Mod 2: Anatomy Flashcards
1
Q
Parts of the parietal pleura around lungs
A
Cervical
Costal
Diaphragmatic
Mediastinal
2
Q
Thoracic wall includes
A
rib cage + sternum
3
Q
Functions of thoracic wall
A
protects organs
attachment for muscles of respiration
attachment for muscles of upper limb, back, and abdomen (supports wt of upper limbs)
resists neg (sub-atm) internal pressure
4
Q
True
False
Floating ribs
A
True (vertebrocostal): 1-7
False (vertebrochondral): 8-10
Floating (vertebral or free): 11-12
5
Q
Inf articular facet of rib articulates with…
Articular facet of tubercle…
A
Inf articular facet: with costal facets of NUMERICALLY CORRESPONDING thoracic vert
Articular facet of tubercle: with TRANSVERSE PROCESS of CORRESPONDING thoracic vert
6
Q
Synovial joint
Synchondroses
Symphyses
A
Synovial: --free mvmt --synovial fluid --articular/hyaline cartilage Synchondroses --primary cartilaginous joints --bending, but not mvmt --hyaline cartilage --Synostosis when cartilage is replaced by bone Symphyses --secondary cartilaginous joints --slight or no mvmt --fibrocartilage
7
Q
In what kind of joint may cartilage be replaced with bone?
What is this called?
A
Syncondroses – when replaced by bone, called:
Synostosis
8
Q
What joints result in synostosis as we age?
A
xiphisternal
manubriosternal
9
Q
Functions of thorax
A
Respiration (pleura/pleural cavities containing the lungs)
Circulation (mediastinum with heart and great vessels)
Nutrition (esophagus passes inf in post mediastinum through the diaphragm to empty into the stomach)
10
Q
What divides sup and inf mediastinum?
Ant, middle, post?
A
Sup-inf: sternal angle (T4-T5)
Ant: in front of heart
Mid: heart
Post: behind heart
11
Q
Sup mediastinum from superficial –> deep
A
Super: Thymus Sup vena cava/ RL brachiocephalic vv Aorta (ascending and aortic arch) Pulmonary arteries Trachea Esophagus Trachea (lymph nodes below bifurcation) Azygos v
12
Q
Intercostal n AKA
A
spinal nerve ventral ramus
13
Q
Intercostal aa
Ant branches from…
Post branches from…
A
Ant: internal thoracic (from subclavian)
Post: descending aorta/ 1st and 2nd from subclavian via supreme intercostal a
14
Q
Openings in diaphragm
A
caval hiatus: inf vena cava (T8)
esophageal hiatus (T10)
aortic hiatus: descending aorta (T12)
15
Q
Diaphragm innervated by…
A
phrenic n (C3-C5)
16
Q
Most lymph from breast drains to…
Clinical significance?
A
axillary lymph nodes (through the sup lat quadrant and axillary process)
Axillary lymph nodes are the first site to examine to determine if cancer is metastasizing
17
Q
Borders and contents of superior thoracic aperture (AKA thoracic inlet/outlet)
A
Ant border: sternal manubrium and 1st rib costal cartilages Post border: T1 centrum Lateral border: 1st ribs Contents: --trachea --esophagus --aortic arch and its branches --sup vena cava
18
Q
Borders and contents of inferior thoracic aperture
A
Ant border: xiphisternal joint and costal margins Post border: T12 Lat border: 12th ribs Contents --diaphragm --esophagus --aorta --inf vena cava
19
Q
Inhalation vs Exhalation mechanics
A
Inhalation: thoracic resp pressure must be LESS than atm pressure (volume must INC)
–contraction of diaphragm
–vertical dimension of thorax inc by 2-10 cm as abdominal contents are forced down
Exhalation: resp pressure is GREATER than atm pressure (volume must dec)
–relaxation of diaphragm
–lungs and chest walls elastic recoil
20
Q
Rib mvmts allow chest circumference to be … in an avg male
A
increased by 7.5 - 10 cm
21
Q
Trachea begins below…
Trachea divides into right and left main bronchi at…
A
Begins below cricoid cartilage
Divides into R and L main bronchi at STERNAL ANGLE (T4)
22
Q
Carina
A
keel-like ridge
cartilaginous projection of the last tracheal ridge associated with the cough reflex
23
Q
Compare R and L main bronchi
A
R: wider, shorter, and more vertical than left
**foreign objects trapped more easily
24
Q
Parietal pleura in contact with thoracic wall via…
A
endothoracic fascia (separates intercostal muscles from pleura)
25
Where do visceral and parietal layers connect in lung?
at hilum
26
Pleural cavity
potential space b/w layers of the pleural sac
27
Recesses
| Def and names in lungs
potential spaces created by uninflated lungs not filling the entirety of the pulmonary cavities
- -Costodiaphagmatic recess
- -Costomediastinal recess
28
What follows the pattern of bronchi?
arterial branching
29
tertiary bronchus + tertiary branch of pulmonary artery
bronchopulmonary segment
30
What kind of neurons carry all afferent information?
| What are the parts of this neuron?
Pseudounipolar
cell body: spinal ganglion --DRG (outside CNS)
periph process: carry signals from structure being innervated
central process: transmits signals to CNS
31
Autonomic innervation AKA
general visceral motor
32
What kind of neurons carry efferent information?
multipolar
33
Sympathetic trunk
preganglionic axons travelling among paravertebral ganglia makes continuous chains
34
Cervical sympathetic ganglia
the 3 cervical sym ganglia are formed by the fusion of 8 paravertebral ganglia
35
Stellate ganglion
inf cervical ganglion fuses with T1 to make the stellate ganglion
36
Ganglion impar
fusion of left and right coccygeal ganglia at the terminal end of the sym trunk
37
Describe innervation of thoracic viscera
sym innervation directly from paravert ganglia via sym organ nn (AKA cardiopulmonary splanchnic nn)
**all sym organ nn are postganglionic (synapsed at a paravertebral ganglion somewhere on sym trunk)
38
What paravertebral ganglia contribute to sym organ nn?
All paravertebral ganglia above T6
39
Neural plexuses
cardiac plexus
pulmonary plexus
formed by interweaving of sym and parasym axons
40
Heart innervated by what spinal levels?
T1-T5
41
Describe innervation of abdominal viscera
```
Abdominopelvic splanchnic nn
Lower thoracic splanchnic nn
--greater (T5-T9)
--lesser (T10-T11)
--least (T12)
Lumbar splanchnic nn (L1-L4)
```
42
How do thoracic splanchnic nn enter abdomen?
pierce diaphragm
43
Where do most splanchnic nn synapse?
on subdiaphragmatic/ preaortic/ prevertebral ganglia located centrally on post abdominal wall
(located along aorta, lumbar/sacral vert column)
44
How do postganglionic n fibers travel to organ being innervated?
travel in periarterial plexuses surrounding the supplying arteries
45
What kind of axons travel to adrenal medulla?
| Why?
Prevertebral axons travel to adrenal medulla and synapse in the organ, stimulating release of hormones
--displaced paravert ganglion
46
Major difference b/w organ nn and splanchnic nn
Organ nn: have already synapsed
| Splanchnic nn: prevert nn that have not yet synapsed
47
Innervation of:
foregut
midgut
hindgut
foregut: greater splanchnic (T5-T9)
midgut: mostly lesser splanchnic with some overlap from greater and least spinal segments; T9-T12
hindgut: least splanchnic with some overlap from lesser and lumbar splanchnic nn; spinal segments T12-L2/4
48
Preganglionic cell bodies of sym NS located...
| of parasym NS located...
sym: intermediolateral column of spinal cord
parasym: medulla oblongata or S3-S4 levels of spinal cord
49
Location of vagus n
```
in mediastinum (b/w heart and lungs), post to root of lungs
vagal trunks then follow esophagus down into abdomen, through esophageal hiatus to participate in subdiaphragmatic plexus
```
50
Vagus nn transition from a ... position in the sup thorax to a ... position in the inf thorax
Vagus nn transition from a right/left position in the sup thorax to a ant/post position in the inf thorax
* *left vagus n becomes ant vagal trunk
* *right vagus n becomes post vagal trunk
51
What kind of sensation does not reach conscious awareness?
| What does?
Does not reach conscious awareness: autonomic motor
| Does: visceral sensation (uncomfortable, dull, difficult to localize)
52
What stimuli result in visceral sensation?
```
ischemia
inflammation
distension
cramping
NOT from cutting, burning, squeezing
```
53
How does visceral sensation travel back to CNS (most)?
| Pelvic viscera?
Most: travel back to dorsal horn of SC via the same pathway that sym motor innervation used to reach the organ UNTIL IT REACHES THE MIXED SPINAL N, AT WHICH POINT SENSORY INFO IS DIVERTED TO DORSAL ROOTS
Pelvic viscera: travel back to SC via parasym pelvic splanchnic n
54
Recurrent laryngeal nn branches from...
R wraps around
L wraps around
branches from vagus (CN X)
R wraps around brachiocephalic a
L wraps around aorta
55
What spinal levels correspond to phrenic n?
C3, C4, C5
56
Types of nn in cardiac, pulmonary, esophageal plexuses
Sym and parasym
| includes vagus CN X
57
Bifurcation of trachea at what level?
T4/T5
58
Carina
keel-like structure at bifurcation of trachea
59
Right vs left bronchi
Right runs more vertically
wider
shorter
60
Most posterior structure in sup mediastinum
esophagus
61
Describe course of R vs L recurrent laryngeal nn
R: ventral/anterior
L: b/w esophagus and trachea
62
Thymus
diminishes at puberty
immune sys organ
Can compress trachea if inflamed or bound by vessels (especially infants)
63
Thoracic duct drains at the junction of...
subclavian and brachiocephalic on LEFT side
64
Cisterna chyli
```
large lymph node
stores lymph fluid
T12
right side b/w aorta and azygos
crosses to left side T4-T5
```
65
Where are pulmonary aa located in relation to pulmonary vv?
aa on top of vv
66
What side of heart has ox/deox blood?
Ox: left
Deox: right
67
Coronary sinus
venous drainage of the heart tissue itself
68
Coronary aa supply blood to...
Coronary vv drain blood from...
Coronary sinus drains to...
aa: supplies myocardium
vv: drain myocardium
coronary sinus drains to right atrium
69
Crista terminalis
Right atrium
| separates rough ant wall from smooth post wall
70
Musculi pectinate
Right AND Left atria
R: internal muscular ridges, fan out anteriorly from crista terminalis
L: pouch-like appendage containing MUSCULI PECTINATE
71
Sinus venarum
Right atrium
| smooth-walled cavity extending posteriorly from cristal terminalis
72
Right auricle
Right atrium
| small, conical muscular pouchlike structure (flap of tissue)
73
Interatrial septum
Right atrium
| forms posteromedial wall of right atrium
74
Fossa ovalis
Right atrium
| remnant of fetal foramen ovale -- oxy blood from placenta passed from right --> left atria
75
Conus arteriosus (infundibulum)
Right ventricle
| smooth-walled, cone-shaped structure that gives rise to the pulmonary trunk
76
Trabeculae carnae
Right AND Left ventricle
muscle ridges and bulges
**finer and more numerous in left ventricle
77
Papillary muscles
Right AND Left ventricles
R: irregular m bundles on ventricular wall of AV valve (ant, post, septal mm)
L: 2 (ant, post) connected to 2 cusps of mitral valve
78
Chordae tendinae
Right AND Left ventricles
slender, fibrous threads that arise from apices of papillary muscles
**thicker but less numerous in left ventricle
79
Septomarginal trabeculae
Right ventricle
AKA moderator band
elevated trabeculae carnae crossing the cavity of the ventricle from the interventricular septum to the base of the ant papillary muscle
--carries the right AV bundle
80
Left auricle
Left atrium
| pouch-like appendage, containing MUSCULI PECTINATE
81
Valvule of foramen ovale
Left atrium
| fetal valve, preventing blood from flowing backward from left to right atria
82
How many openings into right atrium?
| Left
Right: 3 (sup and inf vena cava, coronary sinus)
Left: 4 (4 pulmonary vv)
83
Difference b/w traeculae carnae in right and left ventricles
| Difference b/w chordae tendinae
Trabeculae carnae: Finer and more numerous in left ventricle
| Chordae tendinae: thicker but less numerous in left ventricle
84
What is the first branch of from the aorta leaving the heart?
R and L coronary aa
85
AV valves
| Semilunar valves
AV: mitral and tricuspid
Semilunar: pulmonary and aortic
86
Auscultation points for heart valves
Aortic: 2nd intercostal space to right of sternal border
Pulmonary: 2nd intercostal space to left of sternal border
Tricuspid: 5th-6th intercostal space near left sternal border
Mitral: near apex of heart in 5th-6th intercostal space in the midclavicular line
87
How many cusps/leaflets in each valve of heart?
3 in tricuspid, pulmonary, and aortic valves
| 2 in mitral (bicuspid)
88
What layer of the valves is continuous with chordae tendinae?
ventricularis layer
89
Describe boundaries of abdomen
b/w abdominal diaphragm (concave inf) and pelvic diaphragm (concave sup)
abdomen ends at sup pelvic inlet
90
Nine regions of abdomen defined by what lines?
| Quadrants?
Nine regions:
- -2 midclavicular planes
- -transpyloric plane (L1)
- -interspinous plane (S1)
```
Quadrants
RUQ: liver
LUQ: spleen
RLQ: appendix
LLQ: sigmoid colon
```
91
Muscles of abdominal wall reinforced posteriorly by what structure?
lumbar spine
92
Intra-abdominal pressure is increased to expel the 4 F's
fluid (urine)
flatus
feces
fetuses
93
What abdominal m is absent in 1/5 of people?
pyramidalis
94
Abdominal obliques correspond with what muscles?
EAO: external intercostal m
IAO: internal intercostal m
Transversus abdominus: transversus thoracis
95
What muscles of abdomen fuse to conjoint tendon?
| Where does tendon attach?
IAO and transversus abdominus
| Insert on pecten pubis
96
layers of ant abdominal wall: superficial --> deep
```
Camper's
Scarpa's
EAO
IAO
Transversus abdominus
Transversalis fascia
```
97
Scarpa's fascia continuous with what fascia of other parts of body?
Clinical significance?
Colle's: perineum
Tunica dartos: scrotum
Superficial: penis
If urine leaks, can accumulate in abdomen
98
All lymph channels inf to umbilicus drain to... nodes
Most lymph channels up to umbilicus drain to...nodes
Lymph channels near midline drain to ... nodes
Inf to umbilicus: superficial inguinal lymph nodes (at groin)
Sup to umbilicus: axillary lymph nodes
Midline: parasternal or ant diaphragmatic lymph nodes
99
Iliohypogastric and ilioinguinal nn -- describe course
| branch from what level?
Pierce TA to enter plane b/w TA and IAO (similar to intercostal nn)
Iliohypogastric then pierces IAO to enter plane b/w IAO and EAO, then pierces EAO aponeurosis to innervate surrounding skin
Ilioinguinal: in most people exits superficial inguinal ring to innervate skin near genitalia and inner thigh (in 30% of people, will end after piercing IAO)
branch from L1
100
Inguinal region extends b/w ... and ...
ASIS and pubic tubercle
101
Gubernaculum
cord made of CT and smooth muscle
runs from site of future scrotum/labium majorum to gonad
also attaches to lower front of peritoneal sac --> forms processus vaginalis (eventually obliterates -- if not, hydrocele)
102
Hydroceles
Buildup of serous fluid
Processus vaginalis fails to obliterate
forms in tunica vaginalis (serous covering of testis)
can occur in testis or cord
103
Testicular torsion
twisting of testis and spermatic cord along their long axes
immediate treatment -- could result in testicular necrosis
Once untwisted, both testis fixed to scrotal septum to prevent future occurrences
104
Describe inguinal canal in adult
due to gubernaculum's retraction during development
oblique -- ensures that increased abdominal pressure closes canal, mitigating likelihood of herniation
4 cm long
parallel and superior to medial half of inguinal lig
105
Lig of superificial inguinal canal
| Fibers they originate from
Lacunar lig: from deep fibers of inguinal lig (floor)
Reflected lig (from inguinal lig)
Medial and lateral crus: from EAO aponeurosis (on either side of ring)
Intercrural: from EAO epimysium (roof)
106
Tunica vaginalis
covers testis on all but post sides (parietal and visceral layers)
promotes free mvmt of testes within the spermatic cord and scrotum (fluid allows mvmt)
107
Tunica albigenia
tough fibrous coating of testes (light-colored, below tunica vaginalis)
108
Where are sperm produced?
seminiferous tubules
109
Viscera of foregut
```
abdominal esophagus
stomach
liver
gallbladder
pancrease
spleen
proximal half of duodenum
```
110
Viscera of midgut
```
Distal half of duodenum
jejunum
ileum
cecum
appendix
ascending colon
right 2/3 of transverse colon
part of pancreas
```
111
Viscera of hindgut
Left 1/3 of transverse colon
descending colon
sigmoid colon
rectum
112
Describe course of spenic artery
runs left along neck, body, and tail of pancreas
| enters spleen b/w the folds of the SPLENORENAL LIG (lienorenal lig)
113
Describe course of common hepatic a
courses rightward superior to the neck of the pancreas b/f dividing into proper hepatic and gastroduodenal
114
Ant/post superior pancreaticoduodenal a supplies...
1st and 2nd parts of duodenum and head of pancreas
115
gastric aa at ... curvature of stomach
| gastro-omental aa at ... curvature of stomach
gastric: lesser curvature
| gastro-omental: greater curvature
116
Describe course of L gastric a
ascends retroperitoneally to the esophageal hiatus then courses along the lesser curvature of stomach
117
Right colic a can branch from
ileocolic a
middle colic a
sup mesenteric a
118
What aa participate in arterial arcades?
```
sigmoidal branches (from inf mesenteric)
intestinal aa (from superior mesenteric)
```
119
Terminal branch of superior mesenteric?
| Inf mesenteric?
Sup: ileocolic
Inf: sup rectal
120
Superior rectal a anastamoses with...
```
Middle rectal (from internal iliac)
Inf rectal (from internal pudendal)
```
121
Appendicitis
inflammation of appendix resulting from occlusion causing bacteria to grow in the appendix (fecalith, inflammation of lymphoid tissue, cancer worms)
--rupture results in spread of bacteria through the peritoneal cavity --> causes peritonitis and death
pain begins as diffuse visceral pain at T10
then causes localized somatic pain that radiates to RLQ
122
McBurney's point
point 1/3 of the distance b/w ASIS and umbilicus --> location of base of appendix
REBOUND pain is McBurney's sign
(stretching peritoneum, then letting it go)
123
Kidney at what vert level?
T12-L3
124
Which kidney is higher?
| Why?
Left is higher
| due to presence of liver on R side
125
Describe location of hilum of kidneys in life
kidneys positioned obliquely so hilum faces 45 deg anteromedially
due to protruding lumbar vert column
126
Renal lobe
pyramid + surrounding cortex
127
Ureters
what kind of muscle?
what structure do they cross?
smooth m
| cross into pelvis at bifurcation of common iliac
128
Hormones secreted by suprarenal glands
corticosteroidds
androgens
epinephrine, adrenaline
(part of HPA axis)
129
Position of suprarenal glands on kidneys
medial side rather than right on top
130
Shape of R vs L kidneys
R: pyramid
L: crescent
