Questions Flashcards
How is the first rib different from the others?
atypical because it is wide and short, has two costal grooves, and one articular facet
most tightly curved and broadest
• Upper border lies in plane 30° from horizontal
• Flat upper surface slopes down
Which rib articulates with the sternum at the sternal angle
2nd rib
Which ribs articulate with the sternum
Ribs 1-10
How many pairs of ribs are there?
12
What type of tissue connects the anterior end of each rib to the sternum?
Costal cartilage
Which ribs are true ribs and why?
Ribs 1-6 as each rib is attached to sternum by individual costal cartilage
Which ribs are false ribs and why
Ribs 7-10 as costal cartilage joins together to form costal arch
Which are floating ribs and why
Ribs 11 and 12 as not connected to sternum by costal cartilage
Posteriorly, what do the ribs articulate with?
thoracic vertebrae at costovertebral joints
What lies in the intercostal spaces
External/internal/innermost intercostal muscles
Neurovascular bundle - along the inferior border of the rib superior to the space in a shallow costal groove on deep surface of rib
How many thoracic vertebrae are there
12
How can we distinguish thoracic vertebrae from cervical and lumbar vertebrae?
Larger than cervical, heart-shaped, bears 2 costal facets
Spinous process = Long, sharp and projects inferiorly
Vertebral foramen = circular (not triangular)
What are the joints between the vertebrae and ribs called?
Costovertebral joints
how many vertebral bodies does a typical rib articulate with?
2
what lies between adjacent vertebral bodies? What is the function of these structures?
The bodies of adjacent vertebrae are separated and united by an intervertebral disc, which provides padding and allows for movements between adjacent vertebrae. The disc consists of a fibrous outer layer called the anulus fibrosus and a gel-like center called the nucleus pulposus.
Which bones form the boundaries of the superior thoracic aperture
Ribs 1, T1, manubrium of sternum,
How does the diaphragm move when it contracts during inspiration
How does this movement change the intrathoracic volume?
The diaphragm contracts and moves down/flattens
This increases the intrathoracic volume and decreases the pressure
How does the diaphragm move during expiration, when it relaxes? How does this movement change the intrathoracic volume?
The diaphragm relaxes and moves up, decreasing the intrathoracic volume and increasing the pressure
Which nerves innervate the diaphragm, and which spinal nerves form them?
The phrenic nerves which originate from C3, C4, C5
What three structures comprise the intercostal neurovascular bundle in each space?
Intercostal arteries/veins and intercostal nerves
What structures enter and exit the lungs on the mediastinal surface?
Hilum- bronchus, pulmonary artery, two pulmonary veins, bronchial vessels, pulmonary plexus of nerves and lymphatic vessels
What do the segmental bronchi supply?
What is clinically important about the regions supplied by segmental bronchi?
The 10 different bronchopulmonary segments of each lung
Because they are supplied by their own segmental bronchus and blood vessels, a segment may be resected (surgically removed) without affecting the rest of the lung.
What are the tubes beyond the segmental bronchi called?
Terminal bronchioles -> respiratory bronchioles
Which parts of the bronchial tree contain cartilage
Trachea, primary/lobar/segmental bronchi
Which parts of the bronchial tree contain smooth muscle
All parts
Which nerves control the contraction and relaxation of smooth muscle?
Autonomic nerve fibres- sympathetic and parasympathetic pathways
How many pulmonary arteries and veins enter / exit at the hilum?
1 pulmonary artery
2 pulmonary veins
Why might a bronchoscopy be performed?
Common reasons for needing bronchoscopy are a persistent cough, infection or something unusual seen on a chest X-ray or other test. Bronchoscopy can also be used to obtain samples of mucus or tissue, to remove foreign bodies or other blockages from the airways or lungs, or to provide treatment for lung problems
Which layers of tissue do the surgeons have to penetrate to reach the thoracic cavity?
Skin
Superficial fascia
Serratus anterior muscle
What is normally located in the space between the lungs and the parietal pleura?
A small amount of pleural fluid
Why might a CT scan be more useful than a plain chest x-ray?
enables a three-dimensional insight into the body, giving a more accurate and detailed presentation of the area of interest.
Fast
Not expensive
In a CT image, overlapping structures are eliminated, making the internal anatomy more apparent
Disadvantages of a CT scan
Concerns about CT scans include the risks from exposure to ionizing radiation and possible reactions to the intravenous contrast agent, or dye, which may be used to improve visualization
What imaginary line separates the superior mediastinum from the inferior mediastinum?
The sternal angle (from rib 2 level of T4)
Brachiocephalic trunk – what happens to this vessel?
Branches into right common carotid artery and right subclavian artery
Left common carotid artery – what does it supply?
The head and neck
Bifurcates at carotid sinus into internal and external carotid artery
Left subclavian artery – what does it supply?
The left upper limb
Which chambers form the: base/posterior surface
Left atrium, part of right atrium
Which chambers form the: inferior/diaphragmatic surface
Left ventricle, part of right ventricle
Which chambers form the: anterior/ sternocostal surface
Tight ventricle
Which chambers form the: left pulmonary surface
Left ventricle
Which chambers form the: right pulmonary surface
Right atrium
right border - which chamber forms it?
Right atrium
left border - which chamber forms it?
Left atrium
inferior border - which chambers form it?
Right ventricle and part of left ventricle
Which blood vessels return blood to the right atrium?
Superior and inferior vena cava
What is the role of the foramen ovale in utero?
allows blood flow to bypass the lungs (a fetus gets the oxygen it needs from the placenta, not the lungs). That way, the heart doesn’t work hard to pump blood where it isn’t needed
What structures do the chordae tendineae connect to each other?
Papillary muscles and atrioventricular valves
Which vessel leaves the right ventricle?
Pulmonary artery
Which vessels return blood to the left atrium?
Pulmonary veins
Which vessel leaves the left ventricle?
Aorta
Why is the wall of the left ventricle thicker than that of the right ventricle?
It must generate a greater pressure in order to pump blood around the body- muscle contraction must be stronger
What role do the cords and papillary muscles play in the opening and closing of the AV valves?
functionally prevent regurgitation of ventricular blood via tensile strength by preventing prolapse or inversion of the valves during systole
Why might a patient need a coronary angioplasty?
treatment used to widen and open up narrowed or blocked arteries supplying your heart muscle. During angioplasty and stenting, the narrowed artery is stretched open with a balloon (angioplasty), and a metal strut (stent) is implanted into the coronary artery.
cervical vertebrae - how are they specially adapted for the neck? What features distinguish them from the thoracic and lumbar vertebrae?
small size, transverse foramina, saddle-shaped body, and bifid spinous process
small and articulate with each other at facet joints orientated obliquely (allows for good range of flexion and extension in cervical spine compared to thoracic spine)
What movements occur at the joints between the cervical vertebrae?
Flexion
Extension
Lateral flexion
Rotation
Which blood vessels are protected by the transverse foramina? What do these blood vessels supply?
Vertebral arteries - supply blood to brain (posteriorly) and spinal cord
Which two groups of muscles in the anterior neck move the larynx up and down as a whole during speech and swallowing?
Suprahyoid and infrahyoid muscles
Which muscle separates the anterior and posterior triangles from each other?
Sternocleidomastoid muscle
What is the function of sternocleidomastoid if it acts alone, or together with the same muscle on the other side?
allows you to bend your neck and turn or tilt your head
Which cranial nerve innervates the sternocleidomastoid
Accessory nerve
What structures form the anterior, posterior and superior boundaries of the anterior triangle?
anteriorly (midline of neck), posteriorly (anterior border of sternocleidomastoid), superiorly (lower border of mandible)
What structures form the anterior, posterior and inferior boundaries of the posterior triangle?
anteriorly (posterior border of sternocleidomastoid), posteriorly (anterior border of trapezius), inferiorly (clavicle), superiorly (apex formed by sternocleidomastoid and trapezius)
Name at least five structures in the anterior triangle of the neck.
• the trachea and larynx
• the thyroid gland, parathyroid glands, and the submandibular salivary gland
• the suprahyoid muscles which connect the hyoid to the skull- form the floor of the mouth and move the hyoid and larynx in speech and swallowing.
• the infrahyoid muscles (‘strap’ muscles)- they connect the hyoid to the sternum and scapula. They move the hyoid and larynx in speech and swallowing.
• the common carotid artery and its terminal branches (the external and internal carotid arteries)
• branches of the external carotid artery to the head and neck
• the internal jugular vein
• branches of the facial nerve (CN VII), the glossopharyngeal nerve (CN IX), the vagus nerve (CN X), the accessory nerve (CN XI) and the hypoglossal nerve (CN XII).
• the ansa cervicalis (fibres from C1-C3 which innervate the infrahyoid muscles).
Name at least three structures in the posterior triangle of the neck.
• muscles that move the head
• part of the subclavian artery and the subclavian vein
• the external jugular vein which drains the scalp and face
• the accessory nerve (CN XI)
• the roots of the brachial plexus (spinal nerves that supply the upper limb)
• the cervical plexus (fibres from C1-4)
• the phrenic nerve.
What does the internal carotid artery supply
Brain
What does the external carotid artery supply
Branches to supply parts of face and neck
subclavian artery - what does it supply?
Upper limb
internal jugular vein - where does it drain blood from?
Brain, superficial regions of the face, and neck
What does the external jugular vein drain
blood from the scalp and face to the subclavian vein.
accessory nerve (CN XI) - what type of fibres does it contain, and what does it supply?
Supplies sternocleidomastoid and trapezius muscles
Contains somatic motor fibres
The vagus nerve (CN X) - vital for normal speech and swallowing. In the neck, which two large blood vessels does it descend alongside?
Internal carotid artery and internal jugular vein
The hypoglossal nerve (CN XII) - it does not supply any structures in the neck but travels through it. What type of fibres does it contain, and what does it supply?
Tongue
Somatic motor fibres
Which blood vessel gives rise to the left and right superior thyroid arteries?
External carotid arteries
Which blood vessel gives rise to the left and right inferior thyroid arteries?
Thyrocervical trunk
What is an aortic dissection? How might a patient with an aortic dissection present?
When there is a tear in the wall of the aorta so blood flows between the intima and media layers
Typical signs and symptoms include: Sudden severe chest or upper back pain, often described as a tearing or ripping sensation, that spreads to the neck or down the back. Sudden severe stomach pains
What is atherosclerosis
Formation of a plaque, which can occlude an artery
Tachycardia
Fast heart rate
Arrhythmia
Irregular heart rate
Bradycardia
Slow heart rate
What imaging modality could be used to assess for the presence of plaque, stenosis and reduced blood flow through the carotid arteries?
carotid ultrasound, CT angiography (CTA), magnetic resonance angiography (MRA), or cerebral angiography to determine the presence, location, and severity of stenosis.
intercostal neurovascular bundle(s)- What feature of the rib protects this bundle?
Costal groove
Where do the posterior intercostal arteries originate from?
branches of the supreme intercostal artery (1st and 2nd) and thoracic aorta.
Number of posterior intercostal arteries
11
Number of anterior intercostal arteries
9
Where do anterior intercostal arteries originate from
internal thoracic artery and its terminal branch - the musculophrenic artery
Which system of veins do the posterior intercostal veins drain into? Which larger vein do these veins join?
drain into the azygos vein (right side), and hemiazygos and accessory hemiazygos veins (left side). The latter two veins ultimately drain into the azygos vein. The azygos vein then drains into the superior vena cava.
What is the extent of the sympathetic trunk? Do they only lie alongside the thoracic vertebrae?
Skull base to coccyx
Which structure separates the oropharynx from the nasopharynx?
Soft palate
Which nerve innervates the muscles of the soft palate
Pharyngeal branch of vagus nerve
Which structure separates the oropharynx from the laryngopharynx?
Epiglottis
Which nerve innervates the pharyngeal constrictors (i.e. motor innervation)?
Vagus nerve
Which nerve innervates the internal pharynx (i.e. sensory innervation)?
Glossopharyngeal nerve
What is the purpose of the gag reflex?
To prevent aspiration of food/liquid
If a patient doesn’t have a gag reflex, what are they at risk of?
Chocking
Aspiration pneumonia
What conditions may cause a patient to have an ‘unsafe swallow’?
Stroke
Cerebral palsy
Parkinson’s disease
What can be done to help these patients swallow safely?
SALT (speech and language therapy)
Adding thickeners to food
NG tube
Advice on taking smaller bites, chewing food more thoroughly etc
what is the function of the epiglottis?
To prevent food entering the trachea when swallowing
Why are the arytenoids vital for phonation?
Arytenoids connect to vocal cords via the posterior and lateral cricoarytenoid muscles
Abduction cause the rims glottidis to open
Adduction cause the rims glottidis to close (vital for speech)
What structures inside the thyroid cartilage do arytenoids attach to?
Thyroid cartilage
Cricoid cartilage
Vocal ligaments
What are the vocal ligaments attached to anteriorly and posteriorly?
Anteriorly - laryngeal prominence
Posteriorly- arytenoid cartilage
What happens to the rima glottidis when the vocal cords are adducted
It closes
What happens to the rima glottidis when the vocal cords are abducted
It opens
What position do the cords need to be in for phonation (production of sound)?
Rima glottidis closed
Care must be taken to avoid damage to which structures when using the laryngoscope?
Teeth
Vocal cords
Where is the tip of the laryngoscope placed?
curved laryngoscope tip is placed in the vallecula, exerting upward and forward force on the hyoepiglottic ligament to elevate the epiglottis
How can the anaesthetist be sure that the tube is in the trachea, and not the oesophagus? What is the most reliable sign that the tube is in the trachea?
Equal inflation of the lungs (seen through looking and auscultation of chest)
What symptoms or signs might a patient present with that would warrant direct visualisation of the larynx and vocal cords?
Chronic cough.
Chronic throat pain.
Dysphagia.
Dysphonia.
Foreign body in the throat.
Hoarseness or change in voice.
Odynophagia (painful swallowing)
Sensation of a lump in the throat.
Does a cricothyroidotomy occur above or below the vocal cords?
Below in cricothyroid membrane
cricothyroidotomy which structures are at risk of damage during this procedure?
Hemorrhage, esophageal injury, recurrent laryngeal nerve injury, pneumothorax, hemothorax, false passage of the tube and tracheal stenosis
Where is carotid pulse best palpated
just anterior to sternocleidomastoid at the level of the thyroid cartilage.
What is the function of the paranasal sinuses
To filter, warm and humidify inspired air
What is the hard palate composed of?
Bone
The palatine bone of the maxilla bone and the horizontal plate of the palatine bone
○ horizontal suture between the palatine bone and the horizontal plate
○ sagittal suture between the bones on the left and right
What separates the nasal cavity and nasopharynx from the oral cavity?
The palate (composed of anteriorly hard palate and posterior lay the soft palate)
What is the function of the hard palate?
The tongue presses against the hard palate when swallowing
To create certain sounds when talking
What is the soft palate composed of
Muscle
Function of the soft palate
To prevent fluid or food entering the nasopharynx when swallowing
Which nerves innervate the muscles of the soft palate
Vagus nerve (CN X)
What does the oral cavity contain
Teeth
Gums
Tongue
Opening of salivary ducts
Where does the posterior part (the root of the tongue) lie?
Oropharynx
Function of epiglottis
To close off the trachea during swallowing and prevent aspiration of food
Function of intrinsic tongue muscles
Change shape of tongue
Function of extrinsic tongue muscles
Move tongues as a whole
Which nerve innervates the muscles of the tongue
Hypoglossal nerve
Which nerve supplies taste in the anterior 2/3 of tongue
Facial nerve (CN VII)
Which nerve supplies general sensation in anterior 2/3 of tongue
Trigeminal nerve (CN V)
Which nerve supplies taste and general sensation in posterior 1/3 of tongue
Glossopharyngeal nerve
What type of fibres stimulate secretion from the salivary glands?
Parasympathetic
Parasympathetic fibres in which nerve stimulate secretion from the parotid glands?
Glossopharyngeal nerve
Parasympathetic fibres in which nerve stimulate secretion from the submandibular glands?
Facial nerve
What happens to inspired air as it travels through the meatuses? How does the mucous membrane covering facilitate this?
The air is warmed, humidified and filtered
The cilia, along with mucus produced by seromucous and other glands in the membrane, trap unwanted particles.
What is the function of the auditory tube?
equalize air pressure between the atmosphere and the middle ear
Which larger artery is the maxillary artery a branch of?
External carotid artery
Which cranial nerve supplies the sensory innervation to the nose?
Trigeminal nerve
What separates the left and right nasal cavities from each other?
Midline nasal septum
What separates the left and right nasal cavities from oral cavity?
Hard and soft palate
What separates the left and right nasal cavities from brain?
Cribriform plate
What do you think passes through the cribriform plate, from the nasal cavity to the brain?
Olfactory nerves
How should the nasal tampon be inserted into the nostril - in which direction should it be directed?
Horizontally to avoid damaging the cribriform plate
Inflating the nasal tampon is important for halting the bleeding - why?
It applies pressure to the burst capillaries
How could you check that the tip of the NG tube is in a patient’s stomach?
Take an aspiration and test pH
If in stomach it should be acidic
