Unit 2- Larynx And Thorax Flashcards
What structure connects the lower part of the pharynx to the trachea?
Larynx
What does the larynx connect?
Lower part of the pharynx to the trachea
What is the larynx primarily made up of?
Cartilage
What are three functions of the larynx?
- Prevent passage of food into the airway during swallowing 2. Regulate flow of air into the lungs 3. Vocalization
About how long is the larynx in an adult?
5 cm
Between what cervical vertebral does the larynx lie?
Between CV3 and CV 6
How many cartilages make up the larynx?
6
List the 6 cartilages of the larynx.
- Thyroid 2. Cricoid 3. Epiglottic 4. Arytenoid 5. Corniculate 6. Cuneiform
T/F. The thyroid cartilage of the larynx is a single cartilage.
True
The thyroid cartilage of the larynx presents what 7 structures?
- Superior thyroid notch 2. Inferior thyroid notch 3. Laryngeal prominence 4. Superior horn (attached to greater horn of hyoid bone) 5. Inferior horn (articulates with cricoid cartilage) 6. Laminae 7. Oblique Line
The oblique line located on the external surface of the lamina provides attachment for what three muscles?
- Inferior constrictor 2. Sternothyroid 3. Thyrohyoid muscles
What does cricoid mean in Greek?
Ring
T/F. The Cricoid Cartilage is the most superior of the laryngeal cartilages.
False; most inferior (CV 6)
T/F. The cricoid cartilage consists of a narrow anterior arch and a broad, posterior lamina.
True
The epiglottic cartilage is a single spoon shaped cartilage that lies where?
Behind the root of the tongue and body of the hyoid bone
The lower end of the epiglottic cartilage is attached to the back of the laryngeal prominence of the thyroid cartilage via what structure?
Thyroepiglottic ligament
T/F. The arytenoid cartilage is a single cartilage.
False; paired and pyramidal in shape
The bases of the arytenoid cartilage articulate with what other laryngeal cartilage?
Cricoid cartilage
Each arytenoid cartilage presents what two structures?
- Vocal process 2. Muscular process
The corniculate cartilages are paired cartilages and are closed within what structure?
Aryepiglottic folds
T/F. The cuneiform cartilages are paired cartilages which lie in the aryepiglottic folds posterior to the corniculate cartilages.
False; anterior
From a clinical standpoint, the corniculate and cuneiform cartilage can ossify and also be mistaken for _________.
A fracture
There are two joints of the larynx. What are they and what are their classifications?
- Cricothyroid joint 2. Cricoarytenoid joint
Synovial joints
What type of synovial joint is the cricothyroid joint?
Hinge
Where is the location of the cricothyroid joint?
Between the side of the cricoid cartilage and the inferior horn of the thyroid cartilage
What type of motion does the cricothyroid joint permit?
Rotation of the thyroid cartilage around the horizontal axis
What type of synovial joint is the cricoarytenoid joint?
Planar, arthroidial
Where is the location of the cricoarytenoid joint?
Between the upper border of the cricoid cartilage and the base of the arytenoid cartilage
What motion does the cricoarytenoid joint permit?
Gliding and rotation of the arytenoid cartilage on the cricoid cartilage
List the 5 ligaments of the larynx.
- Thyrohyoid membrane 2. Median cricothyroid ligament 3. Vocal ligament 4. Conus Elasticus 5. Quadrangular membrane
The thyrohyoid membrane extends from the thyroid cartilage to the hyoid bone and is pierced on each side by what two structures?
Internal laryngeal nerve and superior laryngeal vessels
The median cricothyroid ligament extends from what two cartilages?
Arch of the cricoid cartilage to the thyroid cartilage
Since the vocal ligament extends from the thyroid cartilage in front to the vocal process of the arytenoid cartilage behind, it is considered the ________ vocal cord.
True vocal cord
Where is the location of the conus elasticus?
Extending upward from the cricoid cartilage to the vocal ligament
What ligament forms the free edge of the conus elasticus?
Vocal ligament
What does the quadrangular membrane connect?
Epiglottic cartilage to the arytenoid cartilage
What do the superior and inferior margins of the quadrangular membrane form?
S- aryepiglottic ligament within the aryepiglottic fold
I- vestibular ligament within the vestibular fold
Name the two pairs of folds that the larynx contains.
- Vestibular folds (false vocal cords)
2. Vocal folds (true vocal cords)
The vocal folds contain the vocal ligament and what muscle? (This muscle forms the bulk of the vocal fold)
Vocalis muscle
What is the name of the space between the vestibular folds (false vocal cords)?
Rima Vestibuli
What is the name of the space between the vocal folds (true vocal cords)?
Rima Glottidis
T/F. The Rima Vestibuli is the narrowest part of the laryngeal cavity.
False; Rima Glottidis
T/F. The Glottis includes the Rima Glottidis and vocal folds.
True
What are the names of the three cavities in which the larynx is divided into?
- Laryngeal Vestibule
- Laryngeal Ventricle
- Infraglottic Cavity
Which cavity of the larynx extends from the vocal folds to the inferior border of the cricoid cartilage?
Infraglottic cavity
Which cavity of the larynx lies between the false and true vocal cords?
Laryngeal ventricle
Which cavity of the larynx extends from the laryngeal inlet to the false vocal cords?
Laryngeal vestibule
What structure contains glands that lubricate the vocal folds (aka “oil can” of the vocal cords)?
Laryngeal saccule
Which laryngeal fold is responsible for initiating the cough reflex?
False vocal cord
Do the intrinsic or extrinsic muscles of the larynx move the larynx as a whole? What two categories can they be divided into?
Extrinsic
Depressors and elevators
What are the six elevators of the larynx?
- Thyrohyoid
- Stylohyoid
- Mylohyoid
- Digastric
- Stylopharyngeus
- Palatopharyngeus
What are the three depressors of the larynx?
- Omohyoid
- Sternohyoid
- Sternothyroid
What is the origin and insertion of the cricothyroid muscle?
O: cricoid cartilage
I: inferior horn and lower lamina of thyroid cartilage
What is the nerve supply to the cricothyroid muscle?
External laryngeal nerve
What is the function of the cricothyroid muscle?
Tilts thyroid cartilage downward or cricoid cartilage upward thereby tensing the vocal cords
What is the origin and insertion of the posterior cricoarytenoid muscle?
O: posterior surface of lamina of cricoid cartilage
I: muscular process of arytenoid cartilage
What is the nerve supply to the posterior cricoarytenoid muscle?
Recurrent laryngeal nerve
What is the function of the posterior cricoarytenoid muscle?
Abducts the vocal folds
What is the origin and insertion of the Lateral Cricoarytenoid Muscle?
O: arch of cricoid cartilage
I: muscular process of arytenoid cartilage
What is the nerve supply to the Lateral Cricoarytenoid Muscle?
Recurrent laryngeal nerve
What is the action of the Lateral Cricoarytenoid Muscle?
Adducts the vocal cords (whispering)
What is the origin and insertion of the Transverse Arytenoid Muscle?
O: posterior surface of arytenoid cartilage
I: posterior surface of opposite arytenoid cartilage
What is the nerve supply to the Transverse Arytenoid Muscle?
Recurrent laryngeal nerve
What is the action of the Transverse Arytenoid Muscle?
Adducts the vocal folds (coughing)
What is the origin and insertion of the Oblique Arytenoid Muscle?
O: muscular process of arytenoid cartilage
I: apex of opposite arytenoid cartilage
What is the nerve supply to the Oblique Arytenoid Muscle?
Recurrent laryngeal nerve
What is the action of the Oblique Arytenoid Muscle?
Adducts the vocal folds (coughing)
What intrinsic laryngeal muscle(s) function in coughing? Whispering?
Coughing: Transverse and Oblique Arytenoid
Whispering: Lateral Cricoarytenoid
What is the origin and insertion of the Aryepiglottic Muscle?
O: apex of arytenoid cartilage
I: side of epiglottic cartilage
What is the nerve supply to the Aryepiglottic Muscle?
Recurrent laryngeal nerve
What is the action of the Aryepiglottic Muscle?
Closes the laryngeal inlet
What muscle is a continuation of the oblique arytenoid and lies within the aryepiglottic fold?
Aryepiglottic Muscle
What is the origin and insertion of the Thyroepiglottic Muscle?
O: inner surface of thyroid lamina
I: lateral margin of epiglottis
What is the nerve supply to the Thyroepiglottic Muscle?
Recurrent laryngeal nerve
What is the action of the Thyroepiglottic Muscle?
Opens the laryngeal inlet
The Thyroepiglottic Muscle is the antagonist muscle to which muscle?
Aryepiglottic Muscle
What is the origin and insertion of the Thyroarytenoid Muscle?
O: inner surface of thyroid lamina
I: arytenoid cartilage
What is the nerve supply to the Thyroarytenoid Muscle?
Recurrent laryngeal nerve
What is the action of the Thyroarytenoid Muscle?
Shortens and relaxes vocal folds by drawing the arytenoid cartilages forward (decreases the pitch of voice)
What is the origin and insertion of the Vocalis Muscle?
O: inner surface of thyroid lamina
I: vocal process of arytenoid cartilage
What is the nerve supply to the Vocalis Muscle?
Recurrent laryngeal nerve
What is the action of the Vocalis Muscle?
Adjusts tension on the vocal cords during phonation (fine tuning of vocal cord)
All of the intrinsic muscles of the larynx are supplied by the recurrent laryngeal nerve except ________.
Cricothyroid Muscle (external laryngeal nerve)
What folds are important in phonation because they control the stream of air passing through the rima glottidis?
Vocal Folds
The Vocal Folds are important in phonation because they control the stream of air passing though which space?
Rima Glottidis
What are the shapes of the Rima Glottidis during inspiration and then expiration/phonation?
Inspiration- wide
Expiration/Phonation- narrow and wedge shaped
To raise the pitch of the voice, what muscle will have increased tension?
Cricothyroid Muscle
To lower the pitch of the voice, tension will be decreased on what muscle(s)?
Thyroarytenoid and Vocalis muscles
Voice dimorphism is determined by what three factors?
- length of vocal cords
- size of resonating chamber
- thickness of vocal cords- respond to androgens
What nerve is the motor nerve to all of the intrinsic muscles of the larynx except the cricothyroid?
Recurrent laryngeal nerve
The recurrent laryngeal nerve is sensory to what to what structure?
Mucosa of the larynx below the vocal fold
The internal laryngeal nerve is a branch of what nerve?
Superior laryngeal nerve
The internal laryngeal nerve is sensory to what structures?
- Mucosa of the larynx above the vocal folds
2. Superior laryngeal artery as it pierces the thyrohyoid membrane to enter the larynx
The external laryngeal nerve is a branch of what nerve?
Superior laryngeal nerve
The external laryngeal nerve is motor to what muscle(s)?
- Cricothyroid
2. Inferior constrictor muscles
What are the two arteries that supply the the larynx? What artery do they branch from?
Arteries- Superior and Inferior laryngeal artery
Branch:
S- superior thyroid artery
I- inferior thyroid artery
What are the three main function of the lymphatic system (of the head and neck)?
- Picks up protein molecules from tissue fluid which are too large to pass through capillaries and transports them to the bloodstream
- Returns excess tissue fluid to the bloodstream
- Produces lymphocytes
What is the term for the swellings found along the lymphatic system?
Lymph nodes
What are the functions of lymph nodes?
- Produce lymphocytes
2. Act as filters for the lymph, preventing foreign bodies from entering the bloodstream
What lymph vessel drains lymph to a node?
Afferent
What lymph vessel drains lymph from a node?
Efferent
How is lymph moved?
Skeletal muscle contraction
T/F. Exercise clears toxins from tissues.
True
What are the superficial nodes of the head?
- Occipital
- Mastoid
- Parotid
Lymph nodes contain what type of tissue?
Reticular tissue
What are the superficial nodes of the neck?
- Submandibular
- Submental
- Anterior cervical
- Superficial cervical
T/F. The superficial cervical chain of nodes can be located on the external surface of the platysma.
False; external surface of the sternocleidomastoid
The superficial cervical nodes of the neck follow the course of what vein?
External jugular vein
T/F. The deep cervical nodes are located within the carotid sheath, and follow the course of the internal jugular vein.
True
Name the two largest deep cervical nodes.
- Jugulodigastric Node
2. Jugulo-omohyoid Nodes
The two largest deep cervical nodes drain what structure?
The tongue
Match the location to the node.
A. Jugulodigastric Node
B. Jugulodigastric-omohyoid Node
- Intermediate tendon of the onto hyoid
- Posterior belly of the digastric muscle
A. 2
B. 1
The jugulodigastric node and what tonsil drain the tongue?
Palatine tonsil
During tonsillitis, what deep cervical node is enlarged?
Jugulodigastric Node
T/F. Efferents of the deep cervical nodes form the superior and inferior jugular trunks.
False; right and left jugular trunks
The right jugular trunk of the deep cervical nodes drains into the junction of what two veins?
Internal jugular and subclavian veins
The left jugular trunk of the deep cervical nodes drains into what structure?
Thoracic duct
With clinical considerations in mind, what is the lymphatic system very important for?
Tracking the spread of cancer cells
The Submental nodes drain what three structures?
- Lower lip
- Floor of the mouth
- Tip of the tongue
The Submandibular nodes drain what 6 structures?
- Cheek
- Side of the nose
- Upper lip
- Lateral part of the lower lip
- Gums
- Margin of the tongue
What is the term for the spread of cancer via the lymphatic system.
Lymphogenous Metastasis
What is the name of an enlarged supraclavicual are node, usually on the left side?
Signal (sentinel) Node
What is a Signal (sentinel) Node usually the 1st indication of?
Visceral tumor of thorax/abdomen
What is the name of the primary tumor of the lymph nodes?
Lymphoma
What are two types of lymphoma? Which one has a poorer prognosis?
- Hodgkin’s Disease
2. Non-Hodgkin’s Lymphoma- poorer prognosis
A tender or painful enlarged lymph node usually indicates ______.
Infection
A hard and painless enlarged lymph node usually indicates _________ or _________.
Cyst development or cancer
What is the term for parasitic infection of the lymphatic system (worms)?
Filariasis
T/F. The great is an epidermally derived structure which consists of mammillary glands, fat, and fibrous tissue.
False; mammary glands*
The breast is located between what two ribs?
Second and Sixth rib
What is the name of vertical line dividing the armpit into anterior and posterior halves?
Midaxillary Line
The nipple I’d usually located at the level of what intercostal space?
Fourth
What is the term for the ring of pigmented skin which surrounds the nipple?
Areola
What is the term for the portion of the breast which extends back into the armpit and is a frequent site for cancer?
Axillary Process (Tail)
What ligaments support the breast and runs through the breast from the skin to the deep layer of superficial fascia?
Suspensory Ligaments of Breast
T/F. The mammary gland is a modified sweat gland located in the superficial fascia.
True
Each mammary gland has how many lobes of glandular tissue?
15-20 lobes
Each lobe of glandular tissue of a mammary gland opens onto the tip of the nipple though what structure?
Lactiferous Duct
What is the term for an expansion of the lactiferous duct, which serves as a reservoir for milk during lacation?
Lactiferous Sinus
What are the four arteries that supply blood to the breast?
- Internal thoracic artery
- Thoracoacromial artery
- Lateral thoracic artery
- Intercostal arteries
T/F. 75 % of the lymph from the breast drains to the parasternal nodes.
False; the axillary nodes
What is the most common type of cancer in women?
Breast cancer
T/F. Breast cancer spreads to the bloodstream 1st before entering the lymphatics.
False; spreads to the lymphatics 1st before entering the blood stream
The posterior intercostal veins drain to ______ and _________ systems.
Azygos and Hemiazygos
T/F. Connections to the vertebral venous plexus allows spread of breast cancer to vertebral column and brain.
True
What are the three clinical signs for breast cancer?
- Dimpling (due to invasion of suspensions ligament)
- Inverted nipple (due to invasion of lactiferous duct)
- Leathery thickening of skin (like orange due to invasion of dermis and lymphatics)
Breast cancer is one cause of A. Upper B. Mid C. Low thoracic pain in females.
B. Mid thoracic
What bone contains bone marrow and is a major site for RBC formation?
Sternum
What are the three parts of the sternum?
- Manubrium
- Body
- Xiphoid process
What part of the sternum is the widest and thicket part?
Manubrium
The upper border of the manubrium forms the ___________.
Jugular notch
The body of the sternum articulates with what 2 coastal cartilages?
Second and Seventh
The costal cartilage of the second rib articulates directly with what joint?
Manubriosternal Joint
T/F. The Xiphoid process is cartilaginous at birth and rapidly ossifies to support the rib cage.
False; slowly ossifies throughout life.
What part of the sternum is sometimes broken during CPR?
Xiphoid Process
T/F. The sternum can sometimes have a bifid xiphoid process or a xiphoid foramen.
True
What two parts of the sternum form the sternal angle?
Manubrium and the Body