Flashcards in Anatomy Deck (107):
What is the first structure in the lower respiratory tract?
What happens at the level of the C6 vertebra?
Larynx becomes trachea and pharynx becomes oesophagus
Where can the trachea be palpated?
Jugular notch of the manubrium
What is anterior to tracheal cartilages 2-4?
Isthmus of the thyroid gland
What do the pleura secrete and why?
Pleural fluid to lubricate and provide surface tension
Where is the pleural fluid found?
In the pleural cavity
Where do the lungs develop from?
Mediastinum and out
What does each lobar bronchi supply with air?
A lung lobe
What do each segmental bronchi supply?
A bronchopulmonary segment
Each lung has how many bronchopulmonary segments?
What are ribs 1-7 known as and where do they attach?
True ribs- costal cartilage to sternum
What are ribs 8-10 known as and where do they attach?
False ribs- costal cartilage above to sternum
What are ribs 11-12 known as and where do they attach?
Floating ribs- no attachment to sternum
What is the common cartilage bar which attaches the false ribs to the sternum known as?
Where does the head of the rib articulate with?
Body of vertebrae
Where does the rib tubercle articulate with?
Transverse process of vertebra
What is the name of the joint which connects the sternum to the cartilage and what type of joint is it?
Sternocostal joints (synovial)
What is the name of the joint which connects the rib end to the cartilage?
What is the name of the joints which connect the ribs to the vertebrae?
What are the three layers of skeletal muscle located between the ribs and in intercostal spaces?
External, internal and innermost
How do the intercostal muscles make the chest wall expand?
Pull ribs upwards and outwards
How many pairs of intercostal spaces are there?
Each intercostal space contains a neurovascular bundle. Where specifically are these found?
Between internal and innermost intercostal muscles
From superior to inferior, what order do the contents of the neurovascular bundle run in?
Vein, artery, nerve (VAN)
What is the nerve supply to the intercostal spaces?
Intercostal nerve- anterior ramus of a spinal nerve
What is the arterial supply and venous drainage of the intercostal spaces POSTERIORLY?
Arterial supply- thoracic aorta
Venous drainage- azygous vein
What is the arterial supply and venous drainage of the intercostal spaces ANTERIORLY?
Arterial supply- internal thoracic artery
Venous drainage- internal thoracic vein
What do the intercostal arteries supply?
Where do intercostal arteries arise from?
Bilaterally from the thoracic aorta
What do the bronchial arteries supply and where do they arise from?
Supply lung tissue, arise from the anterior surface of the thoracic aorta
The muscular part of the diaphragm attaches to where?
Sternum, lower 6 ribs and costal cartilages, L1-3 vertebrae
The muscular part of the diaphragm is supplied by what?
Phrenic nerve- C3, 4, 5 (anterior rami)
Where are the phrenic nerves found in the neck?
Anterior surface of the scalenus anterior muscle
Where are the phrenic nerves found in the chest?
Descending over the lateral aspects of the heart
What does the phrenic nerve supply to the diaphragm and fibrous pericardium?
Somatic sensory and sympathetic axons
What does the phrenic nerve supply just to the diaphragm?
Somatic motor axons
Lymph from the lateral quadrants of the breast drain where?
Unilaterally to axillary nodes
Lymph from medial quadrants of the breast drain where?
Bilaterally to parasternal nodes
Where is the sternal angle?
At the level of rib 2
What vein is found in the delto-pectoral groove?
What nerve supplies the serratus anterior? If this is damaged what can it cause?
Long thoracic nerve, damage can cause a winged scapula
Where does the pectoralis minor attach?
Between coracoid process of scapula and ribs 3-5
Where does the Scalenus anterior attach?
Cervical vertebrae to the 1st rib
What part of the pleural cavity is found between the costal and diaphragmatic parietal pleura?
What is the most inferior part of the costophrenic recess?
Where is the lung apex auscultated?
Superior to the medial 1/3rd of the clavicle
Where is the right middle lobe auscultated?
Between right ribs 4 and 6 in the mid-clavicular and mid-axillary lines
Where is the horizontal fissure found?
Right rib 4
Where are the oblique fissures found?
Anteriorly- rib 6
Where should the lung base be auscultated?
Scapular line at T11 vertebra
Coughing is stimulated by sensory receptors found where?
Oropharyngeal, laryngopharyngeal and laryngeal mucosa
What sensory receptors are stimulated in sneezing?
CN V or IX
What sensory receptors are stimulated in coughing?
CN IX or X
What are carotid sheaths and where are they found?
Protective tubes of cervical deep fascia which attach to the bones of the base of the skull
What do the carotid sheaths contain?
Vagus nerve, internal carotid artery, common carotid artery, internal jugular vein
What makes up the pulmonary plexus?
Sympathetic axons, parasympathetic axons, visceral afferents
Motor axons travel from the tracheal bifurcation to supply what?
All mucus glands and bronchiolar smooth muscles
Where do pulmonary visceral afferents travel?
Follow vagus nerve to the medulla of the brainstem
What does the phrenic nerve do differently in order to produce a deep inspiration?
Produces a greater outflow of action potentials of longer duration
The intercostal nerves are the anterior rami of what spinal nerves?
What are the accessory muscles of deep forced inspiration?
Pec major, pec minor, sternocleidomastoid and Scalenus anterior/medius/posterior
Where does the pectoralis major attach?
Between sternum/ribs and humerus
Where does the SCM muscle attach?
Sternum/clavicle and the mastoid process of the temporal bone
What type of muscle are the intrinsic muscles of the larynx?
What are the intrinsic muscles of the larynx supplied by?
Somatic motor branches of the vagus nerve
What do the intrinsic muscles of the larynx do to the vocal cords during a cough?
Where does the vagus nerve connect with the CNS?
Where does the vagus nerve pass through the base of the skull?
The vagus nerve supplies somatic sensory to the ? of the larynx and somatic motor to the ? of the larynx?
Motor- intrinsic muscle
Where is the vagus nerve found in the chest?
Descending posterior to the lung root
The vagus nerve supplies parasympathetic axons to the lungs via what?
The vagus nerve passes through the diaphragm attached to what?
What other muscles contract in a deep inspiration to increase intra-thoracic pressure?
Anterolateral abdominal wall muscles
Where do the aponeurosis of the external obliques meet?
Midline linea alba
Where does the right external oblique attach superiorly?
Superficial aspects of lower ribs
Where does the right external oblique attach inferiorly?
Anterior part of iliac crest and pubic tubercle
Where does the right internal oblique attach superiorly?
Inferior border of the lower ribs
Where does the right internal oblique attach inferiorly?
Iliac crest and thoracolumbar fascia of lower back
Where does the transversus abdominus attach superiorly?
Deep aspect of the lower ribs
Where does the trasversus abdominus attach inferiorly?
Iliac crest and thoracolumbar fascia of lower back
The somatic motor, sensory and sympathetic nerve fibres supplying the abdominal wall are conveyed within what?
What nerves become the thoracoabdominal nerves and where?
7-11 intercostal nerves become thoracoabdominal nerves as they branch in the plane between the internal oblique and transversus abdominus
What makes up the subcostal nerve?
T12 anterior ramus
What is made from the two halves of the L1 anterior rami?
Iliohypogastric and ilioinguinal nerves
A breach in the visceral pleura allows what?
Alveolar air to enter the pleural cavity
Dynamic airway compression in asthma makes what difficult?
What are the two causes of a pneumothorax?
Penetrating injury to the parietal pleura or rupture of the visceral pleura
What will a pneumothorax show on examination?
- Reduced breath sounds and chest expansion
- Hyper-resonant percussion
What will a deviated trachea cause?
SVC compression which leads to hypotension
What is the first step management for a large pneumothorax?
Needle aspiration (thoracentesis)
What is the second step management for a large pneumothorax?
Chest drain via the 4th or 5th intercostal space in the midaxillary line
What is the emergency treatment for a tension pneumothorax?
Large cannula inserted into the pleural cavity via the 2nd or 3rd intercostal space midclavicular line
What two factors are required for a hernia to form?
Weakness of one body structure and increased pressure on one side of this
Where are the normal anatomical weaknesses of the diaphragm?
At the xiphoid and posterior attachments
What happens in a paraoesophageal hiatus hernia?
Herniated part of the stomach passes through the oesophageal hiatus to become parallel to the oesophagus in the chest
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
Where does the inguinal ligaments range from?
ASIS to pubic tubercle
The inguinal ligaments are the inferior borders of what?
External oblique aponeurosis
What is the entrance and exit to the inguinal canals?
Entrance- deep ring
Exit- superficial ring
The superficial ring lies superiolateral to what?
Where is the deep ring located?
Superior to the midpoint of the inguinal ligament
What does the inguinal canal contain in adults?
Spermatic cord or round ligament of the uterus
Where is the spermatic cord formed?
What are the fascial coverings of the spermatic cord?
Normal superficial fascia, external spermatic fascia, cremasteric fascia and muscle, internal spermatic fascia
What is the pampiniform plexus?
A network of veins that drains the testis
What is contained within the spermatic cord?
Testicular artery, cremasteric artery and vein, artery to the vas deferens, paminiform plexus, genital branch of the genitofemoral nerve, autonomic nerves, lymph drainage, processus vaginalis, vas deferens