CardioResp Anatomy Flashcards
(146 cards)
1
Q
label the parts of the thoracic cage
A
2
Q
laterally, the manubrium articulates with the?
A
clavicle (collarbone) at the sternoclavicular joint, and with the first rib.
3
Q
the body of the sternum articulates with which ribs?
A
2 - 7
4
Q
the sternal angle articulates with which rib?
A
2
5
Q
● How many pairs of ribs are there?
A
12
6
Q
- The anterior parts of the ribs are composed of?
A
costal cartilage
7
Q
- The ribs articulate with their costal cartilages at [a] joints.
A
costochondral
8
Q
● Which ribs are ‘true’ ribs, ‘false’ ribs, and ‘floating’ ribs? Why are they called true, false and floating ribs?
A
1-7 = true (articulate with sternum directly)
8 -10 = false (unite and join at seventh costal cartilage)
11 - 12 = floating (do not articulate with sternum)
9
Q
● Posteriorly, what do the ribs articulate with? what are the joints called
A
thoracic vertebrae at costovertebral joints
10
Q
what are the typical ribs? describe them
A
- Ribs 3 - 9 are typical ribs. They have a head, neck, tubercle, and body (shaft).
- Ribs 1 - 2 and 10 - 12 are atypical
11
Q
how many thoracic vertebrae are there?
A
12
12
Q
what kind of vertebrae is this? HOw can you tell?
A
Cervical (C1-C7): have bifid (‘two-pronged’) spinous process, holes in the transverse processes (transverse foramen) and oval-shaped bodies. The vertebral foramen is triangular. The first two (C1 and C2) are uniquely modified for rotation of the head.
13
Q
what kind of vertebrae is this and how can you tell?
A
Thoracic (T1-T12): have long, sharp, downward-sloping spinous processes that overlap the vertebra below, additional articular facets for the attachment of ribs and heart-shaped bodies. The vertebral foramen is round.
14
Q
what kind of vertebrae is this? how can you tell?
A
Lumbar (L1-L5): have short, blunt spinous processes and extra-large, oval-shaped bodies to support the weight of the body. The vertebral foramen is triangular.
15
Q
what vertebrae are these
A
Sacral (S1-S5): fused into the sacrum, a triangular-shaped bone that sits in the posterior midline. It articulates with the left and right hip bones to form the bony pelvis.
Coccygeal (Co1-Co4): fused to form the coccyx, which is a vestigial remnant of what used to be a tail.
16
Q
● What are the joints between the vertebrae and ribs called?
A
costvertebral joiny
17
Q
at which dermatone is the umbilicus?
A
t10
18
Q
label the diagram of a breast
A
19
Q
what vessels supply the breast?
A
● internal thoracic artery (which arises from the subclavian artery)
● axillary artery.
Venous blood returns to the axillary and internal thoracic veins.
20
Q
The breast is supplied with somatic nerves and sympathetic fibres via the intercostal nerves.
Somatic sensory fibres innervate the [a] of the breast. Sympathetic fibres innervate [b] in the blood vessel walls and nipple.
A
skin
smooth muscle
21
Q
what are the five groups of lymph nodes in the axilla?
A
central, pectoral, humeral, subscapular, and apical.
● They drain the breast, upper limb, chest wall, scapular region, and the abdominal wall.
● The apical nodes (in the apex of the axilla) receive lymph from all other lymph nodes in the axilla. Because they drain most of the lymph from the breast, the axillary lymph nodes are often involved in the spread of breast cancer.
22
Q
what are the three layers of intercoastal muscle?
A
- External intercostal is most superficial.
- Internal intercostal lies deep to the external intercostal.
- Innermost intercostal lies deep to the internal intercostal.
23
Q
label these muscles
A
- sternocleidmastoid
- deltoid
- pectoralis major
- sternum
- biceps brachii
- -
- clavical
- subscapularis
- Pectoralis minor
- Serratus anterior
- humerus
24
Q
what are the intercostal muscles, what are their orientions and when are they used?
A
External intercostal
- antero-inferiorly, pulls ribs superiorly = inspirarion
Internal Intercostal
- postero-inferiorly, pulls ribs inferiorly = expiration
Innermost
- also postero-inferiorly
25
Where is the intercostal nerve bundle located?
between internal and innermost intercostal muscles
26
In medical procedures that involve piercing the intercostal space (such as placing a chest drain), the incision is made where? why?
middle to lower part of the intercostal space, to avoid the intercostal vessels and nerve.
27
blood supply to the intercostal muscles?
**Anterior and posterior intercostal arteries**
-anterior = from internal thoracic = subclavian
- posterior = descening aorta
## Footnote
* Anterior intercostal veins drain into the internal thoracic vein and posterior intercostal veins drain into the azygos system of veins – we will learn more about these later.
28
are the intercostal nerves somatic/autonomic?
The intercostal nerves are **somatic** and contain **motor** and **sensory** fibres. They innervate the intercostal muscles, the skin of the chest wall and the parietal pleura. Intercostal nerves also carry sympathetic fibres.
29
what are the two pleura of the lungs?
* The **parietal** pleura lines the inside of the thorax.
* The **visceral** pleura covers the surface of the lungs and extends into the fissures.
A very thin pleural cavity (or space) lies between the parietal and visceral pleura.
## Footnote
The parietal pleura is visible with the naked eye, but the visceral pleura is not. The two layers of pleura are continuous with each other. The pleural cells produce a small amount of pleural fluid, which fills the pleural cavity. The pleura and pleural fluid are integral to the mechanics of breathing.
30
Describe the innervation of the pleura of the lungs and how pain is felt
Parietal = Somatic sensory nerves (intercostal nerves) Very painful
Visceral = Autonomic sensory nerves - no conscious
31
how many lobes does the left and right lung have?
● The right lung has three lobes – a superior (upper), middle, and inferior (lower) lobe.
● The left lung has two lobes – a superior and inferior lobe. An anterior extension of the superior lobe – the lingula (Latin for ‘small tongue’) – extends over the heart.
32
label the lobes and fissures of the lung
## Footnote
* Costal surface
* Mediastinal surface -
* Diaphragmatic surface -
## Footnote
* Costal surface - adjacent to the ribs.
* Mediastinal surface - adjacent to the heart.
* Diaphragmatic surface - the inferior surface of the lung.
33
What structures enter and exit the lungs on the mediastinal surface?
Hilum: pulmonary artery, pulmonary veins and main bronchus enter and exit the lung.
34
The positions of the pulmonary artery and main bronchus relative to each other at the hilum is slightly different between the right and left lungs.
right =
left = ?
* At the hilum of the right lung, the pulmonary artery lies anterior to the main bronchus.
* At the hilum of the left lung, the pulmonary artery lies superior to the main bronchus.
## Footnote
At both the right and left hila, the two pulmonary veins are usually the most anterior and inferior vessels.
35
where does the trachea bifurcate?
Sternal Angle
T4 T5
=Carina
36
Which bromchus are foreign bodies more likely to enter? why?
Right Main Bronchus = lies more vertically
37
How many lobar (secondary) bronchi in each lung?
How many segmental (tertiary) bronchi in each lung?
Lobar = three in Right, two in Left
Segmental = 10 in each lung
38
how is it that a segment of the lung may be removed surgically without affecting the rest of the lung?
* Each segmental bronchus supplies a functionally independent region of the lung called a bronchopulmonary segment; there are ten segments in each lung. Because they are supplied by their own segmental bronchus and blood vessels, a segment may be resected (surgically removed) without affecting the rest of the lung.
39
walls of th trachea and bronchi vs walls of bronchioles?
The walls of the trachea and bronchi contain smooth muscle and cartilage, but the walls of bronchioles only contain smooth muscle
## Footnote
. Contraction and relaxation of the smooth muscle is under autonomic control.
40
blood supply of the lungs?
The pulmonary arteries carry deoxygenated blood to the lungs. Bronchial arteries from the descending aorta also supply the lungs.
The pulmonary veins return oxygenated blood to the heart from the lungs. Bronchial veins return blood to the azygos system of veins - we will learn more about these veins later.
41
Autonomic nerves innervate the lungs.
* Parasympathetic fibres stimulate: ?
* Sympathetic fibres: ?
Parasympathetic fibres stimulate:
* constriction of bronchial smooth muscle (bronchoconstriction)
* secretion from the glands of the bronchial tree.
Sympathetic fibres:
* stimulate relaxation of bronchial smooth muscle (bronchodilation)
* inhibit secretion from the glands.
42
● How many pulmonary arteries and veins enter / exit at the hilum?
One pulmonary artery
two pulmonary veins
43
what are the main apertures of the diaphram, at what level are they?
44
what happens to the diaphram during inspiration?
Contracts.
the muscle fibres of the right and left domes are pulled towards their peripheral attachments, and the domes flatten. This increases the intrathoracic volume for the lungs to expand.
45
what happens to the diaphram during expirarion?
relaxes and domes superiorly
This decreases the intrathoracic volume and drives expiration of air from the lungs.
46
innervation of the diaphram?
C3 C4 C5 phrenic nerves (somatic)
keep the diaphram alive
47
basic mechanical principles of expiration
The diaphragm and external intercostal muscles relax, and the internal intercostals contract, decreasing the intrathoracic volume (the internal intercostals pull the ribs inferiorly, and the ribs pull the sternum inferiorly and posteriorly, decreasing the AP and lateral dimensions of the thoracic cavity).
* The lungs recoil (decrease in volume).
* The pressure in the lungs increases above atmospheric pressure and air is expelled from the lungs.
48
explain what happens during inspiration
* The diaphragm and external intercostal muscles contract, increasing the intrathoracic volume (the external intercostals pull the ribs superiorly and laterally, and the ribs pull the sternum superiorly and anteriorly, increasing the AP and lateral dimensions of the thoracic cavity).
* The lungs expand (increase in volume) with the thoracic wall (due to surface tension).
* The pressure in the lungs decreases below atmospheric pressure and air is drawn into the lungs.
49
During ventilation, the dimensions of the thoracic cavity change in three planes:
* Vertically - due to the contraction and relaxation of the diaphragm.
* Laterally - due to contraction of the intercostal muscles which move the ribs.
* Antero-posteriorly (AP) – due to movement of the sternum secondary to movement of the ribs.
50
how does the pleural fluid assist ventilation?
The pleural fluid creates ** surface tension** between the parietal pleura lining the thoracic cavity and the visceral pleura on the surface of the lung.
Surface tension keeps the lung and thoracic wall ‘together’, so when the thoracic cavity changes volume, the lung changes volume with it. Surface tension between the two pleural membranes keeps them in contact with each other and prevents the lung from ‘collapsing’ away from the thoracic wall. If the surface tension is ‘broken’ (e.g. by a penetrating injury of the chest that punctures the parietal pleura and introduces air into the pleural cavity - pneumothorax) then ventilation may become dysfunctional.
51
what muscles are involved in normal, quiet breathing?
inspiration = mainly diaphram
expiration = elastic recoil
52
what muscles are involved in vigorous breathing? (exercise)
the intercostal muscles become important. Active expiration uses the internal intercostal muscles.
53
what muscles are important in forced breathing? (asthma COPD)
accessory muscles of breathing (sternocleidomastoid, pectoralis major and minor, serratus anterior) contribute to movement of the ribs and aid ventilation. The anterior abdominal wall muscles contribute to forced expiration.
54
label what you can on this normal chest xray
55
uh oh whats this?
complete pneumothorax
56
● What imaginary line separates the superior mediastinum from the inferior mediastinum?
The ‘line’ between these compartments runs from the sternal angle anteriorly to the T4/T5 junction posteriorly.
57
ABCS
58
what is the Ligamentum arteriosum
The ligamentum arteriosum is a fibrous, cord-like connection between the pulmonary trunk and the arch of the aorta. It is the remnant of the ductus arteriosus, a foetal circulatory shunt.
59
* The SVC is formed by the union of?
* The SVC is formed by the union of the left and right brachiocephalic veins (brachium = arm; cephalic = head).
60
describe the course of the left and right recurrent laryngeal nerve
* The **left** recurrent laryngeal nerve loops under the **arch of the aorta** before ascending back up the left side of the neck (alongside the trachea) to the larynx.
* The **right** recurrent laryngeal nerve descends anterior to the **right subclavian artery** and then loops under the inferior border of the artery before ascending back up the right side of the neck (between the trachea and oesophagus) to the larynx.
## Footnote
cricothyroid = superior laryngeal nerve
all other intrinsic larynx = recurrent laryngeal nerve
61
what is the thoracic duct?
The thoracic duct is a major channel for lymphatic drainage from most regions of the body. It ascends through the posterior mediastinum and into the superior mediastinum, where it empties into the venous system at the union of the left internal jugular vein and left subclavian vein.
62
what is the thymus gland?
The thymus is a lymphoid organ. It lies anteriorly in the superior mediastinum. It is important in children, but atrophies with age, eventually becoming fatty. We will not see the thymus in the cadavers.
63
name the layer of the pericardium from in to out
64
The surfaces correspond to specific parts of the heart, as summarised below:
* Base / posterior surface =
* Inferior / diaphragmatic surface =
* Anterior / sternocostal surface =
* Left pulmonary surface =
* Right pulmonary surface =
The surfaces correspond to specific parts of the heart, as summarised below:
* Base / posterior surface = left atrium, part of the right atrium
* Inferior / diaphragmatic surface = left ventricle, part of the right ventricle
* Anterior / sternocostal surface = right ventricle
* Left pulmonary surface = left ventricle
* Right pulmonary surface = right atrium
65
# [](http://)
what chambers make up the borders of the heart?
* Right border = right atrium
* Left border = left ventricle
* Inferior border = right ventricle and part of the left ventricle.
66
What are the branches of the RCA?
RMA -
PDA/PIV -
67
what are the branches of the LCA?
LAD
LCx --> LMA
68
which coronary artery supplies the SA node and AV node?
Right Coronary Artery (normally)
69
RMA supplies?
inferior border
## Footnote
R ventricle, Apex
70
PIV (/PDA supply)
Both ventricles
71
LAD (Anterior IV) supplies?
both ventricle
72
Cx supplies?
L Atrium, part of R Ventricle, L Ventricle
73
LMA supplies?
left ventricle
74
what does Anatomical Variation: Right-dominant and Left-dominant Circulation mean?
Where the PIV arises from.
70-80% = Right Coronary Artery
5-10% = Left Coronary Artery
10-20%= codominant
75
what would happen if someone with Left-dominant coronary circulation had a blokage of left main stem?
In someone with a left-dominant coronary circulation, blockage of the left main stem occludes blood flow to the entire left ventricle.
76
what do the valves of the heart do?
ensure unidirectional flow
77
label the anatomy of the right atrium
* interatrial septum which separates it from the left atrium
* fossa ovalis – a depression in the interatrial septum. It is the remnant of the foetal foramen ovale. In the foetus the foramen ovale shunts oxygenated blood from the right atrium to the left atrium, hence bypassing the lungs.
* crista terminalis – a muscular ridge that separates the smooth-walled posterior part of the atrium from the anterior part, which has a ridged, muscular wall. The ridges are pectinate muscles and extend into the right auricle. The parts of the right atrium on either side of the crista have different embryological origins.
78
# *
label the chambers of the heart and its valves
79
label the features of the Left ventricle
* trabeculae carneae – muscular ridges on the internal wall
* papillary muscles – modified regions of trabeculae carneae, which project into the lumen of the ventricle
* chordae tendineae – fibrous cords which connect the tips of the papillary muscles to the tricuspid valve
80
what are the muscular ridges of the walls of ventricles called?
trabeculae carnae
81
fibrous cords which connect the tips of the papillary muscles to the valve?
chordae tendinae
82
what are the paillary muscles in the ventricles?
modified regions of trabeculae carneae, which project into the lumen of the ventricle
83
where can heart sounds be ausculated?
* Aortic = 2nd intercostal space, just to the right of the sternum.
* Pulmonary = 2nd intercostal space, just to the left of the sternum.
* Tricuspid = 5th intercostal space, just to the left of the sternum.
* Mitral = 5th intercostal space, left midclavicular line.
(all patients take medicine)
84
what is the "pacemaker" of the heart?
where is it located?
Sinoatrial nerve
superior end of crista terminalis
85
describe the course of the conducting system
86
what supples the bundle of His in most people?
LCA
87
* [a] stimulation increases the heart rate and force of contraction.
* [b] stimulation slows the heart rate and force of contraction.
* Sympathetic stimulation increases the heart rate and force of contraction.
* Parasympathetic stimulation slows the heart rate and force of contraction.
88
describe how pain in the heart is felt?
Visceral afferent fibres convey sensory information from the heart back to the CNS. Usually, this sensory information doesn’t reach our conscious perception. However, if the myocardium is ischaemic, this visceral sensory information is relayed back to our conscious perception and may be perceived as pain, burning, tightness or pressure in the chest. Typically, the pain cannot be pinpointed, but is felt generally in the chest, the left side of the neck and / or the left arm. This is called referred pain.
89
aorta passes the diaphram at what level?
T12
90
The azygos system of veins arises in the abdomen at the level [a] and traverses the diaphragm to enter the posterior mediastinum. It drains blood from the posterior thoracic wall and returns it to the [b].
L1-L2
SVC
91
explain the nervous system
92
do the sympathetic ganglia lie closer to the CNS than target organs or further?
93
where (preganglionic) sympatheetic fibres arise from?
how are they then distributed to all parts of the body?
T1-L2/3
Distributed to all parts of the body via they sympathetic trunk
[https://www.youtube.com/watch?v=SVm4YSH9Sns](http://)
94
what do pregangliomnic sympathetic fibres do after leaving the spinal chord at t1-L3 upon entering the sympathetic trunk?
1. synapses in the ganglion at its level of entry (see Figure 1)
2. ascends or descends in the trunk before synapsing in a ganglion sacral or cerviacl spine (no sympathetic fibres) ((see Figure 2)
3. travels through a ganglion (and the trunk) without synapsing (splanchnic nerve) (see Figure 3).
## Footnote
[https://www.youtube.com/watch?v=SVm4YSH9Sns](http://)
95
sympathetic and parasympathetic nerve supply to thoracic viscera?
* The cardiopulmonary splanchnic nerves convey postganglionic sympathetic fibres to the thoracic viscera.
* The vagus nerves convey parasympathetic fibres to the thoracic viscera.
96
what autonomic nerve plexuses can be fuond in the thorax? what do they innervated?
**The cardiac plexus** innervates the sinoatrial node of the heart. Sympathetic fibres increase the heart rate and force of contraction, whilst parasympathetic fibres decrease the heart rate and force of contraction.
**The pulmonary plexus** innervates the bronchi. Sympathetic stimulation relaxes the bronchi and parasympathetic stimulation constricts them.
**The oesophageal plexus** overlies the anterior surface of the oesophagus. Sympathetic fibres inhibit peristalsis and parasympathetic fibres stimulate peristalsis.
97
why is cardiac pain felt as referred pain ( in central chest, left neck and left arm?
* The heart is innervated by the **cardiac plexus,** composed of sympathetic and parasympathetic fibres. The sympathetic fibres travel to the cardiac plexus and heart from spinal cord segments T1 -T5 via the cardiopulmonary splanchnic nerves.
* The heart is also innervated by visceral sensory nerves, which convey sensory information from the heart back to the CNS - this sensation normally does not reach our conscious perception. However, if the myocardium is ischaemic this sensation does reach our conscious perception, and is interpreted as pain, tightness, crushing pressure or burning, which may be severe.
* Because the visceral sensory nerves travel back to the CNS alongside the sympathetic fibres that innervate the heart, the visceral sensory information enters spinal cord segments T1 - T5.
* However, somatic sensory information from the skin of the chest wall, neck and arm also returns to spinal cord segments T1 - T5.
* Therefore painful visceral sensory information from the heart and somatic sensory information from the chest wall both enter spinal cord segments T1 - T5. For reasons that are not fully understood, the brain interprets the cardiac pain as coming from the chest, neck, and arm.
98
why is pain in the diaphram felt in the shoulder?
C345 contribute spinal nerve fibres to the phrenic nerve. Cord segments C3-5 also contribute to the nerves that innervate the skin of the neck and shoulder. The brain interprets pain coming from the diaphragm as coming from the shoulder region.
99
What structures can be found in the anterior triange?
* **the trachea and larynx**
* the thyroid **gland**, parathyroid glands, and the submandibular salivary gland
* **the suprahyoid muscles** which connect the hyoid to the skull. They form the floor of the mouth and move the hyoid and larynx in speech and swallowing.
*** the infrahyoid muscles.** Also called the ‘strap’ muscles, they connect the hyoid to the sternum and scapula. They move the hyoid and larynx in speech and swallowing.
* **the common carotid** artery and its terminal branches (the external and internal carotid arteries)
* branches of the** external carotid** artery to the head and neck
* the** internal jugular vein**
* branches of the facial nerve (CN VII), glossopharyngeal (IX) , the vagus nerve (CN X), and the hypoglossal nerve (CN XII).
* the ansa cervicalis (fibres from C1-C3 which innervate the infrahyoid muscles).
## Footnote
ten toads sing in chours, excellent indeed
100
what berves run through the neck?
VII
IX
X
XI
XII
phrenic
101
what structures can be found in the posterior triangle?
* part of the subclavian artery and the subclavian vein
* the external jugular vein which drains the scalp and face
* the accessory nerve (CN XI)
* the roots of the brachial plexus (spinal nerves that supply the upper limb)
* the cervical plexus (fibres from C1-4)
* the phrenic nerve.
| SPACEB
102
what do the Suprahyoid and Infrahyoid muscles do?
Suprahyoid: raise the hyoid and larynx during speech and swallowing
Infrahyoid: draw hyoid and larynx inferiorly during speech and swallowing
103
label the parts of abd blood supply to the thyroid gland
* left and right superior thyroid arteries - branches of the external carotid arteries.
* left and right inferior thyroid arteries - branches of the thyrocervical trunks (which in turn are branches of the subclavian artery).
## Footnote
Superior, middle, and inferior thyroid veins drain the thyroid gland.
104
how many parathayroid glands are there?
4 - left right superior ingerior
supplie by inferior thryroid arteries
105
what does the internal carotid artery supply?
the brain
106
what does the external carotid artery supply?
gives rise to several branches that supply the head and neck, including the pharynx, scalp, thyroid gland, tongue, and the face.
107
* At the point of bifurcation of the common carotid artery there is a small swelling - the [a]. [b] here constantly monitor arterial blood pressure. This visceral sensory information is relayed back to the CNS via the [c] nerve and results in reflex responses that regulate the blood pressure.
[a] carotid sinus
[b] baroreceptors
[c] glossopharyngeal
108
The [a] is a major vein in the neck, which drains blood from the brain and part of the face.
* It unites with the [b] vein, which returns blood from the upper limb, to form the [c] vein.
* The right and left brachiocephalic veins unite to form the [d].
The [d] vein drains blood from the scalp and face. It joins the subclavian vein.
internal jugular
subclavian
brachiosephalic
superior vena cava
external jugular vein
109
facial nerve CN VII supplies the?
platysma in the neck
110
the glossopharyngeal nerve CN IX supplies sesnsory innervation tothe?
* pharynx (sensory innervation)
* carotid sinus (visceral sensory fibres that return to the CNS via CN IX)
111
the vagus nerve CN X supplies hwat that is vital for speech and swallowing?
* the muscles of the pharynx (motor innervation)
* the larynx (motor and sensory innervation)
112
the accessory nerve CN XI supplies what in the neck?
sternocleidomastoid and trapezius muscles.
113
the hypoglossal nerve CN XII supplies what in the neck?
It does not supply any structures in the neck but travels through it. It lies lateral to the internal carotid artery and deep to the external jugular vein.
**motor to the tongue**
114
label the parts of the pharynx
115
where are the pahryngeal and tubal tonsils found?
nasopharynx
* The pharyngeal and tubal tonsils are found in the nasopharynx.
* The pharyngeal tonsil (adenoid) lies in the roof of the nasopharynx.
* The tubal tonsil surrounds the opening of the auditory tube (which connects the nasopharynx to the middle ear - we will come back to this in a later session).
116
where are the palatine tonsils found?
* The palatine tonsil lies next to the pharyngeal wall in the oropharynx.
117
where are the lingual tonsild found?
* The lingual tonsil is a collection of lymphoid tissue on the posterior aspect of the tongue.
118
lable the different tonsils
119
sensory innervation of pharynx
motor?
sensory = glossopharyngeal nerve
motor = vagus
120
explain how a gag reflex works
what could haooen after a stroke?
The gag reflex protects the airway. It is mediated by the glossopharyngeal and vagus nerves. When the back of the mouth, posterior wall of the pharynx or the tonsils are stimulated, this sensation is carried to the CNS via the glossopharyngeal nerve. In response, the muscles of the soft palate and pharynx immediately contract (via motor fibres in the vagus nerve). This reflex does not occur in normal swallowing but does occur at any other time the posterior mouth or pharynx are touched (e.g. swabbing the tonsils).
Swallowing difficulties after a stroke
If a stroke affects the regions of the brain involved in the control of swallowing, then patients may have swallowing difficulties. In normal swallowing, the vagus nerve coordinates contraction of the pharyngeal muscles and soft palate and conveys sensation from the larynx, whilst the glossopharyngeal nerve provides sensory innervation to the pharynx. If these pathways are interrupted, swallowing is dysfunctional, and loss of sensation impairs the cough reflex. Patients are at risk of ‘aspiration’ – swallowed liquid or food may pass into the lungs and cause infection.
121
122
label the cartilages of the larynx (pink)
| three unpaired, three paired
123
Label the parts of the vocal chords:
1. vestibular folds ( false vocal chords)
2. vocal folds (mucus membrane)
+
3. vocal ligament = true vocal chords
4. Rima glottis (space between tru vocal chords)
124
How does the rima glottis open/close?
which is required for Phonation and which is the opposite required for?
**Adduction** of true vocal chords **closes** the rima glottis
(abduction opens)
* Phonation requires adduction of the cords and closure of the rima glottidis.
* Abduction of the cords opens the rima glottidis:
-to a small degree in whispering
-partially in normal breathing
-fully in forced breathing.
125
what are the extrinsic muscles of the larynx and what do they do?
the suprahyoid and infrahyoid muscles. They do not move the individual cartilages, but rather move the larynx as one with speech and swallowing.
126
what do the intrinsic muscles of the larynx do?
move the laryngeal cartilages which in turn move the vocal cords. Injury to the nerves that innervate the intrinsic laryngeal muscles therefore affect speech.
127
what do the cricothyroid muscles do?
Contraction of this muscle places tension on the vocal cords.
128
which of the intrinsic muscles of the cartilage open the rima glottidis and which close it?
posterior cricoarytenoids = abduct vocal chord and open rima glottidis
transverse arytenoid = adduct vocal chords and close rima glottidis
129
what does the recurrent laryngeal nerve innervate?
all the intrinsic muscles except for the cricothyroid and is sensory to the larynx below the vocal folds.
130
what does the superior laryngeal nerve innervate?
cricothyroid muscle and is sensory to the larynx above the vocal folds
131
where is an emergency airway made?
cricothryoid membrane
132
The lateral wall of the nasal cavity bears three projections of bone, the superior, middle, and inferior [a] (Latin = shell), or [a1].
● The spaces inferior to them are the [b]
● As inspired air travels through them, it is warmed, humidified, and filtered.
The lateral wall of the nasal cavity bears three projections of bone, the superior, middle, and inferior conchae (Latin = shell), or turbinates.
● The spaces inferior to them are the meatuses: the superior meatus lies inferior to the superior concha; the middle meatus lies inferior to the middle concha and the inferior meatus lies inferior to the inferior concha.
● As inspired air travels through the meatuses it is warmed, humidified, and filtered.
133
The nasal cavity is separated from the cranium and the brain by the [a] which is a delicate section of bone that is perforated with tiny holes (like a sieve). Mucosa in the upper part of the nasal cavity contains [b].
The nasal cavity is separated from the cranium and the brain by the **cribriform plate**. The cribriform plate is a delicate section of bone that is perforated with tiny holes (like a sieve). Mucosa in the upper part of the nasal cavity contains **olfactory receptors**. The axons of these receptors form olfactory nerves which travel through these perforations to the brain.
134
label the paranasal sinuses
135
The paranasal sinuses communicate with the nasal cavity via small ducts / channels.
● The frontal sinus drains into the [a]
● The sphenoid sinus drains into the [b]
● The ethmoid air cells drain into [c]
● The maxillary sinus drains into the [d] – the opening into the of which lies superomedially, therefore it cannot drain feely when the head is upright.
The paranasal sinuses communicate with the nasal cavity via small ducts / channels.
● The frontal sinus drains into the middle meatus.
● The sphenoid sinus drains into the spheno-ethmoidal recess.
● The ethmoid air cells drain into the superior and middle meatuses.
● The maxillary sinus drains into the middle meatus – the opening into the middle meatus lies superomedially, therefore it cannot drain feely when the head is upright.
## Footnote
The nasal cavity also receives the nasolacrimal duct which drains the fluid (‘tears’) that lubricate the anterior surface of the eye. The duct opens into the inferior meatus. When we cry, we get a runny nose because excess fluid runs down the nasolacrimal duct.
136
what connects the middle ear to the nasopharynx.
The auditory tube (Eustachian tube) connects the middle ear to the nasopharynx.
137
● Frontal sinuses lie within [a]
● Ethmoid air cells lie within the [b]
● Sphenoid sinuses lie within the [c]
● Maxillary sinuses lie within the [d]
● Frontal sinuses lie within the anterior part of the frontal bone.
● Ethmoid air cells lie within the ethmoid bone (superior to the nasal cavity and medial to the orbits).
● Sphenoid sinuses lie within the sphenoid bone.
● Maxillary sinuses lie within the maxillae of the facial skeleton.
138
what happens to the soft palate during swallowing?
muscles of the soft palate contract during swallowing which elevates the soft palate. The nasopharynx is closed off from the oral cavity, preventing reflux of food and fluid into the nasal cavity. The muscles of the soft palate are innervated by the vagus nerve.
139
how many teeth do adults have?
● Adults have 32 teeth – 16 embedded in the maxilla (upper jaw) and 16 embedded in the mandible (lower jaw).
● In the upper and lower jaws there are four incisors, two canines, four premolars and six molars.
140
141
The space between the posterior tongue and the anterior aspect of the epiglottis is the
vallecula
142
what do the intrinsic and extrinsic muscles of the tongue do?
what are they innervated by (motor)?
intrinsic = change the shape of the tongue
extrinsic = move the tongue
The muscles are innervated by the hypoglossal nerve (CN XII).
143
what are the three cranial nerves that provide sensory innervation to the tongue?
Trigeminal (**CN V**) = General sensation (touch, pain, temperature) in the anterior two thirds
Facial (**CN VII**) = Taste in the anterior two thirds
Glossopharyngeal (**CN IX**) = Taste and general sensation in the posterior third
144
Secretion from the parotid gland is stimulated by parasympathetic fibres in which nerve?
Secretion from the parotid gland is stimulated by parasympathetic fibres in the glossopharyngeal nerve.
145
Secretion from the submandibular and sublingual glands are stimulated by parasympathetic fibres in which nerve?
Secretion in sublingual and submandibular gland is stimulated by parasympathetic fibres in the facial nerve.
146
label the three slavivary glands (corrisponding ducts circled)
