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anatomy of the thorax > nerves of the thorax > Flashcards

nerves of the thorax Flashcards

1
Q

somatic nerves

A

supply skeletal muscles only

11 pairs of intercostal nerves and 1 pair phrenic nerves

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2
Q

somatic sensory nerves

A

sensation from the skin muscles and bones and parietal pleura of peicardium
much non-cutaneous sensation is proprioceptive - feedback on function in muscles, tendons, and joints

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3
Q

autonomic

A

supply sm, cardiac muscle, exocrine glands (heart muscles, bv, bronchi, bronchila glands, sweat gland)

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4
Q

autonomic sensory fibres

A

carry sensory info from viscera

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5
Q

sympathetic nerves

A

motor to sm and cardiac muscle, exocrine glands and carry pain sensation from viscera

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6
Q

chest wall sympathetic innevation

A

from spinal nerves T1-11

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7
Q

thoracic viscera innevation

A

from spinal nerves T3-T6

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8
Q

parasympathetic nerves

A

motor- sm, cardiac pacemaker sstem, exocrine glands and carry sensory information providing functional feedback (enteroception) from the viscera
only to viscera

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9
Q

parasympathetic supply to thoracic viscera

A

from brainstem in vagus nerves - 10th pair of cranial nerves

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10
Q

intercostal nerves

A

T1-11
segmental nerves - each pair supplies single body segment containing single vertebrae and associated muscles and skin
forms roots from spinal cord
ventral - motor
dorsal - sensory
cell bodies of sensory in ganglion on posteror root just before spinal nerve
cell bodies of motor - in anterior horn in spinal cord
ganglion and junction of roots is in intervertebral foremen
spinal nerve divide into rami
smaller rami is posterior - imnervates posterior muscles and skin
anterior is larger - runs between internal and innermost IC muscles suppluing muscles to midline and branches that innervate skin (2 branches from each nerve - one lateral and 1 anterior)

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11
Q

intercostal nerves

A

nerves from the anterior rami

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12
Q

dermatome

A

area of skin supplied by spinal nerve

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13
Q

myotome

A

muscles supplied by a particular spinal nerve

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14
Q

what is the overlap between dermatomes

A

50%

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15
Q

phrenic nerves

A

from anterior rami of 3 adjoining cervical spinal nerves C3, 4, 5
C4 main contributor

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16
Q

effect of damage to motor tracts above C4

A

disconnects diaphragm
breathing cant occur
asphyxia

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17
Q

plexi

A

areas of shared distribution of several pairs of spinal nerves - cervical plexus is from C2 - 5

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18
Q

path of phrenic nerve

A

down neck on muscles from cervical transverse process
pass through diaphragm, either side of the mediastinum
R - follow path of great veins (R brachiocephalic - SVC - fibrous pericardium covering sinus venous and inferior vena cava
L crosses arch of aorta and then runs across fibrous pericardium overlaying the L ventricle

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19
Q

what does each phrenic nerve supply

A

the muscles on its side of the diaphragm

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20
Q

difference between the autonomic and somatic motor nerve

A

somatic - axons of lower motor neurons extend from spinal cord to their end plates
autonomic - preganglionic in brain and spinal cord, post ganglionic go to target tissue - reduces cell bodies in CNS, but also reduces precision

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21
Q

SNS

A

preganglionic T1 - L2
simple segmntal spinal nerves
to body wall travel with somatic but have ganglia
preganglionic leave the spinal cord - synapse in sympathetic chain
postganglionic then return to the spinal nerves

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22
Q

rami communicantes

A

bundles of nerves joining the sympathetic ganglia to spinal nerves

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23
Q

SNS preganglionic fibres ramus communican

A

wrapped in white coloured myelin sheath - form white ramus communican

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24
Q

SNS postganglionic fibres ramus communican

A

not myelinated - grey

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25
Q

sympathetic chain

A

formed from the ganglia joined by bundles of nerves

extend beyond T1-L2 from mid cervical to pelvis

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26
Q

purpose of the sympathetic chain

A

allow preganglionic fibres to run up/down for one or more segments before synapsing
therefore provide innervation to the whole body

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27
Q

Visceral SNS

A

pass to white rami but don’t synapse

instead they synapse closer to the target organ

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28
Q

SNS supplies to heart and lungs

A

reach cardiac and pulmonary plexi and synapse here

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29
Q

where do teh thoracic visceral supplies arise from

A

T3-6

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30
Q

where does the sympathetic supply to the heart arise

A

T2 - 4

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31
Q

PNS

A

have preganglionic neurons

supply ganglia containing larger number of postganglionic cells

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32
Q

difference with PNS and SNS

A

no somatic supply in PNS

the entire supply is from the vagus

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33
Q

vagus nerves

A

also affect head and neck
leave the skull with the internal jugular veins through jugular foramina and run down whole length of neck with internal jugular veins and internal carotid and common carotid arteries - take through the thoracic inlet into superior mediastinum - L and R vagi have different relations

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34
Q

path of the R vagus nerve

A

posterior to SVC, root of R lung
break into plexus surrounding oesophagus
abdomen

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35
Q

path of L vagus nerve

A

cross aortic arch
posterior to lung root - join R vagus
form oesophagael plexus
abdomen

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36
Q

what does the oesophagael plexus supply

A

oesophagus

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37
Q

vagi and heart/lungs

A

vagi contribute branches to pul and cardiac plexi - synapse in small ganglia before reaching their targets

38
Q

sensory visceral fibres in the vagus

A

more numerous than motor fibres

sensory info about CVS, respiratory and alimentary system to vital centres in the brainstem

39
Q

features of the heart

A

anterior, sternocostal face (RA)
inferior/diaphragmatic surface from RV
posterior surface - LA
apex - LA

40
Q

when does the IVC enter teh RA

A

just after entry into the thorax

lower region

41
Q

what is teh coronary sinus

A

a vein that drains the heart - entering the RA close to IVC

42
Q

what is the R auricle

A

ear like extension of the RA

overlaps teh root of pul trunk on R side

43
Q

what is the line of demarcation between RA and RV

A

atrioventricular groove

R coronary artery lies here

44
Q

where does the pul trunk leave the heart

A

RV
passes superiorly adn then L
divide into R and L pul arteries beneath the arch of the aorta

45
Q

where is teh anterior interventricular groove

A

obliquely inferiorly to L from root of pul trunk
separates the surfaces of the ventricles
there is also a coronary artery

46
Q

where does the aorta leave

A

superior aspect of LV

under cover of pul trunk - emerges on its R

47
Q

what is the outward bulge in the aortic wall

A

3 aortic sinuses

accomodate cusps of aortic valve in systole

48
Q

where do the R and L coronary arteries originate from

A

2 of the cusps of the aortic valve

49
Q

path of the R coronary artery

A

in atrioventricular groove
to diaphragmatic border
descends as posterior interventricular artery
marginal artery is a branch of the R coronary artery - along inferior region of the heart

50
Q

path of the L coronary artery

A

atrioventricular groove to division of 2 branches
anterior intrventricular branch - in groove to apex and then to diaphragmatic surface
circumflex branch t L margin and to diaphragmatic surface

51
Q

cardiac veins

A

accompany arteries
tributaries of coronary sinus
great cardiac vein accompanies the anterior interventricular artery
middle cardiac vein running
with the posterior interventricular artery
small cardiac vein accompanies the marginal artery

52
Q

angina pectoris

A

chest pain caused by transient ischaemia from narrowing arteries
MI - occlusion of arteries and necrosis of myocardium

53
Q

what are the fossa ovalis

A

the remnant of foramen ovale

54
Q

why does the RV look different to the L

A

thick muscular projections - papillary muscles which the chordae tendineae are attached

55
Q

describe the cusps in the pul valve

A

nodular thickening at medial edge of each cusp

allow it to close properly on diastole

56
Q

how many pulmonary veins are there

A

4

57
Q

what leads into the aorta

A

smooth walled outflow tract

58
Q

why do teh 4 valves lie in a plane

A

they are in the fibrous plaque that separates the atria from the ventricles

59
Q

where is the aortic arch

A

in the superior mediastinum

60
Q

landmarks of the aortic arch

A

begin and end at 2nd CC

top is midway between jugular notch and sternal angle

61
Q

landmarks of the brachiocephalic trunk

A

from aortic arch superolaterally to R sternoclaviacular joint
here it splits int R subclavian and R common carotid

62
Q

landmarks of the R subclavian artery

A

laterally from R sternoclavicular joint

arch over 1st rib

63
Q

R common carotid artery

A

ascends into neck on R side of trachea under sternocleidomastoid
line from R sternoclavicualr joint to lobe of ear

64
Q

left common carotid artery

A 
from aortic arch 
posterior and L of BC trunk 
line to L sternocavicular joint 
L of trachea 
L of SCM muscle to L ear lobe
65
Q

left subclavian artery

A

from L sternoclavicular joint arching over 1st rib

66
Q

internal jugular veins

A

lateral to common carotid to reach sternoclavcular joints

67
Q

subclavian veins

A

parallel to SC arteries behind sternoclavicualr joints

68
Q

R BC vein

A

from R sternoclavicular joint to inferior border of 1st CC

69
Q

L BC vein

A

L sternoclavicular joint to inferior border of 1st CC

70
Q

SVC

A

R 1st CC to R 3rd CC

behind the r side of the manubrium and sternum to join R atrium

71
Q

what plane are the valves in

A

the atrioventricular plane

from medial end of L 3rd CC to medial 4th ICS

72
Q

landmarks for the valves

A

3rd CC pul
3rd ICS aortic
4th CC mitral
4th ICS tricuspid

73
Q

how do you hear soun from 1 valve

A

stethoscope downstream of given valve

74
Q

auscultation of tricuspid

A

L 5th ICS - sternum
lub
(bell then diaphragm)

75
Q

auscultation of mitral

A

L 5th ICS at mid clavicular line

lub

76
Q

auscultation of pul valve

A

L 2nd ICS - sternum

dub

77
Q

auscultation of aortic

A

R 2nd ICS near sternum

dub

78
Q

info from palpation of arterial pulse

A

1) pulse rate
2) rhythm
3) character
4) volume
5) any delays between major arteries (e.g. radiofemoral delay)

79
Q

how do you plapate

A

pulps of forefinger and middle finger

80
Q

palpation in the common carotid artery

A

in the neck, between the lateral side of thyroid

cartilage and medial border of sternocleidomastoid muscle).

81
Q

palpation in the superficial temporal artery

A

in front of the tragus of the ear. This vessel is a

terminal branch of the external carotid artery).

82
Q

palpation in the subclavian artery

A

in the supraclavicular region, at the angle between

clavicle and sternocleido mastoid muscle.

83
Q

palpation in the axillary artery

A

the medial side of humerus,

posterior to the tendon of short head of biceps

84
Q

palpation of the brachial artery mid arm

A

along middle third of humerus , in the medial

bicipital groove behind the medial border of biceps

85
Q

palpation of teh brachial artery pulse in cubital fossa

A

on the medial side of tendon of biceps on a fully

extended elbow)

86
Q

palpation of radial artery

A

at the wrist over the distal end of radius)

87
Q

palpation of teh femoral artery

A

the midinguinal point,

88
Q

palpation of teh popliteal artery

A

inferior part of the popliteal fossa, against the

posterior surface of tibia

89
Q

palpation of the posterior tibial artery

A

behind medial malleolus-bony prominence on the medial side of
ankle joint

90
Q

palpation of the dorsalis pedis artery

A

dorsum of the foot, lateral to extensor hallucis longus

tendon -tendon of the big toe

anatomy of the thorax (14 decks)

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