Exam 4 Regional Anatomy; Vascularization Head & Neck; Axial Skeleton Flashcards
What are the arteries that furnish blood to the brain? (They are paired)
- Vertebral Arteries
- Internal Carotid Arteries
How many vertebrae are in each of the vertebral regions?
Cervical-- 7 Thoracic-- 12 Lumbar-- 5 Sacrum-- 5 fused Coccyx-- 4 fused
What are the four normal vertebral curves?
- Cervical & Lumbar (Anteriorly convex curves)
- Thoracic & Sacral (Anteriorly concave curves)
Intervertebral discs are found where?
2nd Cervical (axis) to sacrum
What is characterized by an abnormal increase in the thoracic curvature?
Kyphosis
Kyphosis may results from what?
Erosion of the anterior part of one or more vertebrae (demineralization resulting from osteoporosis)
What is characterized by an anterior rotation of the pelvis at the hip joints producing an abnormal increase in lumbar curvature?
Lordosis
What are some associated causes of Lordosis?
- Weakened trunk musculature
- Late pregnancy
- Obestity
What is characterized by an abnormal lateral curvature that is accompanied by rotation of the vertebrae?
Scoliosis
Which abnormal curvature is the most common deformity in pubertal girls?
Scoliosis
This abnormal curvature has the spinous processes turn toward the cavity of the abnormal curvature and the ribs protrude when bending over?
Scoliosis
What are the different structural parts of a vertebra?
Vertebral processes
Vertebral Arch
Vertebral Body
What is the name of the cervical vertebra that supports the skull and is the first cervical vertebra?
Atlas
Which cervical vertebra allows for side-to-side rotation of the head?
Axis
What transmits the vertebral arteries?
Transverse Foramina
What are the two craniovertebral joints?
Atlanto-occipital Joint- (Atlas & Occipital Bone)
Atlantoaxial Joint- (Atlas & Axis)
What type of joint are the craniovertebral joints?
Synovial Joint
This is a ring of bone & has the superior facets for the occipital condyles?
Atlas
This cervical vertebra has the dens (odontoid) process as the body?
Axis
What is the name of the strong ligament extending between right & left tubercles of C1 & holds the dens of C2 against the anterior arch of C1, forming the posterior wall of a socket for the dens?
Transverse Ligament
The Thoracic aorta supplies branches to what?
Pericardium Esophagus Bronchi Diaphragm Intercostal Chest Muscles Mammary Gland Skin Vertebrae Spinal Cord
What are the paired arteries that supply blood to the brain?
Vertebral Arteries
Internal Carotid Arteries
The vertebral arteries are direct branches of what?
Subclavian arteries
What foramina do the Vertebral arteries travel through heading toward the brain and pass through to get to the brain?
Travel: Transverse Foramina of the cervical vertebrae
Pass: Foramen Magnum
What do the vertebral arteries unit to form on the inferior posterior part of the brain?
Basilar Artery (single) on ventral surface of the pons
What arteries are branches of the common carotid artery and enter the skull through the carotid foramen (Carotid Canal)?
Internal Carotid Arteries
The Internal Carotid Arteries & External Carotid Arteries are branches of what?
Common carotid arteries (right & left sides)
The internal carotid arteries travel to inferior anterior surface of the brain and contribute to what?
Formation of CIRCLE OF WILLIS
-Supply blood to eyeballs & brain
The external carotid arteries supply blood to what structures?
Structures of the external skull as branches of maxillary & superficial temporal branches
What is the most important anastomosis in the body that connects posterior & anterior blood supplies to the brain?
Arterial Circle of Willis
What vessels make connections in the Circle of Willis?
Basilar Artery (formed from united vertebral arteries) interconnect with branches of the internal carotid arteries
What is the importance of the anastomosis called the Arterial Circle of Willis?
- Control of blood supply to brain when pressure varies in one or more major artery
- Alternate pathways if blockage or occlusion
Name the foramina and what portion of which bone the internal carotid arteries pass through to get to the cranial cavity?
Carotid Foramina (Carotid Canals) in the petrous part of the temporal bones
What vessels drain the head and neck?
External Jugular Vein
Internal Jugular Vein
What vessel do the External & Internal Jugular veins take blood to?
Superior Vena Cava
Where does the Dural Venous Sinuses empty into?
Internal Jugular Vein
Name the groups of Lymph nodes found on the head and neck?
Parotid Occipital Retroauricular (Mastoid) Deep Cervical Superficial Cervical Submental (anterior, inferior mandible) Submandibular (posterior to submental)
The thoracic duct drains lymph into venous blood at what junction?
Left Internal Jugular & Left Subclavian Veins
The Right Lymphatic Duct drains lymph into venous blood at what junction?
Right Internal Jugular & Right Subclavian Veins
What Plexus is formed from the ventral rami of spinal nerves C1-C5?
Cervical Plexus
The cervical plexus supplies nerve innervation of what areas?
Skin & Muscles of the Head, Neck, & Upper Shoulders
What other significant nerve arises from the C3-C5 portion of the Cervical plexus? Innervates what?
Phrenic Nerve
Innervates the Diaphragm
What nerve branch arising from the Cervical Plexus provides cutaneous innervation of skin of the neck & scalp posterosuperior to the auricle?
Lesser Occipital Nerve
What nerve branch arising from the cervical plexus provides cutaneous innervation of skin over the parotid gland, mastoid process, auricle, & area of skin from angle of the mandible to mastoid process (Posterioinferior part of face & inferior part of the auricle)?
Great Auricular Nerve
What nerve is a branch of the dorsal primary ramus of spinal nerve C2, not part of the Cervical plexus?
Greater Occipital Nerve
Where does the Greater Occipital Nerve arise from & emerges beneath what muscle?
Between vertebrae C1 & C2, emerges beneath obliquus capitis inferior muscle
The greater occipital nerve passes through what muscles after it emerges beneath obiquus capitis inferior?
Semispinalis Capitis & Trapezius Muscles
What does the Greater Occipital Nerve supply?
Skin along posterior scalp to the vertex
Disorders of the Greater Occipital Nerve may cause what? & is brought on (due to) by what reason?
Occipital Neuralgias
-Entrapped at the obliquus capitis inferior muscle
What nerve supplies the skin covering the anterior cervical region?
Transverse Cervical Nerve
Which nerves supply the skin over the shoulder?
Supraclavicular Nerves
Which nerve provides motor innervation of the infrahyoid muscles, Omohyoid, Sternohyoid, Sternothyroid?
Ansa Cervicalis
Which nerve provides motor innervation of the infrahyoid muscle, Thyrohyoid?
Hypoglossal Nerve (CN-XII)
Which muscles are the TMJ Muscles?
Temporal
Masseter
Lateral Pterygoid
Medial Pterygoid
Which triangle has the occipital triangle and Subclavian triangle in it?
Posterior Triangle
What separates the occipital triangle from the subclavian triangle?
Omohyoid (inferior belly portion)
What important structures lie within the Occipital Triangle?
- Occipital Artery (for which triangle is named)
- Accessory Nerve (CN-XI)
- Cervical Plexus
The Subclavian Triangle contains what important structures?
Subclavian Artery & Vein (for which triangle is named)
What other name may the Subclavian Triangle be called?
Supraclavicular Triangle
Name the subdivisions of the Anterior Triangle?
Submandibular Triangle
Carotid Triangle
Submental Triangle
Muscular Triangle
Which triangle is bounded inferiorly by the body of the hyoid bone, laterally by right & left anterior bellies of digastric muscles & the floor is the two mylohyoid muscles?
Submental Triangle
What is contained in the submental triangle?
Submental Lymph Nodes
The Submandibular Triangle is the glandular area between what?
Inferior border of mandible & anterior & posterior bellies of the digastric muscle
What other name may the Submandibular Triangle be called?
Digastric Triangle
What structure nearly fills the Submandibular Triangle?
Submandibular gland
What other structures are contained in the Submandibular Triangle?
Facial Artery
Facial Vein
The Carotid Triangle is a vascular area bounded by what structures?
Superior belly of the omohyoid
Posterior belly of Digastric
Anterior border sternocleidomastoid
What important structures are contained in the Carotid triangle?
Common Carotid (pulse auscultated or palpated here)
- Internal & External Carotid Arteries
- Internal Jugular Vein
- Vagus Nerve
- Thyroid Gland
- Larynx
The pulse can be auscultated or palpated by compressing it against what?
Transverse processes of cervical vertebrae
The common carotid divides into the internal & external carotid arteries at what level?
Superior border of the thyroid cartilage
What deeper structures lie within the Carotid Triangle?
Middle Cervical Sympathetic Ganglion
Recurrent Laryngeal nerve
Thyroid branches of inferior thyroid artery
The muscular triangle is bounded by what?
Superior belly of omohyoid muscle
Anterior border of sternocleidomastoid
Median plane of the neck
What is contained in the muscular triangle?
Infrahyoid muscles
Viscera of the neck (Thyroid & Parathyroid Glands)
What deeper structures lie within the Muscular Triangle?
Trachea
Larynx
Thyroid Gland
Nerves that “just pass through” an area on their way to innervate a more distal body part are called?
Transient Nerves
Name two transient nerves within the neck?
Vagus Nerve (CN-X) Phrenic Nerve
Which nerve accompanies the carotid artery & internal jugular vein in the neck on its way to the thorax & abdomen?
Vagus Nerve (CN-X)
Branches of the Vagus Nerve are found in which triangles?
Carotid Triangle
Submandibular Triangle
The phrenic nerve transits along what as it heads to innervate the thoracic diaphragm?
Anterior Scalene Muscle
The most inferior functional intervertebral disc is between?
L5 & S1
No intervertebral disc is found between?
C1 & C2
Which primary vertebral Curve is formed during fetal development?
Thoracic (Anteriorly Concave Curve)
Sacral Curve
Which secondary Vertebral curve forms when a child begins to hold their head erect?
Cervical Curve
Which secondary Vertebral curve forms when a child begins to walk?
Lumbar Curve
All curves of the spine are fully developed by what age?
10
What portion of the vertebrae are the weight bearing portion?
Body of the vertebrae
The vertebral arch has what structures of the vertebrae?
Pedicles
Laminae
What are the seven processes found on a vertebrae?
Transverse -2
Spinous -1
Articular -4
All the vertebral foramina together form what?
Spinal Canal
What is formed from two vertebral notches together?
Intervertebral Foramina
The seventh cervical vertebrae is called what?
Vertebra Prominens
The Cervical Vertebrae C3-C6 structural characteristics?
Smaller Body
Larger Spinal Canal
Transverse processes: shorter
Transverse foramen for vertebral artery
The spinous processes of C2 to C6 are often structurally different in what way?
bifid (split in the middle making two)
What membrane is the strong superior continuation of the posterior longitudinal ligament across the central atlantoaxial joint through the foramen magnum to the central floor of the cranial cavity?
Tectorial Membrane
A hangman’s fracture is the colloquial name given to a fracture of what?
Both Pedicles of C2 (Axis)
What causes a hangman’s fracture?
Forcible hyperextension of the head (Large axial load onto C2)
Which vertebrae articulate with the ribs?
12 Thoracic Vertebrae
What are some structural characteristics of the thoracic vertebrae?
Larger & stronger Body
Longer Transverse Process
Longer Spinous Process
Facets or demifacets on body for head of rib
Facets on transverse Processes for tubercle of rib
The Tubercle of the rib articulates with which portion of the thoracic vertebrae?
Transverse Process
The thoracic vertebral body articulates with what portion of the rib?
Head of the rib
What are the largest and strongest vertebrae in the vertebral column?
Lumbar Vertebrae (5 Lumbar vertebrae)
Which vertebrae have short thick spinous processes and transverse processes?
Lumbar Vertebrae
Which vertebrae are fused by age 30 and serve as a strong foundation for the pelvic girdle?
Sacrum (5 fused)
What area of the Sacrum is covered with hyaline cartilage and is the site of the synovial part of the sacroiliac joint? (named derived from resemblance to an ear)
Auricular Surface
The continuation of the vertebral canal in the sacrum is called what and contains what?
Sacral Canal
Nerve Roots of Cauda Equina
What is formed from the fused rudimentary spinous processes of the Sacrum?
Median Sacral Crest
What is formed from the fused articular processes of the Sacrum?
Medial (Intermediate) Crest
What is formed from the fused tips of the transverse processes of the sacral vertebrae?
Lateral Sacral Crest
What is formed due to the absence of spinous processes and associated laminae on S5 and sometimes S4
Sacral hiatus
This is the inferior articular process of S5 and is a helpful guide to the location of the sacral hiatus?
Sacral Cornu
What portion of the vertebrae is formed from the fusion of 4 bone generally by age 30 and is the remnant of the skeleton of the embryonic tail?
Coccyx
What are the rudimentary articular processes of the Coccyx called?
Coccygeal Cornu
What landmarks on the Sacrum and Coccyx are used to place an Epidural or Caudal block?
Sacral & Coccygeal Cornu
An epidural or caudal block provides anesthesia to what area?
Regions innervated by the sacral and Coccygeal nerves (Approx. waist to knees)
What permits various movements of the vertebral column, absorbs vertical shock between vertebrae and is a Fibrocartilagenous ring (Anulus Fibrosus) with a pulpy center (Nucleus Pulposus)?
Intervertebral Discs
What accounts in part for a loss of height during old age?
Nuclei Pulposi lose turgor and thin due to dehydration and degeneration
What occurs to the intervertebral disc with flexion of the vertebral column?
Nucleus Pulposus: Pushed posteriorly toward thinnest part of annulus fibrosus
What may occur with degeneration of the posterior longitudinal ligament and wearing of the annulus?
Nucleus pulposus may herniate into the vertebral canal
Compress spinal cord or nerve roots
What is the most commonly ruptured intervertebral disc?
C5/C6 (compresses spinal nerve roots C6) &
C6/C7 (compresses spinal nerve roots C7)
Intervertebral disc protrusion within the cervical spine may cause what symptoms?
Pain in Neck, Shoulder, arm, & hand
Hyperextension of the neck may result in what injury?
stretch or tearing of Anterior Longitudinal Ligament
What is a common cause of hyperextension injuries of the neck?
Rear-end collision (Whiplash)
What is the name of the plane synovial joint between the superior and inferior articular processes (vertebral arches) of adjacent vertebrae?
Zygapophysial joint (facet joint)
Zygapophysial joints are surrounded by what? These are especially thin and loose in the cervical region
Articular Capsule (Thin and loose)
The Zygapophysial joints permit what?
Gliding Movements between vertebrae
What purpose do Accessory ligaments of the vertebrae serve?
- Unite the laminae, transverse processes, spinous processes
- Help stabilize the joints
If Zygapophysial joints are diseased (osteoarthritis) or injured what may occur?
- Joint is close to intervertebral foramina and spinal nerves may be affected
- Pain distribution along dermatomes and spasm in muscles derived from associated myotomes
What ligament is a broad fibrous band that covers and connect the anterior aspect of vertebral bodies and intervertebral discs and extends from the atlas to the sacrum?
Anterior longitudinal ligament
The anterior longitudinal ligament serves what purpose?
- Stability of joint between vertebra
- Prevent hyperextension of vertebral column
What ligament runs within the vertebral canal along posterior aspect of the vertebral bodies and is supplied with nociceptive nerve endings?
Posterior Longitudinal Ligament
The posterior longitudinal ligament serves what purpose?
- Prevent Hyperflexion of vertebral column
- Herniation or posterior protrusion of discs
What Ligament is a broad, yellow elastic fibrous tissue that joins laminae of adjacent vertebral arches?
Ligamenta Flava
The Ligamenta Flava serves what purpose?
- Prevent separation of vertebral lamina
- Arrest abrupt flexion of vertebral column
- Help prevent injury to intervertebral discs
What ligament joins the tips of the spinous processes from C7 to the sacrum?
Supraspinous Ligament
This is the thickening of the supraspinous ligament in the neck, extending from C7 to the occipital protuberance?
Ligamentum Nuchae
What provides the blood supply to the vertebrae?
A segmental artery
Spinal arteries enter the Intervertebral foramina and divide to provide blood to what?
Dorsal & ventral roots of spinal nerves & coverings
Spinal veins form what to provide venous drainage of the vertebral column?
- Anterior vertebral venous plexus (Internal & external)
- Posterior vertebral venous plexus (internal & external)
What vertebral veins are large & tortuous and are in the substance of the vertebral bodies?
Basivertebral veins
What veins accompany the spinal nerve through the intervertebral foramina and receive blood from the spinal cord and vertebral plexuses?
Intervertebral veins
The Anterior Internal Plexus and Posterior Internal Plexus together form what venous plexuses?
Internal vertebral (Epidural) Plexus
What is the clinical significance of the vertebral venous plexus being a valve-less system?
Transmit cancer metastases to distant locations that do not lie in the normal venous pathway. i.e. Brain but not the lungs
The bony thorax is formed by?
Thoracic portion of vertebral column
12 pairs of ribs w/costal cartilages
sternum
What function does the bony thorax serve?
Protect: Heart, Lungs, Liver, Spleen, etc..
Attachment for muscles of respiration
Produce red bone marrow
Name the openings of the Bony thorax?
- Superior Thoracic aperture (bounded by first pair of ribs & sternum)
- Inferior Thoracic Aperture (Closed by the diaphragm)
The vertebrosternal ribs are comprised of what?
Ribs 1-7
Costal Cartilage
Attach directly to sternum
Which rib has the sharpest curvature and articulates with the manubrium inferior to the clavicle?
First Rib
Which ribs have sternal costal articulations direct to the body of the sternum?
3-7
The second rib articulates with what?
Junction of Manubrium and body of the sternum
Which ribs are considered “true ribs”?
1-7
Ribs 8-10 indirectly articulate with the sternum by joining the costal cartilage of rib 7, these ribs called?
Vertebrochondral ribs
Ribs 8-10 are also termed what due to the indirect articulation with the sternum?
False ribs
What is formed by the arrangement of costal cartilages that provide for the indirect articulation of ribs 8-10?
Costal Arch
These ribs are also false ribs and have no articulation with the sternum or any anterior articulation?
Ribs 11 & 12
Ribs 11 and 12 are also known as?
“Floating ribs”
What the is name of the joint that articulates between the xiphoid process and body of the sternum and is a synchondrosis?
Xiphisternal joint
What type of joints are formed between ribs 6-9?
Synovial joints (Synovial plane joints)