the dilation of the right ventricle and right atrium resulting in heart failure?
Pulmonary Embolism
498
How fast can a Pulmonary Embolism cause death?
In minutes (More common in the young)
499
What are the two types of semilunar valves?
1. Aortic
| 2. Pulmonary
500
What controls the flow of blood through the heart?
Valves
501
What does each valve consist of?
1. Valve Orifice
2. Fibrous Ring (Anulus)
3. Cusps
502
Structurally, what surrounds the valve orifice of a valve?
Fibrous Ring (Anulus)
503
Structurally, what is attached to the fibrous ring of a valve and are flaps which close the valve?
Cusps
504
What are the four major valves in the human heart?
1. Pulmonary Valve
2. Aortic Valve
3. Mitral (Bicuspid) Valve
4. Tricuspid Valve
505
Which of the four major valves of the heart connects the right ventricle and pulmonary trunk?
Pulmonary Valve
506
How many cusps does the pulmonary valve have?
3 (Anterior, Left, Right)
507
Which of the four major valves of the heart connects the left ventricle and the aorta?
Aortic Valve
508
How many cusps does the aortic valve have?
3 (Left, Right, Posterior)
509
Which of the four major valves of the heart connects the left atrium and left ventricle?
Mitral (Bicuspid) Valve
510
How many cusps does the mitral (bicuspid) valve have?
2 (Anterior, Posterior)
511
Which of the four major valves of the heart connects the right atrium and right ventricle?
Tricuspid Valve
512
How many cusps does the tricuspid have?
3 (Anterior, Posterior, Septal)
513
What is the other name used for the Mitral (Bicuspid) Valve?
Left Atrioventricular Valve
514
What is the other name used for the Bicuspid Valve?
Right Atrioventricular Valve
515
What produces a two-stroke beat ("Lub-Dup") which represents the blood carrying sound in the direction of its flow?
Heart
516
What is produced by contraction of the ventricles and closure of the tricuspid and mitral valves?
Lub Sound
517
What is produced by the closure of the pulmonary and aortic valves?
Dup Sound
518
Where is the Pulmonary Valve located?
Behind the medial end of the third left costal cartilage
519
Where is the Pulmonary Valve most audible?
Over the left second intercostal space
520
Where is the Aortic Valve located?
Behind the left half of the sternum medial to the third intercostal space
521
Where is the Aortic Valve most audible?
Over the right second intercostal space
522
Where is the Mitral (Bicuspid) Valve located?
Behind the left half of the sternum medial to the fourth costal cartilage
523
Where is the Mitral (Bicuspid) Valve most audible?
Over the left fifth intercostal space at the midclavicular line
524
What is the most frequently diseased valve of the heart due to the high pressure produced by the left ventricle which results in micro-abrasions of the valve cusps?
Mitral (Bicuspid) Valve
525
Where is the Tricuspid Valve located?
Behind the right half of the sternum medial to the fourth intercostal space
526
Where is the Tricuspid Valve most audible?
Over the left fifth intercostal space at it border with the sternum
527
In the thorax, what is the orientation of the heart?
It lies obliquely, running forward, downward and to the left from base to apex
528
What is the base of the heart formed by?
The left and the right atria
529
What is the apex of the heart formed by?
The left ventricle
530
Where does the apex of the heart lie?
In the left fifth intercostal space
531
What surfaces are found on the heart?
1. Anterior (Sternocostal)
2. Diaphragmatic
3. Left Pulmonary
4. Right Pulmonary
532
What is the anterior (sternocostal) surface of the heart mostly formed by?
The Right Ventricle
533
What is the diaphragmatic surface of the heart mostly formed by?
The Right and Left Ventricles
534
What is the left pulmonary surface of the heart mostly formed by?
The Left Ventricle
535
What is the right pulmonary surface of the heart mostly formed by?
The Right Atrium
536
What structure located within the right atrium is an ear-like appendage from the superior aspect of the right atrium?
Right Auricle
537
What structures located within the right atrium are prominent parallel ridges located in the anterior atrial wall?
Pectinate Muscles (Musculi Pectinati)
538
What structure located within the right atrium is a vertical muscular ridge which runs from the opening of the superior vena cava to that of the inferior vena cava?
Crista Terminalis
539
What structure located within the right atrium marks the termination of the pectinate muscles and separates the right atrium from the sinus of venae cavae?
Crista Terminalis
540
What structure is a vertical groove which marks the crista terminalis externally?
Sulcus Terminalis
541
What structure located within the right atrium is the smooth-walled area located posteriorly to the crista terminalis?
Sinus of Venae Cavae (Sinus Venarum)
542
What structure located within the right atrium represents the embryonic sinus venosus and receives the openings of the superior vena cava, inferior vena cava, coronary sinus, and anterior veins of the right ventricle?
Sinus of Venae Cavae (Sinus Venarum)
543
What structure located within the right atrium is a depression which is the remnant of the foramen ovale (oval foramen), an opening between the right and left atrium which closes at birth?
Fossa Ovalis (Oval Fossa)
544
What is the sharp border of the fossa ovalis called?
Limbus Fossa Ovalis
545
What condition that occurs in 25% of adults, does the foramen ovale persist as a small opening in the superior part of the fossa ovalis?
Atrial Septal Defect
546
When an Atrial Septal Defect is small what is it called?
Probe Patent Foramen Ovale
547
Is a probe patent foramen ovale clinically significant?
In most cases no
548
When an Atrial Septal Defect is larger what is it called?
Clinical Atrial Septal Defect
549
With an atrial septal defect, blood is shunned from the left atrium to the right, what does this cause dilation of?
1. Right Atrium
2. Right Ventricle
3. Pulmonary Trunk
550
What openings are present in the Right Atrium?
1. Superior Vena Cava (has no valve)
2. Inferior Vena Cava (has a rudimentary valve)
3. Coronary Sinus (has a rudimentary valve)
4. Anterior Veins of the Right Ventricle
5. Right Ventricle (through the Tricuspid Valve
551
What structures located within the right ventricle are interconnecting muscular ridges located in the ventricular wall?
Trabeculae Carneae
552
What structures located within the right ventricle are cone-shaped muscles which originate from the ventricular wall?
Papillary Muscles
553
What structures located within the right ventricle have apices that are connected to the chordae tendineae?
Papillary Muscles
554
What are the three papillary muscles of the ventricle?
1. Anterior (largest)
2. Posterior
3. Septal
555
Can papillary muscles often be bifid, trifid, or multiple?
Yes
556
What structures located within the right ventricle attach the papillary muscles to the borders of the cusps of the tricuspid valve?
Chordae Tendineae (Tendinous Cords)
557
What structures located within the right ventricle prevent eversion of the tricuspid valve during ventricular contraction?
Chordae Tendineae (Tendinous Cords)
558
What structure located within the right ventricle is the upper portion of the right ventricle which ends in the pulmonary trunk?
Conus Arteriosus
559
What structure located within the right ventricle is a thick, muscular ridge which separates the conus arteriosus from the rest of the right ventricle?
Supraventricular Crest
560
What structure located within the right ventricle is a large trabecula which extends from the interventricular septum to the base of the anterior papillary muscle?
Septomarginal Trabecula (Moderator Band)
561
What structure located within the right ventricle transmits the right bundle branch of the conduction system?
Septomarginal Trabecula (Moderator Band)
562
What openings are found within the right ventricle?
1. To Right Atrium (through the tricuspid valve)
| 2. To Pulmonary Trunk (through the mitral valve)
563
Where does oxygenated blood enter the heart?
Left Atrium
564
What structure located within the left atrium is an ear-like appendage of the left atrium?
Left Auricle
565
What structures located within the left atrium consist of a few that are found in the auricle, but mostly the left atrium is smooth?
Pectinate muscles
566
What openings are found within the left atrium?
1. Pulmonary Veins
| 2. To Left Ventricle (through the Mitral Valve)
567
How many pulmonary veins usually open into the left atrium?
Usually 4
568
What structures located within the left ventricle are finer and more numerous interconnecting muscular ridges located in the ventricular wall than that of the right ventricle?
Trabeculae Carneae
569
What structures located within the left ventricle are cone-shaped muscles which originate from the ventricular wall?
Papillary Muscles
570
How many papillary muscles are found within the left ventricle?
2 (Anterio, Posterior)
571
What structures of the left ventricle are attached from the papillary muscles to the borders of the cusps of the mitral valve?
Chordae Tendineae (Tendinous Cords)
572
What structure of the left ventricle is a smooth-walled portion below the cusps of the aortic valve?
Aortic Vestibule
573
What openings are found within the left ventricle?
1. To left atrium (through the Mitral Valve)
| 2. To aorta (through the aortic valve)
574
What 4 parts does the septal wall that divides the heart into right and left halves consist of?
1. Interatrial Septum
2. Atrioventricular Septum
3. Membranous Interventricular Septum
4. Muscular Interventricular Septum
575
What part of the septal wall lies between the two atria?
Interatrial Septum
576
What part of the septal wall is a small portion above the septal cusp of the tricuspid valve and below the anterior cusp of the mitral valve?
Atrioventricular Septum
577
What part of the septal wall is thin, smooth, and fibrous in structure?
Membranous Interventricular Septum
578
What part of the septal wall is very thick?
Muscular Interventricular Septum
579
What two ways can an enlargement of the heart occur?
1. Muscular Hypertrophy
| 2. Dilation of a Chamber
580
With what type of enlargement of the heart is the elasticity of the blood vessels lost with age, particularly with atherosclerosis and/or hypertension?
Muscular Hypertrophy
581
With what type of enlargement of the heart is more force required to push blood through the arteries?
Muscular Hypertrophy
582
With what type of enlargement of the heart do the walls of the heart grow thicker due to enlargement of cardiac muscle fibers?
Muscular Hypertrophy
583
What type of enlargement of the heart may be due to septal defects or valve incompetency?
Dilation of a Chamber
584
When there is an incompetent mitral valve, there is regurgitation of blood from the left ventricle into the left atrium, the left atrium may dilate to accomodate extra blood. What is the response to?
Valve Incompetency
585
Do the Mitral and Tricuspid valves have chordae tendineae and papillary muscles?
Yes
586
Do the Pulmonary and Aortic valves have chordae tendineae and papillary muscles?
No
587
Which valves close due to ventricular contraction?
Mitral and Tricuspid valves
588
Which valves open due to ventricular contraction?
Pulmonary and Aortic valves
589
Structurally, both the pulmonary and aortic valves consist of three semilunar cusps which have what features?
1. Nodules
2. Lunules
3. Pulmonary and Aortic Sinuses
590
What are the small central thickenings on the free edge of each cusp of the pulmonary and aortic valves?
Nodules
591
What is the thin, crescentic part of the cusps of pulmonary and aortic valves?
Lunules
592
What are the spaces of the pulmonary and aortic valves between the cusps and the walls of the vessel, located superiorly?
Pulmonary and Aortic Sinuses
593
What are the pulmonary and aortic valces sometimes referred to as?
Semilunar valves
594
What is the connective tissue framework of the heart?
The Fibrous Skeleton
595
What is the fibrous skeleton composed of?
1. Fibrous Rings
2. Left and Right Fibrous Trigones
3. Membranous Part of the Septal Wall
596
What structures of the fibrous skeleton form the foundation of each of the heart valves (tricuspid, mitral, pulmonary, and aortic)?
Fibrous Rings (Anuli)
597
What structures of the fibrous skeleton connect the fibrous rings together, and represent the strongest part of the fibrous skeleton?
Left and Right Fibrous Trigones
598
What structure of the fibrous skeleton consists of the interatrial, atrioventricular, and membranous interventricular septa?
Membranous Part of the Septal Wall
599
What are the functions of the fibrous skeleton of the Heart?
1. To provide a structural framework for the valves.
2. To insulate the electrical impulses of the conduction system within the atrial wall from those within the ventricular wall.
600
Does the fibrous skeleton resist dilation?
Yes
601
Where do the right and left coronary arteries arise from?
The aorta just superior to the aortic valve (within the right and left aortic sinuses, respectively
602
What does coronary mean?
"Crown"
603
What do the right and left coronary arteries travel within?
The coronary sulcus
604
What are the branches of the right coronary artery?
1. Sinuatrial Nodal Artery
2. Right Marginal Artery
3. Posterior Interventricular Artery
605
What branch of the right coronary artery runs along the right lower margin of the heart?
Right Marginal Artery
606
What branch of the right coronary artery lies within the posterior interventricular sulcus?
Posterior Interventricular Artery
607
What branch of the right coronary artery passes posteriorly around the superior vena cava to the sinuatrial node?
Sinuatrial Nodal Artery
608
What are the branches of the left coronary artery?
1. Anterior Interventricular Artery
2. Circumflex Artery
3. Left Marginal Artery
609
What branch of the left coronary artery lies within the anterior inteventricular sulcus?
Anterior Interventricular Artery
610
What branch of the left coronary artery passes posteriorly to anastomose with the right coronary artery?
Circumflex Artery
611
What branch of the left coronary artery, that actually comes off of the circumflex artery runs along the left margin of the heart and supplies the left ventricle?
Left Marginal Artery
612
Where does the left coronary artery lie?
Deep to the Epicardium
613
What term refers to which coronary artery gives rise to the posterior interventricular artery?
Coronary Artery Dominance
614
What percentage of individuals present with right coronary dominance?
70%
615
What percentage of individuals present with left coronary dominance?
30%
616
What does the right coronary artery usually supply?
1. Right Atrium
2. Most of the Right Ventricle
3. Diaphragmatic Surface of the Left Ventricle
4. Posterior 1/3 of the Interventricular Septum
5. Conduction system to proximal parts of the right and left bundle branches
617
What does the left coronary artery usually supply?
1. Left Atrium
2. Most of the Left Ventricle
3. Part of the Right Ventricle
4. Anterior 2/3 of the Interventricular Septum
618
Which coronary artery always supplies the greatest portion of the heart's tissue?
Left Coronary Artery
619
Branches of what arteries are generally considered to be end arteries?
Coronary Arteries
620
Where do (coronary artery) anastomoses occur between?
1. Right Coronary and Circumflex Arteries
| 2. Anterior and Posterior Interventricular Arteries
621
What is the largest vein of the heart?
Coronary Sinus
622
What structure lies within the coronary sulcus and drains into the right atrium?
Coronary Sinus
623
Does the Coronary Sinus have a valve?
Yes, a rudimentary valve
624
What 5 tributries does the Coronary Sinus receive?
1. Great Cardiac Vein
2. Middle Cardiac Vein
3. Small Cardiac Vein
4. Posterior Vein of the Left Ventricle
5. Oblique Vein of the Right Ventricle
625
What tributary accompanies the Anterior Interventricular Artery?
Great Cardiac Vein
626
What tributary accompanies the Posterior Interventricular Artery?
Middle Cardiac Vein
627
What tributary accompanies the Right Coronary Artery near the right lower margin of the heart?
Small Cardiac Vein
628
What tributary is located to the left of the middle cardiac vein?
Posterior Vein of the Left Atrium
629
What veins drain directly into the right atrium?
Anterior Veins of the Right Ventricle
630
What are the smallest veins of the heart?
Venae Cordis Minimae
631
What veins run within the walls of the heart and drain primarily primarily into the right atrium?
Venae Cordis Minimae
632
What condition is the deposition of lipid plaques on the inner walls of arteries resulting in a narrowing of the lumen?
Atherosclerosis
633
What condition is a substernal chest pain that occurs upon exertion due to insufficient blood flow to heart tissue (ischemia)?
Angina Pectoris
634
What is a symptom of Angina Pectoris?
Occlusion of the Coronary Artery Bronchus
635
What condition occurs when a coronary artery branch become occluded?
Myocardial Infarction
636
What condition results in the portion of the heart supplied by the artery that is occluded, dies (necrosis) and is converted into fibrous scar tissue?
Myocardial Infarction
637
Are men or women more likely to die from heart attacks?
Women
638
What are the most common sites of a myocardial infarction?
1. Anterior Interventricular (40 to 50%)
2. Right Coronary Artery (30 to 40%)
3. Circumflex Artery (15 to 20%)
639
What common site for a myocardial infarction is sometimes referred to as the widow maker because it is usually lethal?
Anterior Interventricular Artery
640
Where does the Subepicardial Plexus drain lymph into?
Tracheobronchial Node
641
What structure has its own contractile mechanism (the conduction system) and does not require a nerve supply to beat rhythmically?
The Heart
642
What is necessary to alter the rate of beating of the heart?
A nerve
643
What increases the heart rate and strength of contraction and dilates the coronary arteries?
Sympathetic Activation
644
What decreases the heart rate and strength of contraction and constricts the coronary arteries?
Parasympathetic Activation
645
What is innervation of the heart?
The Cardiac Plexus
646
What is the cardiac plexus divisible into?
1. Superficial Cardiac Plexus
| 2. Deep Cardiac Plexus
647
Where is the superficial cardiac plexus located?
Beneath the arch of the aorta, anterior to the pulmonary trunk
648
Where is the deep cardiac plexus located?
Posterior to the arch of the aorta
649
Where does sympathetic innervation of the heart come from?
The cervical and thoracic cardiac nerves from the sympathetic trunk (T1-T4)
650
Where does parasympathetic innervation of the heart come from?
The Vagus Nerve
651
Where do sensory fibers of the heart travel?
With both the sympathetic branches and the vagus
652
What are subluxations and related soft tissue changes restricted to T1-T4 frequently associated with and what is the hypothesis behind this?
Myocardial Infarctions and other heart problems;
Impingement on sympathetics could allow parasympathetic activation to dominate, leading to constriction of coronary arteries
653
What stops valves from everting and allowing the backflow of blood?
Papillary muscles
654
What is controlled by specialized cardiac muscle fibers which are collectively known as the conduction system?
The rhytmic beating of the heart
655
What are the parts of the conduction system?
1. Sinuatrial Node
2. Atrioventricular Node
3. Atrioventricular Bundle
4. Subendocardial Plexus of Conduction Cells (Purkinje Fibers)
656
What part of the conduction system is the natural pacemaker of the heart?
Sinuatrial Node
657
What part of the conduction system is located at the upper end of the crista terminalis, near the junction of the right atrium with the superior vena cava?
Sinuatrial Node
658
What part of the conduction system is located in the septal wall, above the opening for the coronary sinus in the right atrium?
Atrioventricular Node
659
What part of the conduction system is located within the septal wall and divides into a right and left bundle branch?
Atrioventricular Bundle
660
What two branches does the atrioventricular bundle divide into?
1. Right Bundle Branch
| 2. Left Bundle Branch
661
What branch of the atrioventricular bundle enters the septomarginal trabecula of the right ventricle?
Right Bundle Branch
662
What branch of the atrioventricular bundle enters the papillary muscles of the left ventricle?
Left Bundle Branch
663
What part of the conduction system is joined by branches of the left and right bundle branches?
Subendocardial Plexus of Conduction Cells (Purkinje Fibers)
664
Where does the conduction impulse begin?
The sinuatrial node
665
Describe the path of the conduction impulse.
1. Begins in the sinuatrial node.
2. Spreads through the atrial wall until it reaches the atrioventricular node.
3. Travels through the atrioventricular bundle and its two bundle branches to the subendocardial plexus of conduction cells.
4. Travels through the myocardium of the ventricles
666
What type of arteries are the aorta and pulmonary trunk and their branches?
Elastic Arteries
667
What great vessels exit the heart?
1. Aorta (from left ventricle)
| 2. Pulmonary Trunk (from right ventricel)
668
What are the branches of the Pulmonary Trunk?
1. Left Pulmonary Artery
| 2. Right Pulmonary Artery
669
What great vessels enter the heart?
1. Pulmonary Veins (to left atrium)
2. Superior Vena Cava (to right atrium)
3. Inferior Vena Cava (to right atrium)
670
Where do the pulmonary veins drain blood to the left atrium from?
Behind the heart (lungs)
671
Where does the superior vena cava drain blood to the right atrium from?
Anything above the heart
672
Where does the inferior vena cava drain blood to the right atrium from?
Anything below the heart
673
What is the remnant of the embryonic ductus arteriosus?
Ligamentum arteriosum
674
What connects the arch of the aorta to the left pulmonary artery or pulmonary trunk?
Ligamentum arteriosum
675
Where is the ligamentum arteriosum located at?
The level of the sternal angle
676
In the embryo, what shunts blood from the pulmonary trunk to the aorta?
Ductus Arterisosus
677
What is prone to aneurysms in the aortic arch?
Ligamentum arteriosum
678
What nerve hooks under the aortic arch posterior to the ligamentum arteriosum?
Left Recurrent Laryngeal Nerve
679
What nerve hooks under the right subclavian artery?
Right Recurrent Laryngeal Nerve
680
What is the muscular tube through which food passes to the stomach?
Esophagus
681
What does the esophagus consist of?
1. An upper 1/3 composed of striated muscle
2. A middle 1/3 composed of mixed striated and smooth muscle
3. A lower 1/3 composed of smooth muscle
682
What three parts make up the esophagus?
1. Cervical Part
2. Thoracic Part
3. Abdominal Part
683
Which part of the esophagus is the longest?
The thoracic part
684
Where does the esophagus begin?
At the laryngopharynx at C.V.6
685
What is a median structure which enters the thorax posterior to the trachea?
Esophagus
686
Where does the esophagus enter the abdomen?
Through the esophageal hiatus at T.V.10
687
Where does the esophagus join the stomach?
At the cardioesophageal junction
688
What sphincters are found in the esophagus?
1. Superior Esophageal Sphincter
| 2. Inferior Esophageal Sphincter
689
What sphincter is formed by the lower part of the inferior constrictor?
Superior Esophageal Sphincter
690
What sphincter is sometimes referred to as the cricopharyngeus?
Superior Esophageal Sphincter
691
What sphincter is formed by encircling fibers of the diaphragm at the esophageal hiatus?
Inferior Esophageal Sphincter
692
Is the esophagus distensible?
Yes
693
What blood vessels supply blood to the esophagus?
1. Inferior Thyroid Artery
2. Bronchial Artery
3. Esophageal Artery
4. Left Gastric Artery
5. Inferior Phrenic Artery
694
What blood vessels drain blood from the esophagus?
1. Esophageal Veins (into adjacent systemic veins)
| 2. Left Gastric Gastric Vein (into the portal vein)
695
What nerves innervate the esophagus?
1. Vagus Nerve
2. Sympathetic fibers from thoracic cord levels
3. Pain fibers carried in the sympathetic trunk
696
What nerve contains special motor fibers which supply the striated muscle portion of the esophagus (upper 1/3 and striated part of the mixed middle 1/3)?
Vagus Nerve
697
What nerve contains parasympathetic fibers which supply the smooth muscle portion of the esophagus (lower 1/3 and smooth muscle part of the mixed middle 1/3)?
Vagus Nerve
698
What are the parts of the Aorta?
1. Ascending Aorta
2. Aortic Arch
3. Descending Aorta
699
Where is the ascending aorta located?
In the middle mediastinum
700
Where is the aortic arch located?
In the superior mediastinum
701
What are the parts of the descending aorta?
1. Thoracic Aorta
| 2. Abdominal Aorta
702
Where is the thoracic aorta located?
In the posterior mediastinum
703
Where is the abdominal aorta located?
In the abdomen
704
Where does the thoracic aorta begin?
At the level of T.V.4
705
Where does the thoracic aorta lie?
Posterior to the esophagus
706
What begins its descent to the left of the vertebral column, but slants toward the midline of the body and ends directly anterior to the vertebral column?
Thoracic Aorta
707
What passes through the aortic hiatus at the level of T.V.12 to become the abdominal aorta?
Thoracic Aorta
708
What two types of branches come from the thoracic aorta?
1. Parietal Branches
| 2. Visceral Branches
709
What do the parietal branches of the thoracic aorta supply?
The Body Wall
710
What do the visceral branches of the thoracic aorta supply?
Thoracic Viscera
711
What are the parietal branches of the thoracic aorta?
1. 3rd through 11th Intercostal Arteries
2. Subcostal Arteries
3. Superior Phrenic Arteries
712
What are the visceral branches of the thoracic aorta?
1. Bronchial Arteries (1 right and 2 left)
2. Pericardial Arteries
3. Mediastinal Arteries
4. Esophageal Arteries
713
Where do important anastomoses of the thoracic aorta occur?
1. Between the anterior and posterior intercostal arteries
| 2. Between the superior and inferior epigastric arteries
714
What does most of the lymph of the body reach the venous system through?
The thoracic duct
715
What begins in the abdomen as a dilation at the junction of three abdominal trunks (intestinal, lumbar, descending intercostal) called the cisterna chyli?
The thoracic duct
716
What passes through the aortic hiatus of the diaphragm and travels upward through the posterior mediastinum between the aorta and the azygos vein?
The thoracic duct
717
What level does the thoracic duct cross over to the left?
T.V.5 or T.V.6
718
What passes posterior to the left subclavian vein, forms an arch, and empties into the junction of the left internal jugular and subclavian veins?
The thoracic duct
719
The thoracic duct drains the lymph of the entire body except for the what?
1. Right upper extremity
2. Right thoracic cavity
3. Right side of the head and neck
720
What nerve enters the thorax after passing down the anterior surface of the scalenus anterior muscle?
Phrenic Nerve
721
What nerve descends between the mediastinal pleura and fibrous pericardium and is accompanied throughout its length by the pericardiacophrenic artery?
Phrenic Nerve
722
What nerve passes anterior to the root of the lung?
Phrenic Nerve
723
What are the functional components of the phrenic nerve?
1. Motor (to diaphragm)
2. Sensory (pain fibers from the diaphragm, pericardium, pleura, and peritoneum)
3. Sympathetic
724
What is a variation which arises from C5 and which is a branch of the nerve to subclavius?
Accessory Phrenic Nerve
725
When what nerve is present, sectioning of the phrenic nerve will not completely paralyze the corresponding half of the diaphragm?
Accessory Phrenic Nerve
726
What extends from the base of the skull to the coccyx on either side of the vertebral column and is located anterior to the neck of the ribs?
Sympathetic Trunk
727
What is the sympathetic trunk connected to the thoracic spinal nerves by?
Gray and white rami communicantes
728
What type of communicantes contain postganglionic sympathetic fibers and are connected to every spinal nerve?
Gray Rami Communicantes
729
What type of communicantes contain preganglionic sympathetic fibers and are limited to spinal cord segments T1 to L2?
White Rami Communicantes
730
What type of communicantes have nerve cell bodies that are located in the sympathetic trunk?
Gray Rami Communicantes
731
What type of communicantes have nerve cell bodies that are located in the lateral horn (intermediolateral cell column) of the spinal cord?
White Rami Communicantes
732
What passes from the thorax to the abdomen behind the medial arcuate ligament or through the crura of the diaphragm?
The sympathetic trunk
733
What is formed by the fusion of the inferior cervical with the first thoracic ganglion?
The cervicothoracic (stellate) ganglion
734
Within the thorax, the sympathetic trunk gives off what branches?
1. Cardiac
2. Pulmonary
3. Mediastinal
4. Splanchnic
735
What are the major visceral branches of the sympathetic trunk which supply abdominal viscera?
Splanchnic Nerves
736
What are the splanchnic nerves?
1. Greater Splanchnic Nerve (T5-T9)
2. Lesser Splanchnic Nerve (T10-T11)
3. Least Splanchnic Nerve (T12)
737
How do all three splanchnic nerves reach the abdomen?
By piercing the crura of the diaphragm, and end in abdominal ganglia
738
Aside from sympathetic fibers, the sympathetic trunk also carries sensory (pain) fibers from where?
Thoracic, Abdominal, and Pelvic Viscera
739
Where does the right vagus nerve enter the thorax?
Anterior to the right subclavian artery
740
Where does the left vagus nerve enter the thorax?
Between the left common carotid and left subclavian arteries
741
Within the thorax, what nerve gives off the recurrent laryngeal nerves and branches to the autonomic plexuses of the thorax?
Vagus Nerve
742
What nerve hooks around the right subclavian artery and ascends into the neck between the trachea and the esophagus?
Right recurrent laryngeal nerve
743
What nerve hooks around the arch of the aorta posterior to the ligamentum arteriosum and ascends into the neck between the trachea and the esophagus?
Left recurrent laryngeal nerve
744
What nerve passes posterior to the root of the lung?
Vagus nerve
745
What forms the esophageal plexus along the esophagus?
Vagus nerve
746
What comes together to form the anterior and posterior vagal trunks near the esophageal hiatus?
Esophageal Plexus
747
What are the functional components of the vagus nerve?
1. Motor (to muscles of the pharynx and larynx only - not to thorax)
2. Sensory (to thoracic and abdominal viscera)
3. Parasympathetic (to thoracic and abdominal viscera)
748
What are the autonomic plexuses?
1. Cardiac Plexus
2. Pulmonary Plexus
3. Esophageal Plexus
4. Thoracic Aortic Plexus
749
What autonomic plexus is related to the arch of the aorta and controls heart rate and is subdivided into superficial and deep parts?
Cardiac Plexus
750
What autonomic plexus is related to the root of the lung?
Pulmonary Plexus
751
What autonomic plexus is formed along the esophagus?
Esophageal Plexus
752
What autonomic plexus is a delicate network of nerves along the thoracic aorta and its branches?
Thoracic Aortic Plexus
753
Where do each of the autonomic plexuses of the thorax receive sympathetic fibers from?
The sympathetic trunk and parasympathetic fibers from the vagus
