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Flashcards in Anatomy Deck (108):
0

What nerves supply the intercostal muscles?

Intercostal nerves

1

What does adduction of the vocal cords do and what nerve does this?

closes the rima glottidis
vagus nerve

2

What nerve controls contraction of the anterolateral abdominal wall muscles?

intercostal nerves

3

What nerve tenses the soft pallate?

CN V - trigeminal

4

What nerve elevate the soft pallate?

vagus nerve

5

When sneezing what sensory receptor nerves are stimulated?

CN V or CN IX (trigeminal or glossopharyngeal)

6

What sensory receptor nerves are stimulated in coughing?

CN IX or CN X (glossopharyngeal or vagus)

7

What does the vagus nerve descend down to the mediastinum in?

Carotid sheath

8

What 4 things does the right carotid sheath obtain?

the vagus nerve
the right internal carotid artery
the right common carotid artery
the right internal jugular vein

9

Where is the pulmonary plexus and what 3 things make it up?

At the bifurcation of the trachea
sympathetic axons, parasympathetic axons, visceral afferents

10

What nerve sensory receptors are present in the mucosa of the oropharynx?

CN IX

11

What nerve sensory receptors are present in the mucosa of the laryngopharynx?

CN X

12

What nerve sensory receptors are present in the mucosa of the larynx?

CN X

13

What are present in the sensory receptors of the mucosa in the respiratory tree?

Visceral afferents

14

What is the phrenic nerve composed of?

The combined anterior rami of cervical spinal nerves 3,4 and 5

15

Where in the neck can the phrenic nerve be found?

On the anterior surface of the scalenus anterior

16

Where in the chest can the phrenic nerve be found?

Descending over the lateral aspect of the fibrous pericardium anterior to the lung root

17

What 4 areas does the phrenic nerve supply somatic sensory and sympathetic axons to?

The fibrous pericardium
The mediastinal parietal pleura
The diaphragmatic parietal pleura
Th diaphragmatic parietal peritoneum

18

What does the phrenic nerves somatic motor axons supply?

The diaphragm

19

What are the intercostal nerves?

The anterior rami of spinal nerves T1 - T11

20

What 3 muscles are the accessory muscles of inspiration?

Pectoralis major
Pectoralis minor
Sternocleidomastoid
Scalenous anterior, medius and posterior

21

What are the muscle attachments of the pectoralis major?

sternum/ribs and the humerus

22

What are the muscle attachments of the pectoralis minor?

ribs 3,4 and 5 (3-5)
the coracoid process of the scapula

23

What are the attachments of the sternocleidomastoid muscle?

sternum/clavicle and mastoid process of the temporal bone

24

What are the attachments of the scalenous anterior, medius and posterior?

Cervical vertebrae and ribs 1 & 2

25

What type of muscles are the intrinsic muscles of the larynx?

Skeletal muscles

26

What are the intrinsic muscles of the larynx supplied by?

(somatic) motor branches of the vagus nerve (CN X)

27

Where do the right and left vagus nerve connect with the CNS?

At the medulla (oblongata) of the brainstem

28

Describe the 5 steps in the course of the vagus nerve.

1. Leaves the base of skull through the jugular foramen
2. Descends through the neck within the carotid sheath
3. Descend posterior to the lung root (supply parasympathetic axons to the chest organs - lungs via pulmonary plexus)
4. Pass through the diaphragm on the oesophagus
5. On the surface of the stomach they divide into many parasympathetic branches for the foregut and midgut organs

29

What is the name of the 6 pack muscles?

Rectus abdominis muscles

30

What are the accessory muscles used in deep, forced expiration?

The 3 layers of skeletal muscles of th antolateral abdominal wall

31

what are the three layers of abdominal muscles from external to internal?

External oblique
Internal oblique
Transverse abdominus

32

What muscle is just lateral to the pectoralis major and superior to the external obliques?

Serratus anterior

33

What is an aponeurosis?

A flattened tendon

34

What is the linea alba?

the right external oblique blends with the aponeurosis of the left external oblique at the midline (linea alba)

35

What is the linea semilunaris?

Where the muscle fibres end and the aponeurosis begins

36

What are the right external obliques attachments?

superiorly - the superficial aspects of the lower ribs
inferiorly - the anterior part of the iliac crest and the pubic tubercle

37

What are the right internal obliques attachments?

Superiorly - the inferior border of the lower ribs
Inferiorly - the iliac crest and the thoracolumnar fascia of the lower back

38

What are the attachments of the transversus abdominus superiorly and inferiorly?

Superiorly - deep aspects of the lower ribs
Inferiorly - the iliac crest and the thoracolumnar fascia of the lower back

39

What are the rectus sheaths composed of?

The aponeuroses of the other 3 muscles:
Transversus abdominis aponeurosis
Internal oblique aponeurosis
External oblique aponeurosis

40

What do tendinous intersections do?

They divide each of the 2 long flat muscles into 3 or 4 smaller quadrate muscles: the 6 pack or 8 pack - this gives improved mechanical efficiency

41

Describe the course of the thoracoabdominal nerves?

The 7th to the 11th intercostal nerves travel anteriorly then their terminal branches leave the intercostal spaces, in the plane between the internal oblique and the transversus abdominus as the thoracoabdominal nerves

42

The subcostal nerve?

T12 anterior ramus

43

The iliohypogastric nerve?

Half of L1 anterior ramus

44

The ilioinguinal nerve?

The other half of L1 anterior ramus

45

In an upright patient where will foreign bodies tend to be inhaled to?

The inferior lobe of the right lung

46

What is the carina?

The internal aspect of the tracheal bifurcation

47

Examination of a patient with a pneumothorax will show?

Reduced ipsilateral chest expansion
Reduced ipsilateral breath sounds
Hyper-resonance on percussion

48

On a CXR what will you notice in the case of a pneumothorax?

Absent lung markings peripherally
Lung edges visible

49

What is a tension pneumothorax?

The torn pleura can create a one-way valve that permits air to enter the pleural cavity on each inspiration but prevents air escaping again on expiration. With each inspiration more air enters the pleural cavity. The pneumothorax exapnds and the lung collapses towards its root. Eventually the build up of air in the pleural cavity applies tension to the mediastinal structures.

50

What will you notice on a CXR of a tension pneumothorax?

No lung markings
Increased lung markings on other side

51

What level of the axial section is the superior medastinum at?

T4

52

What level of the axial section is the posterior mediastinum at?

T7

53

How will you know if there has been a mediastinal shift due to a tension pneumothorax?

Tracheal deviation away from the side of a unilateral pneumothorax, is palpable in the jugular notch.

54

What 2 steps are involved in the management of a large pneumothorax? Where would the needle/chest drain be inserted?

1. Needle aspiration (thoracentesis)
2. The siting of a chest drain

4th or 5th intercostal space in the midaxillary line.

55

Where are intercostal nerve bundles found (VAN)?

In the costal groove of ribs

56

In relation to the management of a large pneumothorax, what borders make up the safe triangle?

The anterior border of latissimus dorsi
The posterior border of pectoralis major
The axial line superior to the nipple

57

What is the emergency management of a tension pneumothorax?

Insert a large gauge cannula (grey/orange) into the pleural cavity via the 2nd or 3rd intercostal space in the midclavicular line on the side of the tension pneumothorax.

58

What is a pleurectomy?

Removal of visceral pleura (can be done by thoracoscopy)

59

What is chemical pleurodesis?

Magnesium silicate (talc) slurry introduced into the pleural cavity to produce adhesion between the parietal and visceral pleura.

60

What are the most likely consequences of a chronic cough?

Herniae

61

Name the 4 parts of the body wall that have normal anatomical weakness?

Diaphragm - diaphragmatic hernia
Umbilicus - umbilical hernia
Inguinal canal - inguinal hernia
Femoral canal - femoral hernia

62

Where are the weak points for herniae to develop in relation to the diaphragm?

Normal anatomical weakness at the attachments to the xiphoid
Normal anatomical weakness at posterior attachments

(hiatus hernia are common - oesophageal hiatus, aortic hiatus, caval opening - IVC)

63

What happens in a paraoesophageal hiatus hernia?

The herniated part of the stomach passes through the oesophageal hiatus to become parallel to the oesophagus and in the chest.

64

What happens in a sliding hiatus hernia?

The herniated part of the stomach slides through the oesophageal hiatus into the chest with the gastro-oesophageal junction/

65

How is the inguinal canal formed embryologically?

During the passage of the testes or the round ligament of the uterus into the perinuem

(In the adult the canal contains the spermatic cord or the round ligament of the uterus)

66

What is the inguinal region from?

The anterior superior iliac spine and the pubic tubercle

67

What are the inguinal ligaments formed from and where are their attachments?

The inguinal ligaments are the inferior borders of the external oblique aponeuroses. They attach between the ASIS and pubic tubercle. (Their medial halves form the floors of the inguinal canals)

68

What is the deep ring of the inguinal canal?

Where the testis are pusehd into the transversalis fascia

69

What is the superficial ring of the inguinal canal?

The defect in the external oblique aponeurosis where the testis is passed into the superficial fascia of the scrotum.

70

What is the conjoint tendon and what does it do?

The medial end of the combined aponeuroses of internal oblique and transversus abdominis: anchors these muscles inferiorly to the pubic bone.

71

What is the spermatic cord made up of?

The three layers of "coverings" gained as the testis passes through the inguinal canal: internal spermatic fascia, cremasteric fascia, external spermatic fascia. It also contains structures within.

72

What does the right spermatic cord contain?

The vas deferens, testicular artery and pampiniform plexus

73

Name the contents of the spermatic cord from posterior to anterior

Vas deferens, testicular artery, testicular vein

74

What nerve emerges from the inguinal canal via the superficial ring?

The ileoinginal nerve

75

The complete contents of the spermatic cord contains 6 things - what are they?

Vas deferens, testicular artery, pampiniform plexus of veins, autonomic nerves supplying the smooth muscle of the vas deferens and arterioles, the genitofemoral artery, lymphatics draining lymph from the testis

76

Explain what a direct inguinal hernia is?

A "finger" of peritoneum is forced through the posterior wall of the inguinal canal and directly out of the superficial ring into the scrotum.

77

Explain what an indirect inguinla hernia is?

A "finger" of peritoneum is forced through the deep ring into the inguinal canal and then out of the superficial ring into the scrotum.

78

How do you clinically differentiate between direct and indirect herniae?

1. reduce the hernia
2. occlude the deep ring with the fingertip pressure
3. ask the patient to cough

If it is a direct hernia the lump will reappear, if indirect the lump will not reappear.

79

Where can you palpate the trachea?

In the jugular notch of the manubrim

80

At what level of the vertebra does the larynx become the trachea and the pharynx become the oesophagus?

C6

81

What is the parietal pleura adherent to?

1. The structures of the mediastinum
2. The internal aspect of the chest walls

82

How many lobes does the right lung have?

3

83

How many lobes does the left lung have?

2

84

Which lung contains the horizontal fissure?

Right lung

85

How many bronchopulmnonary segments are there?

10

86

What lies in the costal groove?

Neurovascular bundle (VAN)

87

What supplies the anterior parts of the intercostal spaces and course vertically either side of the deep surface of the sternum?

The internal thoracic artery and veins (2)

88

What drains the posterior parts of the intercostal spaces

The azygous vein

89

What supplies the 11 pairs of intercostal spaces?

(bilateral) posterior intercostal arteries - supply the chest wall
branches from the thoracic aortas anterior surface (arterial blood for the lung tissue)

90

What nerve and its branches supply all the layers/structures of the right 4th intercostal spaces?

The right T4 anterior ramus also called the right 4th intercostal nerve and its branches

91

Whaat are the three attachments of the diaphragm?

1. the sternum
2. the lower 6 ribs and costal cartilages
3. L1-L3 vertebral bodies

92

What are the phrenic nerves composed up?

Cervical spinal nerves 3,4 & 5 anterior rami

93

Where in the neck are the phrenic nerves found?

Anterior surface of the scalenus anterior

94

Where in the chest are the phrenic nerves found?

Descending over the lateral aspect of the fibrous pericardium

95

What does the phrenic nerve supply to the diaphragm and fibrous pericardium?

Somatic sensory and symnpathetic axons

96

What does the phrenic nerve supply to the diaphragm alone?

Supplies somatic motor axons

97

What is the arterial and venous supply of the breasts?

Subclavian and internal thoracic artery and vein

98

What is the lymph drainage for the breasts?

Unilateral drainage from lateral quadrants to axillary nodes
Bilateral draiange from medial quadrants to parasternal nodes

99

Where is the left cephalic vein found?

In the left delto-pectoral groove

100

What are the 2 heads of the pectoralis major?

Clavicular head
Sternocostal head

101

What is paralysis of serratus anterior a result of and what does it cause?

Usually through injury to the long thoracic nerve results in a "winged scapula"

102

What does the serratus anterior anchor?

The medial border of the scapula to ribs 1 and 8

103

Where does the long thoracic nerve come from?

It is a named branch of the brachial plexus and supplies the serratus anterior via its superficial surface

104

Where does the pectoralis minor attach between?

the coracoid process of the scapula and ribs 3-5

105

Where does the anterior intercostal vein drain into?

The internal thoracic vein

106

What is the anterior intercostal artery a branch of?

Internal thoracic artery

107

Which lung has a lingula?

Left lung