Anatomy Flashcards
(91 cards)
1
Q
What is the blood supply of the lungs
A
Bronchial arteries
Left - off decending aorta
Right - off right 3rd posterior intercostal artery
2
Q
Innervation of diaphragm and intercostals
A
Diaphragm is the major inspiratory muscle - phrenic motor neurons that lie in the cervical spinal cord (C3–C5).
Intercostal and abdominal muscles - thoracolumbar spinal cord, from T1–T11 and T7–L2, respectively.
3
Q
Innervation to the smooth muscle of the airways
A
The parasympathetic nervous system provides the most important innervation via the laryngeal and vagus nerves. Cholinergic and excitatory, reducing airway diameter (via mAChR).
Sympathetic innervation of smooth muscle is scant. Preganglionic sympathetic axons exit at T4 and post-ganglionic adrenergic fibers elicit bronchodilation, acting through B2-AR.
4
Q
Thoracic inlet contents
A
Oesophagus Apex of lung Brachiocephalic artery Left subclavian Left common carotid Left and Right brachiocephalic vein Trachea Vagus and phrenic nerves
5
Q
Superior mediastinum
A
○ Arch of Aorta § + origin of branches ○ Superior Vena Cava § +receiving vessels (L+R brachiocephalic veins) ○ Vagus and phrenic nerves ○ Sympathetic trunk ○ Thymus ○ Trachea ○ Oesophagus
6
Q
Anterior mediastinum
A
• Anterior
Thymus
7
Q
Middle mediastinum
A
○ Heart ○ Pericardium ○ Tracheal bifurcation + L+R Main bronchi ○ Ascending aorta ○ Pulmonary trunk ○ Superior vena cava ○ Phrenic nerves
8
Q
Posterior mediastinum
A
○ Thoracic aorta § Posterior intercostals § Left Bronchial § Oesophageal § Superior phrenic ○ Oesophagus ○ Azygos system of veins ○ Sympathetic trunks
9
Q
What are internodal pathways
A
Internodal pathways from SA to AV nodes - 3, made of purkinje fibres
10
Q
Innervation of the heart
A
The heart is innervated byvagal and sympathetic fibers. The right vagus nerve primarily innervates theSA node, whereas the left vagus innervates theAV node; however, there can be significant overlap.
Sympathetic fibre from the sympathetic chain
11
Q
Effects of autonomic nervous system on the heart
A
○ Vagal
§ Negative chronotropy - SA node - M2
§ Negative inotropy - at least in atria - M2
§ Negative dromotropy - AV node - M2
§ Possible vasoconstriction of the coronary arteries - M2
○ Sympathetic
§ Positive chronotropy - SA node - B1
§ Positive inotropy - Atria + Ventricles (increased intracellular Ca) - B1
§ Positive dromotropy - AV node - B1
§ Vasodilation of the coronary arteries - B2 adrenoceptors - circulating epinephrine (no direct innervation)
12
Q
Innervation of blood vessels
A
Sympathetic adrenergic fibres run in the adventitia of arteries and veins
• Alpha 1 adrenoceptors cause arteriovenous smooth muscle contraction and therefore vasoconstriction
• Alpha 2 adrenoceptors cause arteriovenous smooth muscle contraction however the negative feedback on NA secretion means that Alpha 2 agonists cause vasodilation
• Beta 2 adrenoceptors in the coronary arteries reduce arteriovenous smooth muscle contraction causing vasodilation
13
Q
Common congenital heart defects
A
- VSD
- ASD
- Tetralogy of Fallot
- Single ventricle defects
- Pulmonary valve stenosis
- Patent ductus arteriosus
- Dextro-Transposition of the great arteries
- Aortic valve stenosis
- Dextrocardia
- Ebstein´s abnormality
14
Q
Congenital - Ventricular septal defect
A
20% of Congenital heart disease - surgery if heart failure
15
Q
Congenital - Atrial septal defect
A
80% close spontaneously before adulthood, occasional treatment required
16
Q
Tetralogy of Fallot
A
Overriding aorta, Pulmonary stenosis, VSD and Right ventricular hypertrophy. All get surgery either before or at 6 months
17
Q
Single ventricle defects
A
Range of defects - all require a number of surgeries
18
Q
Congenital - Pulmonary valve stenosis
A
if severe needs balloon valvuloplasty
19
Q
Patent ductus arteriosus
A
if symptomatic, closure using drugs, surgery or catheter procedures
20
Q
Dextro-Transposition of the great arteries
A
10% of CHD - surgery during first week of life
21
Q
Dextrocardia
A
sometimes surgery
22
Q
Ebstein´s abnormality
A
inferiorly displaced tricuspid valve. Causes WPW & HF -
treated with medications or surgery
23
Q
Foetal circulation
A
Placenta - umbilical vein - ductus venosus - IVC - RA - foramen ovale + RV - LA + pulmonary artery - ductus arteriosus + LV - aorta … internal iliac arteries - umbilical arteries - placenta
24
Q
Cells of the brain
A
neurons - responsible for sending and receiving nerve impulses glial cells (glia, neuroglia) - non-neuronal cells that provide support and nutrition, maintain homeostasis, form myelin and facilitate signal transmission - number of glia 50x that of neurons
25
Dura Mater
The outer layer is called the periosteal dura.
An inner layer, the dura, lines the inside of the entire skull and creates little folds or compartments in which parts of the brain are protected and secured. The two special folds of the dura in the brain are called the falx and the tentorium. The falx separates the right and left half of the brain and the tentorium separates the upper and lower parts of the brain.
26
Arachnoid
The second layer of the meninges is the arachnoid. This membrane is thin and delicate and covers the entire brain. There is a space between the dura and the arachnoid membranes that is called the subdural space. The arachnoid is made up of delicate, elastic tissue and blood vessels of varying sizes.
27
Pia Mater
The layer of meninges closest to the surface of the brain is called the pia mater. The pia mater has many blood vessels that reach deep into the surface of the brain. The pia, which covers the entire surface of the brain, follows the folds of the brain. The major arteries supplying the brain provide the pia with its blood vessels. The space that separates the arachnoid and the pia is called the subarachnoid space. It is within this area that cerebrospinal fluid flows.
28
CSF production and absorption
Production - The choroid plexus in the ventricles
| Absorption - The arachnoid granulations
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Ventricular system of the brain
* Lateral ventricles. Communicate with the third ventricle through a separate opening called the Foramen of Munro.
* The third ventricle is in the center of the brain, and its walls are made up of the thalamus and hypothalamus. The third ventricle connects with the fourth ventricle through a long tube called the Aqueduct of Sylvius.
* CSF flowing through the fourth ventricle flows around the brain and spinal cord by passing through foramina of Luschka and Magendie.
30
Brainstem
Midbrain - Important centre for ocular motion
Pons - Involved with coordinating eye and facial movements, facial sensation, hearing and balance.
Medulla oblongata - Controls breathing, blood pressure, heart rhythms and swallowing.
Reticular activating system is found in the midbrain, pons, medulla and part of the thalamus. Controls levels of wakefulness, enables people to pay attention to their environments and is involved in sleep patterns.
31
Cerebellum
* Separated from the cerebrum by the tentorium (fold of dura).
* The cerebellum fine tunes motor activity or movement
* Helps maintain posture, sense of balance or equilibrium, by controlling the tone of muscles and the position of limbs.
* Important in ability to perform rapid and repetitive actions such as playing a video game.
* In the cerebellum, abnormalities produce symptoms on the same side of the body.
32
Cerebrum
* The two hemispheres are joined at the bottom by the corpus callosum which delivers messages from one half of the brain to the other.
* The surface of the cerebrum contains billions of neurons and glia that together form the cerebral cortex "gray matter."
* Beneath the cerebral cortex or surface of the brain, connecting fibers between neurons form "white matter."
* Stimulating the left primary motor cortex would cause the right side of the body to move.
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Cranial nerves
1. Olfactory: Smell
2. Optic: Visual fields and ability to see
3. Occulomotor: Eye movements; eyelid opening
4. Trochlear: Eye movements
5. Trigeminal: Facial sensation
6. Abducens: Eye movements
7. Facial: Eyelid closing; facial expression; taste sensation
8. Vestibular: Hearing; sense of balance
9. Glossopharyngeal: Taste sensation; swallowing
10. Vagus: Swallowing; taste sensation
11. Accessory: Control of neck and shoulder muscles
12. Hypoglossal: Tongue movement
34
Functions of the hypothalamus
```
releasing hormones
regulating body temperature
maintaining daily physiological cycles
controlling appetite
managing of sexual behavior
regulating emotional responses
```
35
Functions of the frontal lobes
• The frontal lobes are the largest of the four lobes.
• Motor skills such as voluntary movement
○ The areas that produce movement in parts of the body are found in the primary motor cortex or precentral gyrus
• Speech functions
○ Broca's area, important in language production, is found in the frontal lobe, usually on the left side.
• Intellectual functions
○ The prefrontal cortex plays an important part in memory, intelligence and concentration
• Behavioral functions
○ The prefrontal cortex plays an important part in temper and personality
36
Functions of the occipital lobes
• These lobes are located at the back of the brain
• Receive and process visual information
○ Influence how humans process colours and shapes.
○ The occipital lobe on the right interprets visual signals from the left visual space, while the left occipital lobe performs the same function for the right visual space.
37
Functions of the parietal lobes
* These lobes interpret simultaneously, signals received from other areas of the brain such as vision, hearing, motor, sensory and memory.
* A person’s memory, and the new sensory information received, give meaning to objects.
38
Functions of the temporal lobes
* Right side is involved in visual memory and helps humans recognize objects and peoples' faces
* Wernicke´s area on the left - verbal memory and helps humans remember and understand language.
* The rear of the temporal lobe enables humans to interpret other people’s emotions and reactions.
39
Functions of the limbic system
* This system is involved in emotions.
* Included in this system are the hypothalamus, part of the thalamus, amygdala (active in producing aggressive behaviour) and hippocampus (plays a role in the ability to remember new information)
40
Functions of the Pineal gland
This gland is an outgrowth from the posterior portion of the third ventricle.
It has some role in sexual maturation with melatonin inhibiting sexual development and has inputs on sleep/wake cycle.
41
Functions of the Thalamus
The thalamus serves as a relay station for sensory information.
It plays a role in pain sensation, attention and alertness.
42
Ascending tracts of the spinal cord
Conscious
Dorsal column-medial lemniscal pathway - Fine touch, vibration and proprioception
Anterior spinothalamic tract - Crude touch and pressure
Lateral spinothalamic tract - Pain and temperature
Unconscious
Posterior spinocerebellar tract - Proprioception from lower limbs to ipsilateral cerebellum
Anterior spinocerebellar tract - Proprioception from lower limbs decussating twice to ipsilateral cerebellum
Cuneocerebellar tract - Proprioception from upper limbs to ipsilateral cerebellum
Rostral spinocerebellar tract - Proprioception from upper limbs to ipsilateral cerebellum
43
Descending tracts of the spinal cord
Pyramidal
Lateral corticospinal tract - Passes through internal capsule (between thalamus and basal ganglia), Decussate caudal medulla, Supplies the musculature of the body
Anterior corticospinal tract - Passes through internal capsule (between thalamus and basal ganglia), Decussate at cervical and upper thoracic segmental levels, Supplies the musculature of the body
Extrapyramidal
Vestibulospinal - Balance and posture
Medial reticulospinal (from the pons) - Facilitates voluntary movements and increases muscle tone
Lateral reticulospinal (from the medulla) - Inhibits voluntary movements and increases muscle tone
Rubrospinal - Fine control of hand movements
Tectospinal - Coordinates movements of the head in relation to visual stimuli
44
Arterial blood supply to the brain
Via the vertebral arteries and the internal carotid arteries
Vertebrals join to form the basilar
Basilar splits into the L+R posterior cerebrals
Posterior communicating artery branches from the posterior cerebral to join the internal carotid
Internal carotid becomes the middle cerebral
Anterior cerebral branches from internal carotid
interior cerebral arteries are connected by the anterior communicating artery
45
Venous drainage of the brain
```
Superior and inferior sagittal sinus
Superficial middle cerebral vein
Superior and inferior anastomotic vein (Trolard and Labbe respectively)
Straight sinus
Transverse sinus
Confluence of sinuses
Internal jugular
```
46
Innervation of the larynx
Sensory innervation - Branches of the vagus nerves - superior laryngeal nerve
Motor innervation to all other muscles of the larynx and sensory innervation to the subglottis is by the recurrent laryngeal nerve
47
Dermatomes
```
C2 - Occipital protuberance
C3 - Supraclavicular Fossa
C4 - Acromioclavicular joint
C5 - Lateral ACF
C6 - Thumb
C7 - Middle finger
C8 - Little finger
T1 - Medial ACF
T2 - Apex of Axilla
```
```
L1 - Upper anterior thigh
L2 - Mid anterior thigh
L3 - Medial femoral condyle
L4 - Medial malleolus
L5 - Dorsum 3rd MTP Joint
S1 - Lateral heel
S2 - Popliteal fossa
S3 - Ischial tuberosity
S5 - Perianal area
```
48
Myotomes
```
C1,C2 - Cervical flexion
C3 - Cervical lateral flexion
C4 - Scapula elevation
C5 - Shoulder abduction
C7 - Elbow flexion and wrist extension
C8 - Thumb extension and ulnar deviation
T1 - Finger abduction
L1,L2 - Hip flexion
L3 - Knee extension
L4 - Ankle dorsiflexion
L5 - Big toe extension
S1 - Ankle plantarflexion
S2 - Knee flexion
```
49
Spinal column ligaments
```
Anterior longitudinal ligament
Posterior longitudinal ligament
Ligamentum flavum
Interspinous ligament
Supraspinous ligament
```
50
Finding L3 spinous process
L3 Most likely found on line of the superior iliac crests
51
Contents of the anterior triangle of the neck - lateral to medial
```
Internal jugular
Carotid
Thyroid cartilage
Median cricothyroid ligament
Cricoid cartilage
Trachea
```
52
Femoral triangle contents - lateral to medial
Femoral nerve
Femoral artery
Femoral vein
53
Safe triangle for chest drain insertion
Anterior - lateral border of pectoralis major
Posterior - lateral border of latismus dorsi
Base - 5th intercostal space
Apex - base of axilla
54
Emergency pericardiocentesis surface anatomy
Subxiphoid or left sternocostal margin
55
Coeliac axis
```
Coeliac trunk
+ Common hepatic artery
- Gastroduodenal artery
o Superior pancreaticoduodenal artery
o Right gastroepiploic artery
- Hepatic artery proper
- Right gastric artery
+ Splenic artery
- Short gastric artery
- Left gastroepiploic artery
+ Left gastric artery
```
56
Superior Mesenteric artery
Middle colic artery
- Marginal artery
Right colic artery
Ileocolic artery
57
Inferior Mesenteric artery
Left colic artery
- Marginal artery
Sigmoid arteries
58
Internal capsule site
Sits between the thalamus and the basal ganglia
59
Internal capsule function
Transmits corticospinal neurons from cerebrum to medullary pyramids
60
Internal capsule blood supply
Lenticulostriate arteries off the middle cerebral
61
Basal ganglia blood supply
Lenticulostriate arteries off the middle cerebral
62
Blood supply of speech
Middle cerebral artery
63
Basal ganglia site
below anterior lateral ventricles
64
Basal ganglia function
control of movements
65
Parasympthatic nervous system - sources
```
Edinger-Westphal nucleus
Superior salivatory nucleus
Inferior salivatory nucleus
Dorsal nucleus of the Vagus
Nucleus ambiguus
```
66
Parasympathetic Edinger-Westphal nucleus , nerve, ganglia, effector organs and effects
○ Occulomotor nerve (CN III)
§ Cilliary ganglion
□ Eye
Stimulates contraction of the circular muscle of the pupil - miosis
67
Parasympathetic Superior salivatory nuleus, nerve, ganglia, effector organs and effects
```
Facial nerve (CN VII)
§ Pterygopalatine ganglion
□ Lacrimal gland - secretion
□ Mucous membranes of nose and palate - secretion
§ Submandibular ganglion
□ Submaxillary gland - secretion
□ Sublingual gland - secretion
```
68
Parasympathetic inferior salivatory nuleus, nerve, ganglia, effector organs and effects
Glossopharyngeal nerve (CN IX)
§ Otic ganglion
□ Mouth mucus membranes - secretion
□ Parotid gland - secretion
69
Vagus nerve, source and effector organs
From Dorsal nucleus of the vagus and nucleus ambiguus
Innervates - Heart, larynx, trachea, bronchi, oesophagus, stomach, small intestine, proximal large intestine, abdominal vasculature, liver, bile duct and pancreas
70
Parasympthetic spinal nerves site, effector organs and function
```
S2-4
○ Pelvic splanchnic nerves
§ Distal Large intestine, rectum
□ Increased mobility
□ Stimulation of secretion
□ Relaxation of sphincters
§ Kidney, Ureters, Bladder
□ Increased motility
□ Detrusor contraction
□ Relaxation of internal sphincter
§ Genitalia
□ Erection
```
71
Vagal effect on the heart
Negative chronotropy
Negative inotropy (atria)
Negative lusitropy (relaxation)(atria)
Negative dromotropy
72
Vagal effect on the Larynx, Trachea, Bronchi
Contraction of smooth muscle
| Secretion
73
Vagal effect on the Oesophagus, Stomach, Small intestine, Proximal large intestine
Increased mobility
Stimulation of secretion
Relaxation of sphincters
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Vagal effect on the abdominal vasculature
Vasodilation
75
Vagal effect on the Liver and bile duct
Stimulation of bile
76
Vagal effect on the Pancreas
Stimulates secretion of both endo and exocrine
77
Sympathetic chain
Ganglia within the sympathetic chain from T1-L2
78
Innervation from all ganglia in chain
blood vessels in muscle and skin, errector pili muscles attached to hairs, and sweat glands
79
Sympathetic effect on Large arteries, arterioles, cutaneous and large (not muscular) veins
Vasoconstriction - a1, a2 (present both postjunction, causing vasocontriction but mainly prejunctional with negative feedback on noradrenaline release)
80
Sympathetic effect on Brown adipose tissue
Non-shivering Thermogenesis via decoupling of oxidative phosphorylation and production of heat rather than ATP - b1,2 and 3, a1 and 2
81
Sympathetic effect on Immune system
Bone marrow, Thymus, Lymph nodes and Spleen
| Modulates immune responses mainly via b2
82
Sympathetic effect on Sweat glands
Piloerection - a1
83
Cervical sympathetic chain
```
○ Eye
§ Dilator pupillae - a1
§ Superior tarsal muscle (smooth muscle attached to levator palpebrae superioris) - a1
§ Ciliary epithelium - a2 - decreases aqueous humor production, b2 - increases aqueous humor production
○ Lacrimal gland
§ Secretion - a1
○ Mucous membranes of the nose and palate
§ Reduces secretion
○ Submaxillary gland
§ Stimulates mucus secretion - a1
○ Sublingual gland
§ Stimulates mucus secretion - a1
○ Mucous membranes of the mouth
§ Reduces secretion
○ Parotid gland
```
84
Upper thoracic sympathetic chain
```
○ Heart
§ Positive chronotropy - SA node - b1
§ Positive dromotropy - AV node - b1
§ Positive inotropy - Atria + Ventricles (increased intracellular Ca) - b1
○ Airways
§ Bronchial muscle - relaxation - b2
```
85
Mid thoracic sympathetic chain
```
○ Greater splanchnic nerve & Small splanchnic nerve
§ Coeliac plexus
□ Oesophagus, stomach, small intestine
® Decreased motility - a1, a2, b2
® Inhibited secretions - a2
® Contraction of sphincters - a1
□ Abdominal vasculature
® Vasoconstriction - a1, a2
□ Liver and bile duct
® Glycogenolysis and gluconeogenesis - a1, b2
® Bile duct and gallbladder relaxation - b2
□ Pancreas
® Inhibits acinar secretion - a
® Inhibits b cell insulin secretion - a2, (during alpha blockade b2 increases secretion)
® Stimulates a cell glucagon secretion - b2, (during beta blockade a decreases secretion)
§ Superior mesenteric plexus
□ Proximal large intestine
® Proximal large intestine
® Decreased motility - a1, a2, b2
® Inhibited secretions - a2
® Contraction of sphincters - a1
```
86
Sympathetic effect on adrenal gland
```
Adrenal gland (no synapse in the ganglia)
Secretion of adrenaline and noradrenaline
```
87
Lower thoracic and lumber sympathetic chain
```
○ Inferior mesenteric plexus
§ Distal large intestine
□ Decreased motility - a1, a2, b2
□ Inhibited secretions - a2
□ Contraction of sphincters - a1
§ Kidney
□ Increased Renin secretion - b1
□ Decreased renal blood flow - a1
□ Increased renal tubular sodium absorption - a1
§ Bladder
□ Bladder neck, prostate and urethral contraction - a1
□ Detrusor relaxation (small effect) - b
§ Vas deferens and seminal vesicles
□ Ejaculation - a1
□ Uterus
§ Nonpregnant - relaxation, b2
§ Pregnant - contraction, a1
```
88
Muscles of inspiration
Priniciple - External intercostals, Diaphragm
Accessory
- SCM, Scalenes, Pectoralis minor
89
Muscles of expiration
Quiet breathing - passive from elastic recoil of the lungs, rib cage and diaphragm
Active breathing - Internal intercostals, abdominals, Quadratus lumborum
90
Humoral immune response
Antibody mediated from plasma cells (converted by T helper cells from B cells) to freely circulating or cell wall antigens (from molecules viruses and foreign cells)
91
Cellular immune response
Pathogen antigens are expressed on cell surface or on antigen presenting cells. T Helper cells release cytokines that help activated T cells to bind to infected cells’ MHC-antigen complex and differentiate into a cytotoxic T cell. These cells then lyse
