Anatomy Flashcards
(93 cards)
1
Q
Branches of the bronchi
A
Right and left bronchi, lobar, segmental bronchi
2
Q
What level does the larynx become trachea and pharynx become oesophagus
A
C6
3
Q
What does the chest cavity contain
A
Mediastinum and right and left pleural cavity
4
Q
Function of pleural fluid
A
Lubrication and provide surface tension
5
Q
What causes the visceral and parietal pleura to stick together
A
Surface tension
6
Q
What are lung lobes
A
Area of lung that each lobar bronchi supply with air
Right side - Upper, middle and lower
Left - Upper and lower
7
Q
What are bronchopulmonary segments
A
Area of lung that each of the segmental bronchi supply with air. 10 in each lung
8
Q
What fissues seperated the lobes
A
Horizontal fissure (only right side) and oblique fissures
9
Q
Classification of the ribs
A
True (1-7), false (8-10) and floating ribs (11-12)
10
Q
Where does the head of the rib articulate
A
Head of the rib articulates with the body of vertebrae of same number and superior body
11
Q
Where does the rib tubercle articulate
A
Articulates with transverse process of vertebrae of same number
12
Q
Joints of thoracic skeleton
A
Sternocoastal joint, Costochondral joint, Costovertebral
13
Q
Skeletal muscles between ribs and intercoastal space
A
External, internal and innermost intercoastal muscles
14
Q
How many intercoastal spaces
A
11
15
Q
Nerve supply to intercoastal space
A
Anterior rami of spinal nerve, intercoastal nerve
16
Q
Blood supply to posterior intercoastal space
A
Thoracic aorta and drained by Azygous vein
17
Q
Blood supply to anterior intercoastal space
A
Internal thoracic artery and internal thoracic vein
18
Q
What forms the intercoastal artery
A
Anastomose between thoracic aorta posteriorly and inner thoracic artery anteriorly
19
Q
Where do bronchial arteries arise from
A
Anterior branches of thoracic aorta
20
Q
Why is right dome of diaphragm higher
A
Due to presence of liver
21
Q
What vertebral bodies diaphragm attaches to
A
L1 to L3 vertebral bodies
22
Q
Nerve supply to diaphragm
A
Phrenic nerve, C3, 4 and 5 anterior rami
23
Q
Route of Phrenic nerve to diaphragm
A
C3, 4 and 5 anterior rami. Anterior surface of scalenus anterior muscle. Lateral aspect of the heart supplying somatic sensory and sympathetic axons to diaphragm and fibrous pericardium, somatic motor to diaphragm
24
Q
What innervates the nipples and umbilicus
A
Nipples - T4, Umbilicus - T10
25
What quadrants can the breast be divided into
Superolateral, superomedial
| Inferolateral, inferomedial
26
Lymph drainage of breasts
Unilateral drainage from lateral quadrants to axillary nodes. Bilateral drainage from medial quadrants to parasternal nodes
27
What level is sternal angle
Coastal cartilage 2, T4 vertebrae
28
What vein can be found in the delto-pectoral groove
Cephalic vein
29
Function of superficial fascia
Fatty tissue, provide insulation
30
Function deep fascia
Fibrous, tough and protective in nature
31
What causes winged scapula
Paralysis of serratus anterior often due to injury to the long thoracic nerve
32
Where does the pectoralis minor attach
Coracoid process and ribs 3-5
33
Where does fluid from haemothorax or pleural effusion generally drain to
Costodiaphragmatic or costophrenic recess
34
Where can the apex of lung be auscultated for
Superior to medial 1/3rd of clavicle
35
Level of horizontal fissures
Rib 4
36
Level of oblique fissures
Rib 6
37
Auscultation of middle lobe
Between ribs 4 and 6, midclavicular and midaxillary line
38
Auscultation of lung base
T11 scapular line
39
Origin of pectoralis major
Clavicular head originates on the clavicle, sternocoastal head on the sternum and costal cartilage 1 to 6. This inserts into the intertubercular groove of humerus.
40
What nerve supplies pectoralis major
Pectoral nerve from brachial plexus
41
Actions of pectoralis major
Adduction and medial rotation of upper limb at shoulder joint. Accessory muscle of inspiration
42
Origin of pectoralis minor
Coracoid process of scapula
43
Insertion of pectoralis minor
Ribs 3-5 midcalvicular line
44
Actions of pectoralis minor
Stabilize scapula, accessory muscle of inspiration
45
Nerve supply of pectoralis minor
Pectoral nerve from brachial plexus
46
Origin and insertion of serratus anterior
Origin on ribs 1-8 anterior axillary line and inserts in the medial border of deep (anterior) surface of scapula
47
Main actions of serratus anterior
Stabilize and protraction of scapula
48
Nerve supply of serratus anterior
Long thoracic nerve from brachial plexus
49
CNS coordination of coughing
Deep inspiration using diaphragm (phrenic nerve C3,4,5), intercostal muscles (intercostal nerves) and accessory muscles on inspiration
Adduction of vocal cords to close rima glottidis (vagus nerve)
Contraction of anterolateral abdominal wall (intercostal nerve) to build-up abdominal pressure which pushes diaphragm up and builds pressure in the chest inferior to adducted vocal cords. The vocal cords suddenly abduct to open rima glottidis (vagus nerve).
The soft palate (CN V - Trigeminal) and elevates (Vagus nerve) to close off the entrance into nasopharynx and direct stream of air through oral cavity rather than nasal cavity as a sneeze
50
What nerves are involved in sneezing
CN V - Trigeminal and CN IX - Glossopharyngeal
51
What nerves are involved in coughing
CN IX - Glossopharyngeal and CN X - Vagus nerve
52
What are the carotid sheaths
Protective deep fascia that contains the vagus nerve, internal carotid artery, common carotid artery and internal jugular vein
53
Route of Phrenic nerve to diaphragm
Anterior rami of C 3,4,5. Anterior surface of scalenus anterior muscle. In the thorax descending over lateral aspect of fibrous pericardium anterior to lung root
54
Muscles of quiet inspiration
External, internal and innermost intercoastal muscles
55
Accessory muscles of inspiration
Pectoralis major and minor, Sternocleidomastoid, Scelenus anterior, middle and posterior
56
What ribs do Pectoralis minor pull
Ribs 3-5 superiorly towards the coracoid process of scapula
57
Where does the sternocleidomastoid attach
Sternum/clavicle and mastoid process of temporal bone
58
What supplies the vocal cords
Somatic motor nerves part of CN X - Vagus nerve
59
Vagus nerve connections in brainstem
Medulla oblongata at brainstem. Exit cranium at jugular foramen
60
Location of vagus nerve at root lung
Posterior to root lung whereas Phrenic nerve is anterior to lung root
61
Where does the aponeurosis of left and right external oblique meet
Linea alba
62
Where does external oblique attach inferiorly
Iliac crest and pubic tubercle
63
What is the attachment of muscle fibre to aponeurosis called
Linea semilunaris
64
Inferior attachment of internal obliques
Iliac crest and thoracolumbar fascia of lower back
65
Inferior attachment of transverse abdominus
Iliac crest and thoracolumbar fascia
66
What do the tendinous intersections of rectus abdominus do
Divide the 2 long flat muscles into 3 or 4 quadrate muscles
67
How is the thoracoabdominal nerve formed
7 to 11 intercoastal nerve travel anteriorly then their terminal branches leave the intercoastal space in plane between transverse abdominus and internal oblique muscles as thoracoabdominal nerve
68
What nerve arises from T12 anterior ramus
Subcostal nerve
69
What nerve arises from one half of L1 anterior ramus
Iliohypogastric nerve and Ilioinguinal nerve from the other half
70
Openings of diaphragm
Caval opening for SVC, oesophageal hiatus and aortic hiatus
71
What makes up the rectus sheath
Aponeuroses of transverse abdominus, internal and external obliques
72
What happens when air enters pleural cavity
Vacuum is lost and elastic lung recoil towards lung root making expiration harder.
73
Small vs large pneumothorax
Small < 2 cm
| Large > 2 cm
74
What in tension pneumothorax
Torn pleura can create a one-way valve that permits air to enter pleura but not leave. This increases pleural pressure with every breath applying increased tension to mediastinal structures causing a mediastinal shift and decreases in lung volume of unaffected lung
75
Level of sternal angle
T4
76
How can tension pneumothorax cause hypotension
It can cause SVC compression, leading to decrease venous return; this causes hypotension
77
Management of large pneumothorax
Thoracentesis/needle aspiration/pleural tap in 4th-5th intercostal space, midaxillary line
78
What is a safe triangle
Triangular region in the axilla formed by anterior boundary of latissimus dorsi, posterior boundary of pectoralis major and axial line superior to nipples. It is a safe region for thoracentesis and chest drains. Insert the needle posterior to rib to avoid the neurovascular bundle
79
Emergency management of tension pneumothorax
Large gauge cannulae inserted into pleural cavity via 2nd or 3rd intercoastal space, midclavicular line on side of tension pneumothorax
80
What factors cause development of herniae
Weakness of one structure, commonly part of body wall
| Chronic cough, increases ipsilateral pressure
81
Paraoesophageal vs sliding hiatus hernia
Paraoesophageal hitus hernia - Herniated part of stomach becomes parallel to oesophagus in chest
Sliding hiatus hernia - Herniated part slides though oesophageal hiatus into chest with gastro-oesophageal junction
82
Inguinal ligaments attach where
Between ASIS and pubic tubercle
83
Describe the inguinal canals
4cm long passageways through anterior abdominal wall in inguinal regions. Deep ring superior to midpoint of inguinal ligament and superficial ring superolateral to pubic tubercle
84
What does the inguinal canal contain in adults
Spermatic cord or round ligament of uterus
85
Embryonic developmental outpouching of parietal peritoneum in the testes
Processus vaginalis
86
What is the cremasteric fascia
Covering of skeletal muscle fibres from internal oblique
87
What is the external spermatic fascia
Covering of external oblique aponeurosis
88
What is the superficial ring of inguinal canal
Defect in external oblique aponeurosis where the testis pass into the superficial fascia of scrotum
89
Layers the spermatic cord passes through, posterior to anterior
Visceral peritoneum, parietal peritoneum (processus vaginalis), transversalis fascia (internal spermatic fascia), transverse abdominus, internal oblique (cremasteric fascia), external oblique aponeurosis (external spermatic fascia)
90
What is the spermatic cord
Vas defernece, testicular artery and pampiniform plexus, sympathetic nerves, lymphatic vessels, internal spermatic fascia, cremasteric fascia and external spermatic fascia
91
Direct vs indirect hernia
Direct - Peritoneum is pushed though posterior wall of inguinal canal and directly out of superficial ring into scrotum
Indirect - Peritoneum is pushed through deep ring into inguinal canal and then though superficial ring into scrotum
92
How to clinically differentiate direct and indirect
Place a finger on deep ring and ask the patient to cough. If it's a direct hernia, the lump will reappear. It it's indirect, won't appear
93
Significance of internal thoracic artery
Branch of subclavian artery
Anterior parts of intercoastal space are supplied via anterior intercoastal branches. This artery can be mobilised form its attachment to sternum, sectioned inferiorly and anastomosed to a coronary artery distal to occlusion
