Greys for Students Concept Overview Flashcards
Describe the curvatures of the adult spine
Lordotic Cervical (secondary)
Thoracic (primary)
Lumbar Lordosis (secondary)
Sacral/Coccygeal curvature (primary)
Which region of the spine has more movement?
Lumbar moves more in comparsion to thorasic
What is main function of extrinsic muscles back? And innervated by what?
Move the upper limbs and the ribs. anterior Rami of spinal nerves.
What is main function of intrinsic muscles back? And innervated by what?
posture and move vertebral column. Posterior Rami of spinal nerves
Movements of vertebral column?
Flexion (bend forwards)
Extension (bend back)
lateral flexion and rotation
Which vertebrae is responsible for the flexion and extension (nodding) of the head?
C1 or atlas
Which vertebrae is responsible for the rotation of the head?
THe rotation of C1 on CII 9 (axis)
How many vertebrae?
33 7 C 12 T 5 L 5 fused sacral 3-4 fused coccygeal
Describe a typical vertebra?
Anterior is the Vertebral body and Posterior is the Vertebral Arch.
The arch is formed by the spinous process posteriorly, Transverse processes laterally. Two pedicles that form the lateral pillars of teh arch. And the roof is formed by the two Lamina that fuse to form the SP. So it goes body, Pedicle, TP, Lamina, SP, Lamina, TP, Pedicle, Body.
Extrinsic muscles of the back include?
Trapezius and Latissimus dorsi, Serratus Posterior superior and inferior
Intrinsic muscles of the back?
mainly Eractor spinae
Describe three regions and action of trapezius muscles?
The trapezius has three functional regions: the superior region (descending part), which supports the weight of the arm; the intermediate region (transverse part), which retracts the scapulae; and the inferior region (ascending part), which medially rotates and depresses the scapulae.
Describe Anterior wall of the vertebral canal to spinal cord?
Anterior Longitudinal Ligament, Vertebral body/IV disc, Posterior longitudinal ligament, extradural fat (within= anterior internal vertebral venous plexus), Dura mater, Arachnoid mater, Sub arachnoid space, Pia Mater, Anterior spinal vein and artery Stem with Anterior roots coming out either side.
Describe the Posterior wall of the vertebral canal to spinal cord?
Supraspinous Ligament, Spinous process, Lamina, Ligamenta flava, extradural fat with venous plexus, Dura, Arachnoid, Sub arachnoid space, Pia, Posterior spinal vein and artery, Chord with posterior roots
Ligament between vertebrae outside of the canal?
Interspinous ligament between the vertebral spinous processes.
Where does the Nerve C1 emerge from?
Between skull and C1 aka atlas
How does Nerve C2 emerge?
Superior to the pedicle of the C2 vertebrae
How does Nerve C8 emerge?
Inferior to C7 vertebrae pedicle
How does T1 to Cx emerge?
Inferior to the pedicles of their similarly named vertebrae
How many Spinal nerves?
31 pairs 8 C 12 T 5 L 5 S
How does each spinal nerve branch after existing the vertebral canal?
Into a posterior ramus (smaller and innervate back)
And a anterior ramus (rest of body besides the head both PNS and somatic plexuses.
How many major plexuses are there? and Name them
Cervical, Brachial, Lumbar and Sacral
What travels through the transverse processes of CVI to CI then passes through foramen magnum?
Vertebral Arteries that with the internal carotids supply the brain.
Where does the spinal cord end for an adult?
L1/2
Name the superior, inferior, posterior and anteior margins/borders of the intervertebral foramen
Superior/inferior = Adjancent pedicles
Posterior: Articular processes of the vertebral arches and associated joint (zygapophysial joit)
Anterior: IV disc and bodies.
Where does the Sub Arachnoid space extend from without the Spinal cord but with CSF. How would you access the CSF?
From L1/2 to S2 = removal of CSF with needle through the two adjacent bertebral spinous processes through supraspiinous and interspinous ligaments into extra dural to CSF.
Which apertures of the thorax are closed?
The larger inferior = diaphragam, the lateral walls with ribs + muscle (flexible). Anterior = sternum, Posterior = vertebrae. Superior = open.
What compartments are the thorax divided into?
Left and Right pleural cavity each surrounding a lung.
And a mediastinum
What is in the mediastinum?
Heart, esophagus, trachea, major nerves and major systemic blood vessels
Main Features of Pleural cavities
- separate from each other by mediastinum
- extend above the level of rib 1, apex of each lung extends into the root of the neck.
Where does the kidneys lie in relation to the thorax?
The posterior ascpects of the superior poles of the kidney lie on the diaphragam, Anterior to the XII rib on the right and ribgs XI and XII on the left.
What abdo organs lie on the left and right under the diaphragm?
Right: Liver
Left: Stomach and Spleen
What organs pass through the mediastinum to the rest of the body?
Esophagus, vagus nerves and thoracic duct, phrenic nerves (start in neck and pass through mediastinum to penetrate and supply diaphragm.
What makes up the posterior wall of the thorax?
12 thoracic vertebrae and their intervening intervertebra discs.
Lateral Walls of the thorax?
Skin, 12 Ribs OR skin, Lateral cutaneous branches of vessels, external intercostal muscles (membrane anteriorly), internal intercostal muscle (posterior membrane), neurovascular bundle (tucked into interior costal groove: Vein, Artery, Nerve).\, Innermost intercostal muscle, Endothoracic fascia, Parietal pleura.
What are the three articulations of the ribs?
body of its own vertebra, body of the vertebra above, and as it curves posteriorly each articulates with transverse process.
Which ribs articulate with the sternum?
Ribs I to VII, Articulate with the costal cartilage.
Describe the false ribs?
False ribs = VIII to X , their costal cartilages articular/join with the inferior margins of the costal cartilages above them, then join on the the Body of the sternum.
Describe the First Rib and the vessels passing over it.
1st ribs is shorter. Posteriorly attaches to T1 then slopes inferioly to its anterior attachment on the manubrium of the sternum. THe Subclavian artery and veins pass over superiorly.
Describe Left and Right Crus of Diaphragm
Right Crus goes higher over the liver (up to rib V) and attaches over L1,2 and 3.
Left Crus attaches to L1/2
Attachments of diaphragm?
Xiphoid process then laterally along costal margins (lower 6) to tips of 11th and 12th ribs, along fascia (Arcuate ligaments) of Quadratus Lumborum and Psoas Major to vertebral column.
Three main hiatuses, contents and levels?
- IVC through central tendon at T8 (right of midline)
- Oesophagus+vagus through muscular part at T10 (left of midline).
- Aorta passes through the midline between the crus at T12.
Defining borders of the superior media
Inferior border: horizontal plane through the sternal angle and IV disc between verebrae TIV and TV.
How is the inferior mediastinum further divided?
THe middle mediastinum = pericardium surrounding heart. Anterior = infront heart. Posteior = behind (Descending Arota, Oesophagus.
Contents of the Superior Mediastinum?
Anterior:
Thymus
Great vessles:
- Brachiocephalic veins and SVC
- Arch of Aorta (brachiocephlaic runk, left common carotid, left subclavian).
Related vessels: vagus, phrenic, and cardiac plexus.
- Continuation of cervical viscera: trachea anterior and posteriorly the oesphagus.
+ related nerves = recurrent laryngeal.
- thrroacic duct and lymphatic trunks.
Contents of Middle Mediastinum?
- pericardium
- heart
- great vessels joining the heart
ascending aorta
pulmonary trunk
right and left pulmonary arteries
lower half of the superior vena cava- tracheal bifurcation and both main bronchi
- phrenic nerves
- cardiac plexus
- tracheobronchial lymph nodes
Contents of Posterior Mediastinum?
- Oesophagus
- Thoracic aorta + branches
- Thoracic duct (posterior lymph nodes).
- Azygos-hemiazygos venous system
How is the Plane of ludwig/angle of Louis Defined? And what structures?
Plane of Ludwig (angle of Louis) at T4/T5 disc posteriorly and sternal angle anteriorly.
CLAPTRAP:
C cardiac plexus
L: ligamentum arteriosum
A: aortic arch - begins and ends
P: Superior limit of pulmonary trunk
T: tracheal bifurcation
R: right-to-left movement of the thoracic duct (posterior to the oesophagus)
A: azygos vein drains into SVC/ SVC enters heart.
P: pre-vertebral fascia and pre-tracheal fascia end
Position of 2nd Rib
Where does the potential space exits in relation to the lungs?
A potential space exists between the visceral pleura covering the lung and parietal pleura lining the wall of the thoracic cavity.
What define the costodiagphragmatic recess?
Potential space not filled by lung inferiorly between the thoracic wall and the diaphragm. Helps to accommodate the changes in lung volume during normal breathing.
Describe the Acillary inlet ro gateway to the upper limb from the Superior thoracic aperture?
One on each side”
Posterior: Superior margin of the scapular, Coracoid process = apex of triangle
- Brachial plexus traveling from vertebrae.
- Subclavin vessels (vein anterior)
Anterior: Clavicle
Medial: lateral border of the 1st rib
Breasts extend between which ribs?
2nd to 6th rib
What muscles underlie the breast tissue?
lateral: Serratus anterior
Major = Pectoralis major then minor
- reromammory space bettwen breast and pect major = allows breast movement.
Describe lymph drainage of Breast?
Shares lymph, arterilal and venous supply thwithe upper limb laterally and the throasic wall medially (interncostal muscles) - sites for cancer mets.
As the deoxy blood enters the heart in the Right Atrium on the right side of the body the blood from the left side needs to cross over in the venous system. Where does it do this?
Left brachiocephalic vein cross at manubrium and enters SVC (blood from left head and neck)
Accessory hemiazygos vein and hemiazygos vein drain lateral and posterior parts of thorasic wall and cross over anterior to throasic vertebrae to enter azygous vein that runs onthe right side of teh verterbae and enters SVC.
Describe the arterial supply of the throasic cage?
Anterior and posteriory intercostal arteries anastomoste laterally. Posterior branch comes from throacic arota (also gives off dorsal branch of posterior intercostal artery. Anterior comes from internal thoracic artery (from subclavian artery) and gives off perforating (cutatneous branch).
Describe the origin of the Phrenic nerve, the course and the structures it supplies?
Origin: Anterior Rami of C3-C5 nerves.
Course: Anterior to lung roots, within fibrous pericardium.
Right Passes through superior thoracic aperture -> between sub-clavian artery and origin of brachiocephalic vein (anterior to nerve) –> right side of this vein –> the SVC –> Descends along right side of pericardial sac within fibrous pericardium –> then with IVC through diaphragm at T8.
Left enters lateral to vagus, and lateral/posterior to right brachiocephalic vein. Continues across the left lateral surface of arch of aotra, then superficial to left vagus nerve. Goes along the left side of pericardial sac within fibrous pericarium, anterior to root of lung. Pieces the diaphragm near apex of the heart.
Supply: Somatic afferent fibers to: - mediastinal pleura - fibrous pericardium - parietal layer of serous pericardium. Then Diaphragm (motor + sensory)
General course of the vagus nerves and innervation?
Passes through the superior and posteiro divisions of mediastinum on their way to abdo cavity. Passing through thorax provide parasympathetic innervation to thoracic viscera and carry visceral afferent from the thoracic viscera. Do not carry pain innervation
Course of the Right vagus and R recurrent laryngeal nerve?
Enters: between R brachiocephalic vein and Brachiocephalic trunk (artery).
Gives off Recurrent Laryngeal nerve anterior to R sub-clavian artery and hooks around it and up trachea -> eosphagus to supply larynx.
Goes down posteriorly towards and along the trachea.
Crosses laterally to pass posterioly to root of lung. (gives of pulmonary plexus)
Is crossed by the azygous vein.
Reaches the esophagus (contributes fibres to esophagel plexus).
Course of the Left Vagus and L Recurrent Laryngeal Nerve?
Enters: Posterior to L Brachiocephalic vein between L common carotid and L subclavian arteries.
Goes along left side of the arch of the aorta –> goes posterior to L Phrenic nerves (inbetween them is the L superior intercostal vein, which goes over vagus and under phrenic to L Brachiocephalic Vein).
As it curves medially gives off L Recurrent Laryngeal Nerve: passes inferior to arch of aorta, lateral to ligamentum arteriosum. Goes up medial side of aorta into groove between esophagus and trachea up to larynx.
L Vagus goes posterior to Lung Roots (gives off branches to left pulmonary plexus). Then leaves as single branch and goes posteriorly towards esophagus plexus with R Vagus
Where is ligamentum arteriosum?
Ligament between inferior surface of Arch of Aorta and the left pulmonary artery.
Compression of aortapulmonary window occurs when and what happens clinically?
Where the L recurrent laryngeal nerve branches of left vagas and goes between pulmonary artery and aorta. Compression = hoarse voice. Because of lymph node enlargement.
Mass at apex of right lung can effect the R Recurrent Laryngeal nerve where?
Where it hooks under the right subclavian artery at the superior sulcus of the right lung.
Why are ribs more likely to break then detach from there attachments at vertebrae?
Two Joints:
- Costovertebral Joints: Facets on body of vertebrae & the head of the rib.
- joint capsule surrounding two separate synovial compartemnts divided by intra-articular ligament. - Costotransverse joints
- between tubercle of rib and transverse process of vertebra.
- Stabilized by three strong ligaments
* Costotransverse ligament: medial, neck of rib to the transverse process.
* Lateral Costrotransverse ligament: tip transverse process to roughened part of tubercle
* Superior costrotransverse ligament: Superior surface of neck of rib to transverse process of vertebra above.
Action of Intercostal muscles during breathing?
Superficial:
External Intercostals: active during inspiration by moving ribs superiorly. Pulls ribs below up and out.
Internal Intercostals: Active during expiration, moves ribs inferiorly (acessory).
Innermost Intercostals: Acts with internal intercostal muscles.
How do the lower ribs move during inspiration?
Move laterally when elevated and expand the boy thorax in lateral dimension = inspiration
How do the upper ribs move in inspiration?
Muscles life upper ribs –> moves the sternum and superior anterior –> changes the AP dimension of thorax makes it larger -> decrease pressure –> inspiration.
Describe insertion of chest drain?
Postion tube on superior border of a rib (lower region of intercostal space).
In the safe triangle:
Lateral to anterior border of latissimus dorsi.
Posterior to lateral border of the pectoralis major muscle.
Superior to Level of nipples
Diaphragm roles in inspiration?
On contraction descends and increases depth of thoracic cavity.= inspiration.
Where is the parietal layer continuous with visceral pleura?
As a sleeve around the lung root structures.
What is the pulmonary ligament?
A dependent double fold of pleura inferiror to the lung root structures.
What is the nerve supply to parietal and visceral pleura ? and features of pain from each?
Nerve Supply: shared with structures they line.
Pain:
Parietal = severe well localised pain - somatic afferent fibers
Visceral = dull and poorly localised pain-
The inferior borders of the pleura cavities?
Mid clavicular line - cavity extends to rib VIII
Mid axillary line - rib X
Then round to vertebrae T XII across ribs Xi and XII.
Impressions on the mediastinal surface of the right lung?
SVC & IVC anterioly
Subclavian vessles over the apex of lung anteriorly
Posterior: Azygous vein and esophagus.
Impressions on the mediastinal surface of the left lung?
Aortic arch over the hilum of lung, Thoracic aorta descends down lung.
Left Subclavian artery and Left Brachiocephalic Vein over anterior apex.
Differences between Left and Right main bronchi?
Right main bronchus = wider and more vertical course = inhale foregin bodies. Divides by the time it reaches the hilum. Pulmonary artery is anterior to Right bronchus.
Left main bronchus = Pulmonary artery is Superior. Bronchus noramlly doesn’t divde before hlium.
Where are the pulmonary veins located at lung hilums? What kind of blood flows through there?
The Pair of pulmonary veins are inferior and anterior. They carry oxygenated blood to the Left Atrium.
Where does the biffucation of the pulmonary trunk occur?
Midline just inferior to vertebral level TIV/V and anteroinferiorly to the left of the bifucation of the trachea. Inferior to the Arch of the Aorta.
Main differences between left and right pulmonary arteries?
Right: longer and passes across mediastinum posterior to ascending aorta, SVC and upper right pulmonary veins.
Left: shorter and passes anterior to the Descending aorta and posterior to Superior pulmonary vein.
Which nerves are responsible for dilateing broncioles? Constricting the bronchioles?
Constriction = vagus Dilation= sympathetic system.
Where does the lymphatics from teh throax drain?
To the deep veins at base of neck or the the right lymphatic trunk or thoracic. duct.
What are the transverse and oblique pericardinal sinuses?
Reflections of parietal and visceral serous pericardium.
Transverse: separates arteries from veins (posterioly to Ascending Aorta and pulmonary trunk - anterior to SVC + superior to left atrium.
Oblique pericardial sinus: refelction surrouding pulmonary veins is J shaped and posterior the left atrium.
Why can pain from MI radiate to the arm?
Somatic sensation from parietal pericardium is carried by somatic afferent fibres in phrenic nerves. Dermatomes for spinal chord segments C3,4,5 (roots of phrenic nerve) are supraclavicular region of shoulder or laternal neck area
Layers of pericardium of Heart?
Outer = Fibrous : base attached to diaphragm and to adventitia of great vessles at apex.
Inner = Serous: has two layers:
1. Parietal lines inner surface of fibrous
2. Vsiceral layer or epicardium (adheres to heart)
= friction free suface of heart of texpand and contract.
How do you find anteiror surface of the heart?
The 2 x Auricles point towards front = Atrial Appendeges.
Right Border of the Heart?
Right Atrium + Right Ventricle
Left Border of the Heart?
Left Ventricle = Apex
Inferior Margin of the Heart?
Right Ventricle.
Where is the coronary sulcus and what lies within it?
Separates the atria from the ventricles. Contains the right coronary artery, small cardiac veins, coronary sinus and the circumflex branch of L coronary arteries.
Main Features of the Right Atrium
- Deoxy blood enters via IVC and SVC and coronary sinus from heart.
- Posterior Wall: Fossa ovalis that would lead to LA in fetus in smooth walls.
- Anterior Wall: Musculi pectinati leading to crista terminalis.
- Leading to Tricupsid Valve to Right Ventricle.
- SA node in the superior end of crista terminalis at junction between SVC and RA.
Main Features of the Right Ventricle
- Blood enters through tricupsid valve (chordae tendinae to papillary muscles)
- All of walls covered by trabeculae carnae except area just before pulmonary valve/trunk.
- pulmonary valve has 3 leaflets.
- thicker wall then Right ventricle.
- AV node with in the atrioventiuclar spetum near opening of coronary sinus.
- Av bundle = continuation of av node heas towards interventricular septum.
Main Features of the Left Atrium:
- Thin and smoothed walled
- 4 openings for pulmonary veins (2 x right & 2 x left)
- Ridges inside the Left auricle that heads anterioly.
- Base or posterior surface of the heart.
- Blood flows through the bifold mitral valve.
Main Features of Left Ventricle
- Thickest wall with rough Trabeculae carnae.
- Two papilary muscles anterior and posterior heading to Chordae tendinae of Mitral vale cusps.
- Blood then ejected out through the aortic vale = three semilunar cups.
- Has Left bundle branch that branches into Purkinje Fibres
Where is the origin of the coronary arteries?
At the aortic valve = just anterior to pulmonary valve on the Base of the Heart.
What is the function of papillary muscles in the heart?
They DON’T act to close the valves. They are connected to ventricle wall so when they contract it holds the valves closed during ejection.
What does the Fibro-skeleton of the heart surround and what is its main role?
Surround all 4 valves = annulus firbosus.
- provide structure
- Stop electrical impulses jumping between atria and ventricles.
Which Heart valves are open or closed during diastole?
The mitral and tricuspid are open
Aortic and Pulmonary are closed
Filling
Which Heart valves are open or closed during systole?
Open = aortic and pulmonary
Closed = mitral and tricupid
Ejection
Describe the course of the Right coronary arteries?
Right Coronary artery:
- arises from the R Aortic sinus of the ascending aorta
- gives of branch to SA node
- Goes anterior between R auricle and the pulmonary trunk
- Descends vertically in coronary sulcus (between RA and RV)
- Inferior Margin of Heart turns posterior and continues in sulcus onto diaphrag surface and base of heart
- gives of marginal branch towards apex
- branch to AV node as going posterior.
- Last major branch = posterior interventriulcar branch (in posterior IV sulcus) - anastomose with LAD
- Bit that doesn’t branch anastomose with Circumflex branch of Left Coronary Artery.
What does the Right Coronary artery Supply?
RA RV SA node AV node Interatrial septum A portion of LA Posterioinferior 1/3 of IV septum
Describe the Course of the Left Coronary Artery?
- Starts in Left aortic Sinus
- Goes between pulmonary trunk and left auricle then into coronary sulcus
- divides into two terminal branches
- Anterior interventicular (LAD) and cirumflex
- LAD: descends obliquely towards apex of heart in anterior interventicular sulcus.
- Circumflex: goes left in coronary sulcus onto base/diaphrag surface.
- branch left marginal artery continues across rounded obtuse margin of heart.
Supply of the Left Coronary artery?
LA
LV
Anterior 2/3 of interventricular septum
AV bundel and branches.
Supply of LAD in Heart?
R and L vetnrilces and 2/3 of IVS
Left Circumflex supply?
LA and RV
Supply of Posterior descending artery (PDA) aka Posterior interventicular of Right Coronary ?
R and L ventricles and Posterior 1/3 of IVS
Supply of Right Marginal? And Course?
Supplies the Right Ventricle and Apex of the Heart. When RCA reaches inferior margin of the heart small branch truns inferior towards apex of heart.
