Thorax, Heart, Lungs etc (COPIED) Flashcards
What is the origin of pectoralis major?
- Medial third of clavicle.
- Sternum.
- Costal cartilages.
What are the 4 vertical lines of the chest wall called?
- Mid-clavicular.
- Anterior axillary line.
- Mid axillary line.
- Posterior axillary line.
Insertion of Pec Major
Humerus
Action of Pec Major
Adduction and medial rotation of the humerus at the shoulder.
What is the insertion of pectoralis minor?
The coracoid process of the scapula.
What is the action of pectoralis minor?
Protraction of the shoulder.
What is the insertion of serratus anterior?
Costal surface of the scapula.
What is the action of serratus anterior?
Protraction of the scapula.
What is the innervation of the intercostal muscles?
The intercostal nerves.
What is the function of the lungs?
Oxygenates blood by bringing inspired air into contact with O2 poor blood in the pulmonary capillaries.
What is the Pleural Cavity?
A Potential space between the visceral and parietal pleura. It is continuous at the Hilum of the lung
Name 2 functions of the serous fluid within the pleural cavity?
- Lubricates the pleurae.
- Creates a surface tension helping the lungs to expand on inspiration.
Name the 4 main structures that are found at the hilum of the lung.
- Pulmonary artery x1.
- Bronchus x1.
- Pulmonary vein x2.
What branch does the right main bronchus give off outside of the right lung?
Superior and inferior lobar bronchi.
Which lung are inhaled foreign bodies most likely to be found in and why?
The right lung. The right main bronchus is shorter and more vertical.
How many lobes does the right lung have and what are they called?
3 lobes.
Superior, middle and inferior.
How many lobes does the left lung have and what are they called?
2 lobes.
Superior and Inferior.
What is the fissure in the left lung called?
Oblique (lies along 6th rib).
What are the fissures in the right lung called?
Horizontal (extends from mid-axiallry line anteriorly along the 4th rib) and Oblique (lies along 6th rib).
Name the 3 surfaces of the lungs.
- Costal.
- Mediastinal.
- Diaphragmatic.
What is the action of parasympathetic innervation in the lung?
Bronchoconstriction and vasodilation of pulmonary vessels.
What is the action of sympathetic innervation in the lung?
Bronchodilation and vasoconstriction of vessels that are poorly ventilated.
What is the surface marking for the apex of the lung?
2 finger breadths (3cm) above the medial clavicle in the neck.
What are the surface markings for the lower border of the lung?
6th rib anteriorly (mid-clavicular line).
8th rib laterally (mid-axillary line).
10th rib posteriorly (vertebral column).
What are the 3 branches of the arch of the aorta?
- Brachiocephalic trunk.
- Left common carotid artery.
- Left subclavian artery.
What are the branches of the brachiocephalic trunk?
Right common carotid (LHS).
Right subclavian (RHS).
What is the ligamentum arteriosum a remnant of and what was its function in the foetus?
Remnant of the ductus arteriosum.
Itās function was to shunt blood between the pulmonary trunk and the aorta in order to bypass the non-functioning lungs.
What spinal roots is the phrenic nerve derived?
C3, 4 and 5 (cervical plexus).
What does the phrenic nerve supply?
Motor innervation to the diaphragm.
Sensory innervation to the pleura, peritoneum and pericardium.
Does the phrenic nerve enter the diaphragm? If so where?
Yes. It pierces the central tendon of the diaphragm alongside the IVC on the right (T8).
Does the vagus nerve enter the diaphragm? If so where?
Yes. Through the oesophageal hiatus (T10).
What are the layers of the pericardium?
- Outer fibrous layer.
- Parietal serous layer.
- Visceral serous layer.
What structure forms the left border of the heart? Where are the surface markings for this region?
Left ventricle.
It extends from the left 2nd intercostal space to the 5th intercostal space in the left midclavicular line (the apex).
What is the surface marking for the apex of the heart?
5th intercostal space in the left mid-clavicular line.
On what aspect of the heart would you find the left atrium?
The posterior aspect. It is closely related to the oesophagus.
Where is the RCA found?
In the atrio-ventricular sulcus
Name the 3 main branches of the RCA.
- Sino-atrial nodal branch.
- Right marginal branch.
- Posterior inter-ventricular branch.
In 90% of hearts where does the posterior inter-ventricular artery arise from?
RCA.
In 30% of hearts where does the posterior inter-ventricular artery arise from?
The circumflex artery.
In 20% of hearts where does the posterior inter-ventricular artery arise from?
The RCA and the circumflex artery
Name the 2 main branches of the LCA.
- Circumflex.
- Left anterior descending (LAD).
In what sulcus does the circumflex artery lie? What other large vessel can be found here?
Left atrio-ventricular sulcus.
The coronary sinus can also be found here. It passes posteriorly and drains into the RA.
Where is the SAN located?
The upper aspect of the crista terminalis in the RA.
Where is the AVN located?
Inter-atrial septum.
At what phase of the cardiac cycle do the coronary arteries fill?
Diastole; when the ventricles are relaxed.
What 2 spaces does the crista terminalis divide in the RA?
Crista terminalis is a muscular ridge that separates the smooth-walled posterior part of the atrium from the anterior part, which has a ridged, muscular wall.
The ridges are pectinate muscles and extend into the right auricle. The parts of the right atrium on either side of the crista have different embryological origins.
What is the Fossa Ovalis a remnant of?
The Foramen Ovale. In the foetus the foramen ovale shunted blood from the RA to the LA so as to bypass the lungs.
In the ventricles, what are the chordae tendinae attached to?
The valves (mitral or tricuspid) and the papillary muscles.
How do the mitral and tricuspid valves work?
They open passively when the atria contract and then close afterwards to prevent backflow. The papillary muscles and chordae tendinae work to keep the valves closed during ventricular contraction.
How do the atrial and pulmonary valves work
They open passively when the ventricles contract. Towards the end of systole they close to prevent the back flow of blood. The pressure of blood on the valves keeps them closed.
How would you know if the atrial and pulmonary valves were incompetent?
You would get regurgitation of blood into the ventricles. This could be heard as a diastolic murmur.
Where can you hear the pulmonary valve?
Left of the sternum, 2nd intercostal space.
Where can you hear the aortic valve?
Right of the sternum, 2nd intercostal space.
What vessels are contained within the carotid sheath?
- Carotid artery.
- Jugular vein.
- Vagus nerve.
What vertebral level is the tracheal bifurcation?
T4.
Where does the azygous vein drain into?
The azygos vein carries blood from the back of your chest and abdomen to your heart.
It drains into the superior vena cava.
What are the names of the three splanchnic nerves?
The greater (T5-9), the lesser (T10-11) and the least (T12).
Occlusion of which vessel is most likely to result in a fatal heart attack?
The left main coronary artery.
Which artery provides the main blood supply to the left ventricle?
The left anterior descending artery.
Which vessel is most likely to become occluded without producing any symptoms?
Right marginal artery.
What is the function of the pericardium?
It provides a friction free surface to accommodate the heartās sliding movements.
What is the surface on the anterior border of the heart?
Sternocostal
What are the 3 layers of heart tissue?
Epicardium, Myocardium, Endocardium
What does the superior laryngeal nerve innervate?
Internal - Sensory to the larynx above the vocal folds.
External - Innervates the cricothyroid muscle of the larynx.
Phrenic and vagus nerve - what is their relation to the hilum of the lung?
phrenic ANTERIOR to hilum of lung
Vagus POSTERIOR to hilum of lung
Where would referred pain be for the diaphragm?
in the neck, as it is innervated by C3, 4,5
Valve Osculation: where would you place the stethoscope to listen to the Apex beat of the heart?
5th Intercostal Space in Left Midclavicular line
Valve Osculation: where would you place the stethoscope to listen to the Aortic and Pulmonary Valves?
Pulmonary valve: 2nd intercostal space at the left sternal edge.
Aortic valve: 2nd intercostal space at the right sternal edge.
(either sides of sternum)
Where would you listen to the Mitral valve?
Mitral valve: 5th intercostal space in the left midclavicular line - Same as APEX beat
Where would you listen to the Tricuspid valve?
Tricuspid valve: 4th or 5th intercostal space at the lower left sternal edge.
What is the role of the internal intercostals in breathing?
When they contract, they pull the ribs inferiorly, so they are most active in expiration.
What level does the IVC go through the Diaphragm?
Central Tendinous ring/Caval Hiatus at T8
What level does the Oesophagus, Vagus and Oesophageal branches of the of the left gastric artery pierce through the Diaphragm?
oesophageal Hiatus, T10
What level does the abdominal aorta, Thoracic duct and Azygous vein through the diaphragm?
Aortic Hiatus, T12
What direction do the inner intercostal muscle fibres run? what about the innermost intercostal muscle Fibres?
The internal intercostal muscle fibers run in a superomedial to an inferolateral direction, whereas the innermost intercostal muscles run in more of a perpendicular direction to the ribs.
What can tell you if you are looking at the right or left lung?
- look for the cardiac notch On the left lung (large indentation on inner surface of left lung from the heart)
- lingula (small tongue shaped out portion on the front inferior part of left lung)
What makes up the conducting airway? (first part)
Pharynx, larynx, trachea, Lobar bronchi, Segmental bronchi, terminal bronchi.
what level does the trachea bifurcate? what is this called
The carina, at level T4
What goes through the diaphragm at the caval Hiatus? What level is it?
Inferior vena cava
Terminal branches of right phrenic nerve
at T8 level
What goes through the diaphragm at the Oesophageal Hiatus? At what level?
Oesophagus
Right and left vagus nerves
Oesophageal branches of left gastric artery/vein
at T10 level
What goes through the diaphragm at the Aortic Hiatus?
Aorta
Thoracic duct
Azygous vein
at T12
2,3,3,
Phrenic provides sensation to 3 places. What are they?
3 pās:
Pleura, peritoneum, pericardium
Where would you find the parietal pleura?
What is it innervated by?
Thoracic wall.
Phrenic innervation.
Needs anaesthetizing for surgery
Continuous with Visceral pleura at root of lung
Intrapleural fluid fills space, lubricating surfaces
where would you find the visceral pleura?
What is it innervated by?
Visceral ā on lung surface, autonomic innervation
HAS SENSORY FIBRES THAT DETECT STRETCH
Continuous with parietal pleura at root of lung
Intrapleural fluid fills space, lubricating surfaces
What is the name of the muscular ridge that separates the interior surface of the right
atrium?
The interatrial septum is the muscular ridge separating the interior surface of the right atrium.
Where are trabeculae carnae found, and what is their purpose?
Located on the inner surface of the left and right ventricles, these irregular elevations of muscle prevent suction.
What marks the divisions between the upper and lower respiratory tracts?
The True vocal folds (chords) mark the division
between the upper and lower respiratory tract.
Draw the tree of coronary arteries and their supply.
Also a SAN branch off of RCA.
What are the recurrent laryngeal nerves?
The left and right recurrent layrngeal nerves arise from the L/R vagus nerves, respectively.
LRLN loops under arch of the aorta.
RRLN loops under the right subclavian artery, just after the brachiocephalic right trunk.
They innervate the L/R muscles of the larynx, respectively, bar the cricothyroid muscle.
What term is used to describe the remnant of the middle lobe of the left lung?
The Lingula
