Respiratory and CNS Flashcards
Nose, nasal cavities, sinuses, pharynx and larynx (down to vocal cords)
Upper respiratory tract
Larynx (below the vocal cords), trachea, bronchi, bronchioles, alveoli
Lower respiratory tract
Trachea, bronchi, bronchioles and alveoli
Tracheobronchial tree
Point of attachement to forehead
Root of nose
tip of nose
Apex
Project from face and meeting in midline to dorsum of nose
Lateral walls DELETE
connects root to apex
Dorsum nasi
nostrils
external nares
Upper part of dorsum nasi supported by nasal bones
bridge
shape of external nose is determined by what?
Skeleton of external nose
bones that form the bridge of the nose
Nasal bones
DELETE
Form much of the dorsum and lateral aspect of nose, continuous with nasal bones
lateral nasal cartilages
Bilateal, having lateral and medial crus which holds the nares open and give shape to tip of nose.
Greater alar cartilages
Usually several small bones posterior to greater alar cartilage.
Lesser alar cartilages
Unpaired midline cartilage, helps divide nasal cavity into 2 halves (fossae)
Septal cartilage
What forms the cartilaginous septum?
Nasal bones, lateral nasal cartilages, greater alar cartilages, lesser alar cartilages, septal cartilage
Extends from external nares to choanea (internal/posterior nares)
Nasal cavity
_______ are openings into nasopharynx (at posterior edge of hard palate and vomer)
Choanae
Internally, corresponds to alae; contains sweat, sebaceous glands and hairs.
Vestibule
Each nasal fossa consists of:
Floor
Medial wall
Roof
Lateral nasal wall
Hard palate (maxillae + palatine bones) - part of nasal fossa
Floor of nasal fossa
septal cartilage, perpendicular plate of ethmoid, vomer, nasal crest of maxillae and palatine bones. Part of nasal fossa
Medial wall
nasal bone, frontal bone, cribiform plate, body of sphenoid - part of nasal fossa
Roof
Limen nasi, agger nasi, olfactory sulcus, conchae are all part of what?
Lateral nasal wall
Ridge formed by lower edge of lateral nasal cartilages. Separates vestibule from rest of nasal fossae. Marks transition of epithelial types.
Limen nasi
Midway between anterior end of middle concha and dorsum of nose.
Marks site of anterior ethmoid air cells
Agger nasi
Slight groove above agger nasi. Leads to olfactory area (mucosa) on roof of nasal cavity
Olfactory sulcus
Usually 3 (or 4) scroll - like elevations covered by mucous membrane
Inferior, middle, superior and supreme portions.
Chonchae (turbinates)
Inferior nasal conchae
Largest, separate bone!!
Supreme nasal conchae
inconsistent (-60%), part of ethmoid
IF present
what is the function of middle, superior and supreme nasal conchae?
Circulate
Filter heavy particulates
Moisturize air
Heat up air
Kiesselbach’s plexus
Along midline - behind Limen Nasi
Blood supply
Reason why epistaxis (Nose bleeds) flow is so heavy
Interval between lateral nasal wall and each conchae –> not enclosed
Meatuses
Receives ostium of nasolacrimal duct
Inferior meatus –> Why nose runs while you’re crying
Receives ostia of posterior ethmoid cells
Superior meatus of the lateral nasal walls
What is the blood supply to the nose?
Mainly sphenopalatine artery
Minor supply via nasal branches of superior labial artery
ethmoidal branches of opthamic artery
Greater palatine branches of maxillary artery
Drains via frontonasal duct and ethmoid infundibulum into middle meatus
Frontal paranasal sinus
Drains via small ducts into middle and superior meatuses
Ethmoidal paranasal sinuses
Drains into sphenoethmoidal recess
Sphenoid paranasal sinus
Drains directly or via infundibulum into middle meatus
Maxillary paranasal sinus
What is the function of the Paranasal sinuses?
Reduce weight of skull, modify voice, secrete mucus to protect mucosa and cool the brain.
NI: sensory – and sinus pain/headaches are related to what CN?
CN5
NI: motor – Secretions are related to what CN?
CN7
Extends from internal nares (choanae) to free edge of soft palate
Nasopharynx
Contains pharyngeal muscles & ostia of auditory tubes
Lateral walls of Nasopharynx
Where is the Torus Tubarius located and what clinical significance does it have?
Located on Posterior lip of ostium
Influence by dragging finger down oropharynx for ear to drain
Nasopharynx(/Roof of nasopharynx?) may contribute to what?
Sleep apnia
When the Pharyngeal tonsils become hypertrophied, what do they become and what causes the hypertropy?
They become “Adenoids” because of increased alcohol consumption and allergins
What passes through superior and posterior mediastinae?
Trachea “wind pipe”
What v-body level does the trachea split into R and L primary bronchi at the sternal angle?
T4/T5 disc level
Modified tracheal ring supporting bifurcation
Carina
Arch of aorta pushes tracheal bifurcation slightly to Right as it ____________
Loops over Left primary bronchi
Primary bronchi enter the lungs at the _____
Hilus
Potential space between parietal pleura and visceral (pulmonary pleura. Contains pleural fluid
Pleural cavity
Reflections of parietal which provide for expansion of lungs during expiration
Pleural recesses
Circumferential in angle between thoracic wall and diaphragm.
Costodiaphragmatic
Vertical, posterior to sternum, between thoracic wall and mediastinum
Costomediastinal
Located between hilus and root of lung. Represents reflection of mediastinal parietal pleura into lungs. Its really just a reflection of fascia and not ligamentous
Pulmonary ligament
Superior part projects through thoracic inlet. 1” above clavicle
Apex of lung
Partial pleura extending over apex of lung
Cupula
Lies on diaphragm
Base of lung
inhalation causes the ______ to fill the _____ almost completely
Apex
Cupula
How many fissures are on the lobes?
(2) oblique fissures
(1) horizontal fissure
Extension of right superior lobe, Homologous to the middle lobe of right lung.
Lingula
What land marks on the Left lobe are different from the Right lobe?
Left lobe has a groove for the aortic arch and groove for the descending aorta
In the roof of the lung, what structures pass through the hilus, but not the hilus itself?
Bronchi and pulmonary artery, vein, nerves and lymphatics
Portion of lungs supplied with air from tertiary bronchus and subsequent branches. R=10 L=8-10
Bronchopulmonary segment
Point of insertion for various peripheral mm (QL and Psoas major)
Tendinous portion
Hiatus for IVC; terminal branches of R phrenic n
T8
Esophageal hiatus; R and L vagus nerve (CN10)
T10
Aortic hiatus; thoracic duct, azygos vein
T12
Lumbar portion - lateral arcuate ligament
Over QL
Lumbar portion - Medial arcuate ligament
Over posas major
Anterior and mainly posterior to root of lung
Pulmonary plexuses
Synapse w/ Parasymp ganglion cells in pulmonary plexuses and in bronchial tree.
Motor to smooth muscles bronchoconstrictors, vasodilators of vessels and secretomotor
Parasympathetic presynaptic fibers from CN10
Inhibit bronchial smooth muscles - bronchodilator, vasoconstrictor and inhibit alveolar glands
Sympathetic post synaptic fibers from sympathetic trunk
Muscles/structures involved in quiet breathing
Diaphragm, internal intercostals, elastic recoil
Muscles involved in active/labored inspirtation
Scalenes, SCM, external intercostals
Serratus anterior, pec minor
Traps, levator scapulae, lat dorsi
Erector spinae group, QL, serratus posterior superior
Muscles involved in expiration
Serratus posterior inferior
Abdominal muscles, pyramidalis
Lower traps, lat dorsi
In the midline of anterior aspect of neck between C4 and 6
Larynx
Superficially seen - larger, more prominent in males due to effects of testosterone secretions making for a lower voice.
Laryngeal prominence (adam’s apple) on the larynx.
Production of sound/phonation
Coming from larynx
Larynx + Tongue + Pharynx + Jaw + Face muscles = __________
Speech
Thyroid cartilage has what two points superiorly and inferiorly?
Superior Cornu and Inferior cornu
The Cornu articulate with what superiorly and inferiorly?
Superiorly articulate with hyoid bone
Inferiorly articulate with cricoid cartilage
Gap between superior border and hyoid bone by _____________
Thyrohyoid membrane
What are the major cartilages (hyaline) that are the skeleton of the larynx
Thyroid cartilage
Cricoid cartilage
Arytenoid cartilage (2)
Epiglottic cartilage
Unpaired, ring-shaped, directly inferior to thyroid cartilage - anterior arch and broad posterior lamina
Cricoid cartilage
Paired, small, situated atop superior edge of lamina of cricoid - Pyramid shaped with prominent vocal and muscular processes
(2) Arytenoid cartilage
Unpaired and leaf shaped. Forms anterior wall of laryngeal aditus. Attached by ligaments to hyoid and thyroid cartilages.
Epiglottic cartilage (epiglottis)
What are the 2 minor laryngeal cartilages?
Corniculate cartilages and cuneiform cartilages
Paired small, cone shaped. Atop apices of arytenoid cartilages
Corniculate cartilages
Paired, small, upper edge of quadrangular membrane anterior to corniculate cartilage.
Cuneform cartilage
Extends from sides of epiglottic cartilage to corniculate and arytenoid cartilage.
Quadrangular membrane
Well-developed sheet which arises from the upper border of arch of cricoid cartilage and extends upward and medially. Upper edges of both sheets are thickened to form vocal ligaments. –> Sound production
Conus elasticus
Common site of bits of food getting stuck, especially fish bones
Piriform recess
Mucosa of piriform recess is reflected over lateral and medial sides of quadrangular membrane. The reflection of mucosa over upper edge of the quad membrane creates _________________________
Aryepiglottic fold
Mucosal lining continues down medial surface of quad membrane and at lower free edge of membrane is reflected laterally. This creates ______________
creates the vestibular fold/false vocal cord
Lateral reflection of mucosa from vestibular fold creates a small lateral recess, ventricle of larynx. Inferior leaf of this reflection continues over free edges of the vocal ligament to form the __________________
true vocal folds (vocal cords)
space forms entrance to larynx. Bounded anteriorly by epiglottis, laterally by aryepiglottic folds, posteriorly by corniculate tubercles and arytenoideus muscle
Aditus
Cavity between medial surfaces of two quadrangular membranes
Vestibule
Space between vestibular folds
Rima vestibuli
Small lateral recess
Ventricle
Space between true vocal cords
Rima glottidis
From vocal cords to inferior border of cricoid cartilage
Subglottic cavity
Pulls thyroid cartialge anteroinferiorly toward arch of the cricoid vocal cord
Cricoidthyroid
Rotates arytenoid cartilage laterally (only muscle that abducts vocal cords)
Posterior cricoarytenoid
Antagonist of posterior cricoarytenoid, rotates arytenoid medially (adducting vocal cord)
Lateral cricoarytenoid
Extends transversely between posterior surface of arytenoid cartilages - approximates arytenoid cartilage.
Transverse arytenoid
Pulls arytenoid cartilage anteriorly. Lowers pitch
Thyroarytenoid
Adducts and tenses vocal cords. Increases pitch
Vocalis
What are the nerves to the Larynx?
Recurrent laryngeal N which is a branch off of Vagus nerve
External branch of superior laryngeal nerve of vagus
Cricothyroid Nerve (motor)
Internal branch of superior laryngeal nerve of vagus
Sensory from mucosa ABOVE vocal cords
Nerve giving sensory input from mucosa below vocal cords
Recurrent laryngeal nerve of vagus
Superior laryngeal branch of superior thyroid A and V.
Upper half of larynx A and V
Inferior laryngeal branch of inferior thyroid A and V.
Lower half of larynx A and V
Projects superiorly and laterally to the junction and middle 1/3 and inferior 1/3 of thyroid cartilage
Lateral lobes: apex of thyroid gland
Metabolism, homeostasis - Calcitonin secretions (reduces blood calcium)
Thyroid gland - T3/T4 hormone
Where is the base of the thyroid gland located?
5th and 6th tracheal ring
Deep to SCM, superior belly of omohyoid, sternohyoid, sternothyroid, pretracheal cartilage (forms capsule around thyroid)
Lateral surface of thyroid
Overlaps common carotid artery and parathyroid glands
Posterior border of thyroid gland
Connects lower 1/3 of lateral lobes - covers 2nd and 3rd tracheal ring
Isthmus of thyroid gland
40% of population - Arises from upper part of isthmus or from lateral part (mostly left) - May extend from hyoid - Has accessory thyroid tissue, some times present near lateral lobes of isthmus.
Pyramidal lobe of thyroid gland
What arteries supply the thyroid gland?
Superior thyroid artery (br from external carotid)
Inferior thyroid artery (br of thyrocervical trunk of 1st subclavian)
Thyroidea ima
What is the venous supply to the thyroid gland?
Superior thyroid vein drains into Internal jugular
Middle thyroid vein drains into internal jugular
Inferior thyroid vein drains into BCV
Sometimes attached to the body of hyoid and isthmus or pyramidal lobe. - Derived from embryonic remnants of cricothyroid, sternohyoid, thyrohyoid of inferior pharyngeal constrictors.
Levator muscle of thyroid gland
Excess T3/T4 secreted - Weight loss, increased appetite, insomnia, tremor, palpitations, loss of heat regulation. What condition is this?
Hyperthyroidism
Weight gain, tiredness, heavy menstrual bleeding, hair loss, cold intolerance
Hypothyroidism
2-4% of population - usually asymptomatic
Nodes
Iodine deficiency, Hashimoto’s thyroiditis, Disease
Swelling (goiter)
Low blood serum calcium causes the release of what hormone?
PTH
What hormone causes bone resorption and increases in serum Ca++ levels
PTH
85% of brain mass
Cerebrum (telencephalon)
Cerebral cortex has what fissures and hemispheres in it?
(Medial) longitudinal fissure
L and R cerebral hemispheres
What landmarks are involved in grey matter
Sulci and Gyri
What grooves increase surface area/ we develop more as we learn subconsciously
Sulci
What is in the white matter of the brain
Ascending sensory tracts - Principal of divergence
Primary motor cortex, socially acceptable, consequence, personality, language and numeracy tests, smell.
Motor speech (Broca’s area) (Brodmann area 44-45)
L and R fissure – Precentral gyrus
What lobe of the brain is this?
Frontal (motor) lobe
Sensory (2-point touch, manipulation of numbers, self transcendence, predisposition of spirituality, spacial orientation).
Central sulcus – Postcentral gyrus
What lobe of the brain is this?
Parietal (sensory) lobe
Language, emotional association, visual memories.
Lateral sulcus/fissure
Superior, middle, inferior temporal gyri
What lobe of the brain is this?
Temporal lobe
Primary visual cortex (area 17, V1) –> Lights, color, distance, depth, recognizing structures, movements, relationships
visual association (area 18,19)
Parieto-occipital fissure
What lobe of the brain is this?
Occipital
Consciousness, homeostasis, motor control, perceptual self-awareness, cognitive functioning, psychopathology, transmission of pain.
Interoception, multimodal sensory processing, autonomic control, emotional guidance of social behavior.
Taste - Distinct taste - Flavor effect modifier
Insula lobe of the brain
Part of limbic system (emotion), emotion formation and processing, memory, love, linking motivation and learning
Superior to corpus collosum
Cingulate Gyrus
Limbic system, consolidating short term to long term memory, special memory/navigation, ANS (probably)
Hippocampus
C-shaped extrapyramidal motor nucleus
-located in the wall of the lateral ventricle
Caudate Nucleus
Wedge-shaped extrapyramidal motor nucleus
- Composed of two distinctly different nuclei
Lenticular (lentiform) Nucleus
Pea-shaped structure, located in the temporal lobe - associated with the olfactory and limbic system
Amygdaloid Nucleus (body)
Voluntary motor control, habit formation, eye movements, cognition, emotion
Cerebrum (telencephalon)
Connecting cortices within the same hemisphere
When doing an action for the first time
Association fibers
Connecting cortices in opposite hemispheres
- example: corpus callosum
Commissural fibers
Connecting the cortex with subcortical areas
- example: internal capsule
- Ascending or descending
Projection fibers
Projection fibers - includes corticospinal and thalamocortical fibers
-internal boundaries of lenticular nucleus
Internal capsule
Major commissure
Corpus Callosum
Fiber tract from (and some to) the hippocampus to the mammillary nucleus (part of the limbic system)
-Between hippocampus and Hypothalamus
-Probably long term recall
Fornix
A large collection of nuclei which projects (relay) to the cerebral cortex including the:
Middle, lateral geniculate and ventral posterior.
Thalamus
Involved in the auditory pathway
Medial geniculate
Involved in the visual pathway - termination of the optic tract
Lateral geniculate
Involved in the general sensory pathway
Ventral posterior
Collection of nuclei located anterior and inferior to the thalamus
-Influences the autonomic and endocrine systems
-Includes the mamillary nucleus, part of the limbic system
-Includes the infundibulum, a downward growth forming the neurohypophysis
Hypothalamus
Region above and posterior to the thalamus
-Part of the limbic system
-Contains the pineal gland - Melatonin
Epithalamus
In the midline
Third Ventricle
AKA: Paleomammalian cortex
Memory, emotion, long-term memory, motivation, olfaction
Components from telencephalon diencephalon with input from all over
Limbic system
Portion dorsal to the cerebral aqueduct
Tectum (roof)
Portion ventral to the cerebral aqueduct
Cerebral peduncle
Posterior to substantia nigra
-Extrapyramidal motor nucleus; Dopamine, PD
Tegmentum
Extrapyramidal motor; nucleus
Red Nucleus
Anterior to substantia nigra
-Contains corticospinal tract
-Cerebral cortex to LMN
Basal peduncle
In the tectum. More specifically, the corpora quadrigemina are composed of: Super colliculi and Inferior colliculi
Form most of tectum
Corpora quadrigemenia
Cranial nerves emerging = III oculomotor, IV trochlear (posterior)
Midbrain (mesencephalon)
Fibers connecting the midbrain
Superior cerebellar peduncle
What is the contents of the midbrain?
Corpora Quadrigemina
Cranial nerves (3 and 4)
Superior cerebellar peduncle
cerebral aqueduct
The Pons is divided into what 2 parts?
Dorsal pons/tegmentum and Basal Pons
Posterior portion - forms the floor of the 4th ventricle - contains nuclei and tracts.
Dorsal pons/tegmentum
Ventral, bulbous portion
-Contains neurons whose axons cross to the opposite side and enter the cerebellum providing a connection between the cerebellum and the contralateral cerebrum
-These fibers connecting the pons and cerebellum form the middle cerebellar peduncle.
Basal pons
What Cranial nerves are emerging from the Pons/in the tegmentum?
V - Trigeminal (part)
VI - Abducens
VII - Fascial
VIII - Vestibulocochlear (part)
Lateral to pyramids. Produced by the inferior olivary nucleus which projects fibers to the cerebellum - Ventrolateral sulcus
Olive –> in the medulla (myelencephalon)
(dorsal, medial) Contains ascending ipsilateral sensory fibers (vibration, discriminating touch) from T6 and below
Fasciculus Gracilis
Contains ascending ipsilateral sensory fibers (proprioception, vibration, discriminating touch) From T6 and above
Fasciculus cuneatus
What cranial nerves emerge from the Medulla(myelencephalon)?
IX - Glossopharyngeal
X-Vagus
XI - Spinal accessory (cranial portion)
XII - Hypoglossal
Fibers connecting the medulla and cerebellum
Inferior cerebellar peduncle
The caudal portion with the central canal
Closed medulla region
The rostral portion with the 4th ventricle
Open medulla region
Medulla cranial nerve nuclei
V - trigeminal (part)
VIII - vestibulochchlear (part)
IX - Glossopharyngeal
X - vagus
XI - spinal accessory (cranial portion)
XII - Hypoglossal
Nucleus ambiguous - speech and swallowing
Motor control, equilibrium, adjusting muscle tone, influences synergy of muscle movement, fine motor movement
Attention
Language
Fear
Cerebellum
10% of volume, 50% of neurons
A large extrapyramidal motor center
Location = posterior cranial fossa
Cerebellum (metencephalon)
Cortex of the nerve cell bodies, parallel ridges - medullary white composed of white matter (arbor vitae)
Organization of cerebellum
3 groups of fibers connecting brainstem and cerebellum. What are they?
Superior, middle and inferior cerebellar peduncle
Fibers connecting MIDBRAIN and CEREBELLUM
Superior cerebellar peduncle
Fibers connecting PONS and CEREBELLUM
Middle cerebellar peduncle
Fibers connecting the MEDULLA and CEREBELLUM
Inferior cerebellar peduncle
Delicate vascular tissue lying on the surface of the CNS
Pia mater
External to the Pia mater - separated from the Pia by the subarachnoid space but connected to the pia by delicate strands of connective tissue
Arachnoid mater
Between the pia and arachnoid - contains cerebrospinal fluid
Subarachnoid space
The outermost layer - composed of very dense connective tissue - the dura covering the brain adheres to the skull and has osteogenic capabilities
Dura mater
Blood spaces within the dura overlying the brain - contains most of the venous blood from the brain
Dural sinuses
Small out-pockets of arachnoid bulging into the dural sinuses - for absorption of cerebrospinal fluid from subarachnoid space into the dural sinuses
Arachnoid Granulations / Arachnoid Villi
Separates the left and right hemispheres
Contains superior sagittal sinus and inferior sagittal sinus within reflection
Falx Cerebri
Forms a tent over the cerebellum
Contains transverse sinus and straight sinus at junction of falx cerebri
Tentorium Cerebelli
Forms roof of hypophyseal fossa, allows hypophyseal stalk through dura
Diaphagma Sellae
A sheath of dural within the vertebral canal extending from the foramen magnum to the second sacral segment
- Anchored to the coccyx by a cord of connective tissue
Dural sac
Tooth-like lateral extensions of the pia around the cord
Anchors the pia and arachnoid to the dura
Denticulate ligaments
A cord of pia running in the dural sac from the end of the spinal cord (L1-L2) to the bottom of the dural sac (S2)
- At the end of the dural sac, the cord picks up a layer of dura and runs in the vertebral canal (outside the sac) to attach to the coccyx
Filum terminale
