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Anatomy of Systems Flashcards

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1
Q

What are the primary and secondary curves of the spinal chord?

A

Primary: kyphotic
Secondary: cervical and lumbar regions (lordotic)

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2
Q

Name the parts of the vertebra

A

Spinous process, lamina, pedicle, vertebral foramen, superior articular facet (synovial joint), transverse processes, inferior articular facet, inferior notch, superior notch

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3
Q

What are the characteristics of cervical vertebrae?

A 
Body, foramen transversarium (vertebral artery), anterior and posterior tubercles
Atlas and axis: don't really have a body
Atlas: anterior arch has facet for dens
Axis: has dens
C7: first palpable spinous process
Articulation btw 1 and 2: flat
articulation btw 2 and 3: round
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4
Q

What are the characteristics of thoracic vertebrae?

A

Costal facets: one upper and one lower, 10, 11 and 12 only one
T1-2: spinous process not facing downwards
T11-12: spinous process facing backwards

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5
Q

What are the characteristics of lumbar vertebrae?

A

Vertebral foramen changes from round to pyramidal

Processes: spinous + mamillary, accessory, transverse

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6
Q

What type of joint is the sacroiliac joint?

A

Synovial joint anteriorly and interosseous ligament posteriorly

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7
Q

What are intervertebral discs composed of?

A
  1. Nucleus pulposus
  2. Annulus fibrosus (collagen type I)
  3. Vertebral end plate
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8
Q

What is the difference between primary and secondary cartilaginous joints?

A

Primary (synchondroses): hyaline cartilage only

Secondary (symphyses): fibrocartilage sandwiched between hyaline cartilage

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9
Q

What are the ligaments of the spinal cord?

A 
Anterior longitudinal ligament
Posterior longitudinal ligament
Ligamentum flavum (attaches lamina)
Interspinous ligament
Supraspinous ligament
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10
Q

Which are the extrinsic superficial posterior trunk muscles?

A

Trapezius
Latissimus dorsi
Serratus posterior
Levator scapulae + rhomboids

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11
Q

Which are the intrinsic posterior trunk muscles?

A

Superficial layer: splenius muscles
Intermediate layer: erector spinae (Ilio-costalis, longissimus, spinalis)
Deep layer: transverso-spinalis (rotatores, multifidus, semispinalis)

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12
Q

Which are the lateral trunk muscles?

A

Quadratus lomborum

Psoas major

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13
Q

What does the intercostal neurovascular bundle supply?

A

Intrinsic muscles

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14
Q

What types of joints are the manubrio-sternal and the sterno-xiphoid joint?

A 
secondary cartilaginous (symphyses)
xiphisternum is cartilaginous
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15
Q

What type of joint is the 1st sternocostal joint?

A

primary cartilaginous (synchondrosis); only joint of this type

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16
Q

Which are the true, false and floating ribs and what type of joints do they have?

A 
True: 1-7
False: 8-12
Floating: 11-12
Joints:
2-7 --> sternocostal joints (synovial)
8-10 --> chondrocondral joints (synovial)
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17
Q

Which upper muscles are attached to the rib cage?

A

Sternocleidomastoid

Scalenes: anterior to 1st rib, posterior to 2nd rib, medius to both

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18
Q

What is the osteology of typical ribs?

A

Head: superior demi-facet, interarticular crest, inferior demi-facet
Neck
Tubercle: articular (facet), non articular (ligamentous)
Shaft
Subcostal groove on the bottom
Ligaments: costotransverse and lateral costotransverse

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19
Q

Which are the typical and atypical ribs?

A

Typical: 3-9 (10th usually is)
Atypical: 1-2, 11-12

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20
Q

What is the osteology of atypical ribs?

A

1st: short, strong, flat and very curved, has tubercle for scalenus anterior, grooves for subclavian vessels, single facet on head
2nd: tubercles for scalenus posterior and serratus anterior
11 and 12: do not have tubercles and do not attach to sternum

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21
Q

Which are the atypical vertebrae?

A

1st, 10th, 11th and 12th

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22
Q

What is the arterial supply to the chest wall?

A

Posterior intercostal artery –> lateral cutaneous branch

Internal thoracic artery (branch of subclavian) –> anterior intercostal artery

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23
Q

What is the azygos venous system?

A

Posterior intercostal veins (except first couple –> brachiocephalic directly)
Upper left chest –> accessory hemiazygos vein
Lower left chest –> azygos vein
Cross midline at T7-8
Drain into SVC

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24
Q

What does the internal thoracic artery give rise to?

A

Superior epigastric artery + musculo-phrenic artery

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25
What are the lymphatics of the chest wall?
Superficial: axillary, supraclavicular and parasternal Deep: 1. Anteriorly: internal thoracic, brachiocephalic, tracheobronchial --> bronchomediastinal trunk 2. Posteriorly: posterior mediastinal + posterior intercostal --> thoracic duct --> left lymphovenous portal
26
What is the nerve supply to the chest wall?
Anterior rami of thoracic spinal nerves --> intercostal muscles (supply chest wall intrinsic muscles), runs between internal and innermost intercostal muscles Below the level of the sternal angle: start with T2 Nipple: T4 Xiphoid sternum: T6-7
27
Which are the layers of the heart?
Fibrous pericardium, parietal (serous) pericardium, visceral serous epicardium, myocardium, endocardium
28
What are the positions of the heart?
Sits on central tendon of the diaphragm --> pericardium is fused here
29
What is a cardiac tamponade?
excess fluid build up in pericardial cavity --> pressure on fibrous pericardium --> no expansion --> inward pressure on the heart muscle
30
What is the origin of the phrenic nerve?
C3,4,5
31
Which are the AV valves?
Tricuspid: right Mitral: left
32
How do you check for abnormal heart size?
Transverse diameter of heart should be smaller or equal to diameter of hemi thorax
33
What are the layers of blood vessels?
Epithelium Tunica intima: internal elastic lamina + fibrocollagenous tissue Tunica media: smooth muscle Tunica externa/adventitia: fibrocollagenous tissue with external elastic lamina + fibrocollagenous tissue
34
Where does the thoracic duct drain into?
Junction between internal jugular and subclavian vein (lympho-venous portal)
35
What are the structures of the right atrium?
``` Right auricle Sinus venarum Fossa ovalis Opening of coronary sinus Musculi pectinati Crista terminalis: embryological remnant, junction between true atrium and smooth sinus venosus ```
36
What are the structures of the right ventricle?
Membranous portion of the interventricular septum Trabeculae carneae Infundibulum Cordae tendinae + papillary muscles (ant, pos and additional ones)
37
What are the structures of the left ventricle and atrium?
Atrium: entirely smooth apart from auricle, fossa ovalis is less pronounced, opening of four pulmonary veins Ventricle: less pronounced infundibulum
38
What are the characteristics of fetal circulation?
80% through foramen ovale + 20% into pulmonary chunk (19% through ductus arteriosus + 1% pulmonary circulation)
39
What are the components of the conducting system of the heart?
SA node --> AV node --> bundle of his (right and left bundle branches) --> moderator band (septomarginal bundle) --> purkinje fibers
40
Where is the cardiac pacemaker implanted?
Right atrium, coronary sinus and right ventricle
41
What is the nerve supply to the heart?
Sympathetics: T1-T5 (cardiac nerve from cardiac plexus) Superior cervical ganglion --> superior cardiac nerves Middle cervical ganglion --> middle cardiac nerves Inferior cervical ganglion --> inferior cardiac nerves Parasympathetics: vagal nerve
42
What are the coronary arteries of the heart?
``` Right coronary artery from right ostium: 1. SA nodal branch 2. Right marginal 3. Posterior interventricular (descending) Left coronary artery from left ostium: 1. Circumflex 2. Anterior interventricular (descending) 3. Left marginal ```
43
What is the most common coronary artery to be occluded?
Anterior descending artery
44
What are the structures that form cardiac valves?
Lunule + nodule
45
Which imaging would you use to see blood vessels?
CT or MRI
46
Which intercostal space would you puncture to get access to the pleural space?
9th or 10th intercostal space during expiration
47
Where does the vagus nerve pass?
Between internal jugular and carotid
48
In expiration, at what intercostal spaces are the right and left domes of the diaphragm?
Right: 4th Left: 5th
49
What are the levels of the costodiaphragmatic recess?
8-11th intercostals; also known as phrenic angle
50
What are the innervations of the costoparietal, diaphragmatic and mediastinal pleura?
Costoparietal: intercostal nerves Diaphragmatic: phrenic nerve (C3,4,5) Mediastinal: phrenic nerve
51
What are the openings of the diaphragm?
Median arcuate ligament: aortic hiatus (opening for abdominal aorta) Caval opening: in central tendon (aponeurosis), opening for IVC Oesophageal opening: wrapped around right crura, situated in the left hemidiaphragm
52
What is the neurovasculature of the diaphragm?
Motor supply: phrenic nerve (mainly C4) | Blood supply: superior and inferior phrenic arteries + musculophrenic arteries + intercostal arteries
53
Which muscles are active in the inspiratory phase of quiet breathing?
1. Diaphragm 2. Scalenes: stabilise 1st rib 3. Intercostals: stiffen to prevent bellowing
54
Which are the inspiratory muscles?
External ics + parasternal intercostal muscles
55
What are the functions of the subcostal muscles and transversus thoracis?
Subcostal muscles: inspiration | Transversus thoracis: expiration
56
What are the functions of the sternocleidomastoid muscle and what is its innervation?
1. extends head, flexes neck 2. turns head 3. inspiratory muscle Innervation: CN XI
57
What are the functions of the scalene muscles and what is its innervation?
1. lateral flexion of the head 2. flexion of the neck 3. inspiratory muscle Innervation: cervical plexus
58
What are the accessory muscles of respiration?
Inspiration: 1. Pectoralis major: stabilising upper limb --> muscle of respiration, attaches to costal margins 6,7,8 up to sternum and humerus 2. Serratus anterior: attaches to scapula 3. Pectoralis minor: elevates ribs 2,3,4 or 3,4,5 Expiration: 1. Abdominal muscles: rectus abdominis, external oblique, IO, TA
59
Which muscles are active in the inspiratory phase of forced breathing?
1. Scalenes and sternocleidomastoid 2. Intercostals 3. Pec major and serratus anterior 4. erector spinae 5. lower limb stabilisation (quadratus lomborum)
60
Which muscles are active in the expiratory phase of quiet breathing?
1. Elastic recoil of lungs and gravity 2. Intercostals 3. Elevation of relaxed diaphragm
61
Which muscles are active in the expiratory phase of forced breathing?
1. Abdominal muscles 2. Intercostals 3. Elevated diaphragm 4. Latissimus dorsi and serratus posterior superior and inferior
62
How many divisions of the airway through the bronchi are there?
At least 23
63
What is the blood supply to the bronchi?
Pulmonary arteries and veins | Bronchial arteries: 2 or 3, supply O2 to non-exchanging parts of the pulmonary system
64
What connects the oral and nasal cavities?
The nasal pharynx
65
How many nasal sinuses are there and what type of epithelium is present?
4 sets, connected to the nasal cavity; pseudostratified ciliated columnar cells
66
How does the cough reflex work?
Laryngeal and tracheobronchial rapidly adapting irritant receptors, non-myelinated c-fibers: 1. bronchial submucosal glands 2. Ipsilateral vagus nerve --> cough centre in medulla --> efferents through phrenic and other somatic nerves, recurrent laryngeal, vagal efferents: a. expiratory muscles, larynx, trachealis, bronchial SM
67
What is the outside structure of the ring of the larynx?
1. epiglottis | 2. arytenoids: cartilage opposite to epiglottis
68
Which structures control the diameter of the ring in the larynx?
aryepiglottic folds and aryepiglottic muscles (contraction --> closing)
69
What is the function of the piriform recesses?
Channeling of fluid and food into the oesophagus
70
Which structures are contained inside the ring of the larynx?
Vestibular folds, vocal folds and glottis
71
What is the structure of the larynx?
Hyoid bone, thyrohyoid membrane, thyroid cartilage, cricothyroid membrane, cricoid cartilage
72
What is the innervation of the larynx?
Inferior vagal ganglion: 1. Superior laryngeal: internal (mucosa --> cough reflex above vocal cords), external 2. Left recurrent laryngeal: goes down to mediastinum, loops around aorta and goes back up for motor and sensory supply to trachea and larynx below vocal cords 3. Right recurrent laryngeal: loops around subclavian artery and goes back up
73
What are the levels of the cricoid and carina?
Cricoid: C6 Carina: T4/5
74
Where is the trachealis muscle situated and what is its nerve supply?
Fills space between cartilage and oesophagus, smooth muscle supplied by recurrent laryngeal
75
What are the levels of the pulmonary fissures?
Transverse fissure: 5th rib laterally and 4th costal cartilage anteriorly Oblique fissure: spine of T3 posteriorly to 6th costal cartilage
76
What is the characteristic of the LUL?
Lingula: anchored around bottom bit of the heart
77
What is the structure of the bronchopulmonary tree?
2 bronchi —> secondary bronchi (lobar bronchi: 2 on the left and 3 on the right) —> tertiary bronchus (supplies bronchopulmonary segments —> 10 in each lung (right: 3,2,5), vary on the left (5,5; might fuse))
78
What is the relationship of the lung hila to the other structures in the chest wall?
Posteriorly: oesophagus + descending aorta behind Anteriorly: heart right atrium On top: aortic arch and azygos vein
79
What is the lymphatic drainage of the lungs?
Intrapulmonary lymph nodes --> hilar lymph nodes --> inferior + superior tracheo-bronchial lymph nodes --> paratracheal lymph nodes --> bronchomediastinal lymph trunk LLL: both ipsi and contralateral
80
What is the innervation to the lungs?
Sympathetics: T1-T4 Parasymp: vagus: bronchoconstriction Anterior and posterior bronchial plexus around bronchial tree Bronchodilation: controlled by NO release from endothelial cells
81
How is the mediastinum divided?
Superior mediastinum: T4 up, sternal angle | Inferior mediastinum: anterior, middle and posterior
82
What are the first three branches of the aorta?
Brachiocephalic trunk, left common carotid artery, left subclavian artery
83
At what position does the aortic arch begin and end?
Level of sternal angle
84
Which structure is purely in the superior mediastinum?
Trachea
85
At what level does the oesophagus begin?
C6 --> cricoid cartilage
86
Where do the oesophageal plexuses sit?
Left in front, right in the back
87
How does the muscle in the oesophagus change?
Upper oesophagus: skeletal muscle | Lower oesophagus: smooth muscle
88
What are the constrictions of the oesophagus?
1. Cricoid (C6) 2. Arch of aorta (T4) 3. Left main bronchus (T5) 4. Left atrium (T6-10) 5. Oesophageal hiatus (T10)
89
What is the pathway of the phrenic nerve?
In between the subclavian artery and vein, anterior to the root of the lung
90
Which are the autonomic nerves of the chest?
``` Pulmonary plexus (T1-5) Cardiac plexus (T1-4) Oesophageal plexus (T2-6) ```

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