Exam II Flashcards
1
Q
The larynx is primarily made of what type of cartilage?
A
Hyaline
2
Q
What are the functions of the larynx?
A
- Prevents the passage of food into the airway during swallowing
- Regulates the flow of air into the lungs
- Functions in vocalization
3
Q
What levels of the spinal column is the larynx located?
A
Between C3 and C6
4
Q
This is a single cartilage of the larynx which presents the superior thyroid notch, inferior thyroid notch, anterior medial elevation, superior horn, inferior horn , laminae, and oblique line.
A
Thyroid cartilage
5
Q
This feature of the thyroid cartilage of the larynx is also called the laryngeal prominence.
A
Anterior median elevation
6
Q
This feature of the thyroid cartilage of the larynx attaches to the greater horn of the hyoid bone.
A
Superior horn
7
Q
This feature of the thyroid cartilage of the larynx articulates with the cricoid cartilage.
A
Inferior horn
8
Q
This feature of the thyroid cartilage of the larynx is located on the external surface of the lamina and provides attachment for the inferior constrictor, sternothryoid, and thyrohyoid muscles.
A
Oblique line
9
Q
This is a single cartilage of the larynx, which is shaped like a signet ring. It consists of a narrow anterior arch and a broad, posterior lamina. It is the most inferior of the laryngeal cartilages.
A
Cricoid cartilage (C6 level)
10
Q
This is a single spoon-shaped cartilage of the larynx, which lies behind the root of the tongue and body of the hyoid bone.
A
Epiglottic cartilage
11
Q
The lower end of the epiglottic cartilage is attached to the back of the laryngeal prominence of the thyroid cartilage by what structure?
A
Thyroepiglottic ligament
12
Q
These are paired cartilages of the larynx that are pyramidal in shape. Their bases articulate with the cricoid cartilage and each one presents a vocal and muscular process.
A
Arytenoid cartilages
13
Q
The vocal process of the arytenoid cartilages give attachment to what structure? Muscular process?
A
Vocal ligament; intrinsic muscles of the larynx
14
Q
These are paired cartilages of the larynx which lie on the apices of the arytenoid cartilages, and are closed within the aryepiglottic folds.
A
Corniculate cartilages
15
Q
These are paired cartilages of the larynx which lied in the aryepiglottic folds anterior to the corniculate cartilages.
A
Cuneiform cartilages
16
Q
What two cartilages of the larynx have the potential to ossify and be mistaken as a fracture on an X-ray?
A
Corniculate and cuneiform cartilages
17
Q
This is a synovial joint of the larynx between the side of the cricoid cartilage and the inferior horn of the thyroid cartilage. It permits rotation of the thyroid cartilage around a horizontal axis.
A
Cricothyroid joint
18
Q
This is a synovial joint of the larynx between the upper border of the cricoid cartilage and the base of thd arytenoid cartilage. It permits gliding and rotation of the arytenoid cartilage on the cricoid cartilage.
A
Cricoarytenoid joint
19
Q
This is a ligament of the larynx that extends from the thyroid cartilage to the hyoid bone. It is pierced on each side by the internal laryngeal nerve and the superior laryngeal vessels.
A
Thryohyoid membrane
20
Q
This is a ligament of the larynx that extends from the arch of the cricoid cartilage to the thyroid cartilage.
A
Median cricothyroid ligament
21
Q
This is a ligament of the larynx that extends from teh thyroid cartilage in front to the vocal process of the arytenoid cartilage behind.
A
Vocal ligament
22
Q
This is a ligament/fibroelastic membrane of the larynx which extends upward from the cricoid cartilage to the vocal ligament. The vocal ligament forms the free edge of this membrane.
A
Conus elasticus (cricovocal membrane, lateral cricothyroid ligament)
23
Q
This is a ligament of the larynx which connects the epiglottic cartilage to the arytenoid cartilage on each side.
A
Quadrangular membrane
24
Q
This margin of the quadrangular membrane of the larynx form the aryepiglottic ligament within the aryepiglottic fold.`
A
Superior margin
25
This margin of the quadrangular membrane forms the vestibular ligament within the vestibular ligament.
Inferior margin
26
What are the two pairs of folds within the larynx?
- Vestibular folds (false vocal cords, protective in function and initiates the cough reflex)
- Vocal cords (true vocal cords)
27
This is the space between the vestibular folds.
Rima vestibuli
28
This is the space between the vocal folds. It is the narrowest part of the laryngeal cavity.
Rima glottidis
29
This includes the rima glottidis and vocal folds.
Glottis
30
The larynx is divided into three cavities by the vestibular and vocal folds, what are they?
Laryngeal vestibule: extends from the laryngeal inlet to the vestibular folds
Laryngeal ventricles: lie between the vestibular folds and vocal folds
Infraglottic cavity: extends from the vocal folds to the inferior border of the cricoid cartilage
31
This is a small diverticulum within the laryngeal ventricle. It contains glands which lubricate the vocal folds. It has been called the "oil can" of the vocal folds.
Laryngeal saccule
32
What are the elevators of the larynx?
Thyrohyoid, stylohyoid, mylohyoid, digastric, stylopharyngeus, palatopharyngeus
33
What are the depressors of the larynx?
Omohyoid, sternohyoid, and sternothryoid
34
The elevators and depressors of the larynx can be considered what type of muscles?
Extrinsic muscles of the larynx
35
What are the intrinsic muscles of the larynx (important for speech)?
Cricothyroid, posterior cricoarytenoid, lateral cricoarytenoid, transverse arytenoid, oblique arytenoid, aryepiglottic, thyroepiglottic, thyroarytenoid, and vocalis
36
What is the origin of the cricothyroid muscle?
Cricoid cartilage
37
What is the insertion of the cricothryoid muscle?
Inferior horn and lower lamina of the thyroid cartilage
38
What is the innervation of the cricothyroid muscle?
External laryngeal nerve
39
What is the function of the cricothyroid muscle?
Tilts the thyroid cartilage downward or cricoid cartilage upward thereby tensing the vocal cords and raising the pitch of the voice.
40
What is the origin of the posterior cricoarytenoid muscle?
Posterior surface of the lamina of the cricoid cartilage
41
What is the insertion of the posterior cricoarytenoid muscle?
Muscular process of arytenoid cartilage
42
What is the innervation of the posterior cricoarytenoid muscle?
Muscular process of arytenoid cartilage
43
What is the function of the posterior cricoarytenoid cartilage?
Abducts the vocal folds
44
What is the neutral position of the vocal folds? Why?
They are partially abducted to reduce the risk of suffocation
45
What is the origin of the lateral cricoarytenoid muscle?
Arch of the cricoid cartilage
46
What is the insertion of the lateral cricoarytenoid muscle?
Muscular process of arytenoid cartilage
47
What is the innervation of the lateral cricoarytenoid muscle?
Recurrent laryngeal nerve
48
What is the function of the lateral cricoarytenoid muscle?
Adducts the vocal cords and functions in whispering
49
What is the origin of the transverse arytenoid muscle?
Posterior surface of the arytenoid cartilage
50
What is the insertion of the transverse arytenoid muscle?
Posterior surface of the opposite arytenoid cartilage
51
What is the innervation of the transverse arytenoid muscle?
Recurrent laryngeal nerve
52
What is the function of the transverse arytenoid muscle?
Adducts the vocal folds and functions in coughing to clear the airway
53
What is the origin of the oblique arytenoid muscle?
Muscular process of arytenoid cartilage
54
What is the insertion of the oblique arytenoid muscle?
Apex of the opposite arytenoid cartilage
55
What is the innervation of the oblique arytenoid muscle?
Recurrent laryngeal nerve
56
What is the function of the oblique arytenoid muscle?
Adducts the vocal folds
57
What is the origin of the aryepiglottic muscle?
Apex of the arytenoid cartilage
58
What is the insertion of the aryepiglottic muscle?
Side of the epiglottic cartilage
59
What is the innervation of the aryepiglottic muscle?
Recurrent laryngeal nerve
60
What is the function of the aryepiglottic muscle?
Closes the laryngeal inlet
61
The aryepiglottic muscle is a continuation of the ____ and lies within the aryepiglottic fold.
Oblique arytenoid
62
What is the origin of the thyroepiglottic muscle?
Inner surface of the thyroid lamina
63
What is the insertion of the thyroepiglottic muscle?
Lateral margin of the epiglottis
64
What is the innervation of the thyroepiglottic muscle?
Recurrent laryngeal nerve
65
What is the function of the thyroepiglottic muscle?
Opens the laryngeal inlet
66
What is the origin of the thyroarytenoid muscle?
Inner surface of the thyroid lamina
67
What is the insertion of the thyroarytenoid muscle?
Arytenoid cartilage
68
What is the innervation of the thyroarytenoid muscle?
Recurrent laryngeal nerve
69
What is the function of the thyroarytenoid muscle?
Shortens and relaxes the vocal folds by drawing the arytenoid cartilages forward.
70
What is the origin of the vocalis muscle?
Inner surface of the thyroid lamina
71
What is the insertion of the vocalis muscle?
Vocal process of arytenoid cartilage
72
What is the innervation of the vocalis muscle?
Recurrent laryngeal nerve
73
What is the function of the vocalis muscle?
Adjusts the tension of the vocal cords during phonation. Fine tuning control of the vocal cords
74
The size and shape of the rima glottidis is altered during phonation and respiration by movements of what?
Artenoid cartilages
75
The rima glottidis is ___ during inspiration, and ___ during expiration and phonation.
Wide; narrow and wedge shaped
76
Voice dimorphism is determined by what three factors?
- Length of the vocal cords
- Size of resonating chambers
- Thickness of the vocal cords (have androgen receptors)
77
This nerve is motor to all of the intrinsic muscles of the larynx except the cricothyroid. It is sensory to the mucosa of the larynx below the vocal fold.
Recurrent laryngeal nerve
78
This is a branch of the superior laryngeal nerve. It is sensory to the mucosa of the larynx above the vocal folds. Along with the superior laryngeal artery it pierces the thyrohyoid membrane to enter the larynx.
Internal laryngeal nerve
79
This is the other branch of the superior laryngeal nerve. It is motor to the cricothyroid and inferior constrictor muscles.
External laryngeal nerve
80
What two arteries primarily supply the larynx?
- Superior laryngeal artery from the superior thyroid artery
| - Inferior laryngeal artery from the inferior thyroid artery
81
What are the three main functions of the lymphatic system?
- It picks up protein molecules from tissue fluid which are too large to pass through capillaries and transports them to the bloodstream
- It returns excess tissue fluid to the bloodstream
- It produces lymphocytes
82
These are swellings found along the lymphatic system. They produce lymphocytes and acct as filters for the lymph, preventing foreign bodies from entering the bloodstream.
Lymph nodes
83
These vessels drain lymph to a node.
Afferent lymph vessels
84
These vessels drain lymph from a node.
Efferent lymph vessels
85
What are the superficial lymph nodes of the head?
Occipital: apex of the posterior triangle
Mastoid: over the mastoid process
Parotid: in front of the ear on the surface of the parotid gland
86
What are the superficial lymph nodes of the neck?
Submandicular: submandibular triangle
Submental: submental triangle
Anterior cervical
Superficial cervical: chain of nodes on the external surface of the SCM and follows the course of the external jugular vein.
87
How is lymph moved throughout the body?
Skeletal muscle contractions
- Exercise clears toxins from tissue
- Health benefits of massage
88
Where are the deep cervical nodes located?
Within the carotid sheath and they follow the course of the internal jugular vein
89
What are the two largest deep cervical nodes?
- Jugulodigastric node
| - Jugulo-omohyoid node
90
This deep cervical node drains the tongue and the palatine tonsils. It is found near the posterior belly of the digastric muscle.
Jugulodigastric node
91
This deep cervical node also drains the tongue and is found near the intermediate tendon of the omohyoid.
Jugulo-omohyoid node
92
All lymphatics of the head and neck drain either directly or indirectly into what?
The deep cervical nodes
93
This lymphatic vessel drains into the junction between the internal jugular and subclavian veins.
Right jugular trunk
94
This is the larges lymphatic vessel in the body and drains into the junction between the internal jugular and subclavian veins.
Left jugular trunk
95
Afferents of these lymph nodes drain the central portions of the lower lip, the floor of teh mout, adn the tip of the tongue.
Submental nodes
96
Afferents of these lymph nodes drain the cheek, the side of the nose, the upper lip, the lateral part of the lower lip, the gums, and the margin of the tongue.
Submandibular nodes
97
This term refers to the spread of cancer via the lymphatic system.
Lymphogenous metastasis
98
This is an enlarge supraclavicular node, usually on the left side and is often the first indication of a visceral tumor of teh thorax or abdomen.
Signal (Sentinel) node
99
This is a primary tumor of the lymph nodes. It has Hodgkin's and Non-Hodgkins variants.
Lymphoma
100
If a lymph node is tender or painful upon palpating, what does this indicate? If its hard and painless?
It indicates infection; it indicates cyst development or cancer
101
The breast is an epidermally derived structure which consists of what parts?
Mammary glands, fat, fibrous tissue
102
This is a vertical line dividing the armpit into anterior and posterior halves.
Midaxillary line
103
This is a ring of pigmented skin which surrounds the nipple.
Areola
104
This is the portion of the breast which extends back into the armpit. This is a frequent site for cancer.
Axillary process (tail)
105
These are strong fibrous septa which support the breast and which run through the breast from the skin to the deep layer of superficial fascia.
Suspensory ligaments
106
This is a modified sweat gland located in the superficial fascia of the breast. Each gland has 15 to 20 lobes of glandular tissue which open onto the tip of the nipple through a lactiferous duct.
Mammary gland
107
This is an expansion of the lactiferous duct, which serves as a reservoir for milk during lactation.
Lactiferous sinus
108
What is the blood supply to the breast?
- Internal thoracic artery
- Thoracoacromial artery
- Lateral thoracic artery
- Intercostal arteries
109
What is the lymphatic drainage of the breast?
- Axillary nodes (75% drain from these nodes)
- Parasternal nodes
- Nodes of the opposite breast
- Nodes of the anterior abdominal wall
110
What are the clinical signs of breast cancer?
- Dimpling (due to invasion of suspensory ligaments)
- Inverted nipple (due to invasion of lactiferous ducts)
- Leathery thickening of the skin (like an orange)
111
Chiropractic Note: Breast cancer is one cause of _____ in a female.
Mid thoracic back pain
112
This bone of the thoracic wall contains bone marrow and is a major site of red blood cell production.
Sternum
113
This is the widest and thickest part of the sternum. Its upper border forms the jugular notch.
Manubrium
114
This part of the sternum articulates with the second to seventh costal cartilages.
Body
115
This part of the sternum is cartilaginous at birth and slowly ossifies throughout life. It is a site of muscle attachment for the diaphragm and rectus abdominus and is sometimes broken during CPR.
Xiphoid process
116
What are some structural variations that the xiphoid process can exhibit?
- Bifid xiphoid process
| - Xiphoid foramen
117
The articulation of the manubrium with the body of the sternum forms what feature?
Sternal angle
118
The sternal angle is found at the level of the intervertebral disc between what vertebrae?
T4 and T5
119
What condition can result in a larger sternal angle (Barrel chest)?
COPD
120
What is the superior thoracic aperture bounded by?
Manubrium, first rib, and first thoracic vertebrae
121
What is the inferior thoracic aperture is bounded by?
Xiphoid process, costal margin, twelfth rib, distal end of the eleventh rib, and twelfth thoracic vertebra
122
What are the true ribs?
Ribs 1-7 which articulate with the sternum directly through their own costal cartilages
123
What are the false ribs?
- Ribs 8-10 which articulate with the sternum indirectly by attaching to the costal cartilage of the rib above
- Ribs 11 and 12 which are not connected to the sternum at all. These are often referred to as floating ribs
124
Morphologically, what are the typical ribs?
Ribs 3-9
125
Morphologically, what are the atypical ribs?
Ribs 1, 2, 10, 11, and 12
126
What are the functions of the thoracic cage?
- Protection of thoracic and upper abdominal organs
- Muscle attachments
- Respiration
127
What is the origin of the external intercostal muscle?
Lower border of ribs 1-11
128
What is the insertion of the external intercostal muscle?
Upper border of ribs 2-12
129
What is the innervation of the external intercostal muscle?
Corresponding intercostal nerve
130
What is the function of the external intercostal muscle?
Elevates the ribs in inspiration
131
What is the origin of the internal intercostal muscle?
The upper border of ribs 2-12
132
What is the insertion of the internal intercostal muscle?
The lower border of ribs 1-11
133
What is the innervation of the internal intercostal muscle?
Corresponding intercostal nerve
134
What is the function of the internal intercostal muscle?
Depresses the ribs in forced expiration
135
What is the origin of the innermost intercostal muscle?
The upper border of ribs 2-12
136
What is the insertion of the innermost intercostal muscle?
The lower border of ribs 1-11
137
What is the innervation of the innermost intercostal muscle?
Corresponding intercostal nerve
138
What is the function of the innermost intercostal muscle?
Depresses the ribs in forced expiration
139
What is the origin of the subcostalis muscle?
Inner surface of the ribs near their angles
140
What is the insertion of the subcostalis muscle?
The muscle crosses a rib without inserting and then inserts into the rib above that
141
What is the innervation of the subcostalis muscle?
Intercostal nerve
142
What is the function of the subcostalis muscle?
Depresses the ribs in forced expiration
143
What is the origin of the transversus thoracis muscle?
Posterior surface of the lower sternal body and xiphoid process
144
What is the insertion of the transversus thoracis muscle?
Inner surface of costal cartilages 2-6
145
What is the innervation of the transversus thoracis muscle?
Intercostal nerve
146
What is the action of the transversus thoracis muscle?
Depresses the ribs in forced expiration
147
What is the arterial supply of the anterior aspect of the thoracic wall?
Internal Thoracic Artery (from subclavian)
- pericardicophrenic artery: accompanies the phrenic nerve, supplies the pleura, pericardium, and diaphragm
- anterior intercostal arteries: supply the upper 6 intercostal spaces, anastomose with the posterior intercostal arteries
- musculophrenic artery: lateral terminal branch of the internal thoracic artery
- superior epigastric artery: medial terminal branch of the internal thoracic artery
148
What is the arterial supply of the posterior aspect of the thoracic wall?
- Supreme (superior) intercostal artery (from the costocervical trunk): branches into the first and second posterior intercostal arteries
- Third through eleventh posterior intercostal arteries (arise directly from the thoracic aorta)
- Subcostal artery (also from the thoracic aorta): lies below the 12th rib
149
What is the venous drainage of the anterior aspect of the thoracic wall?
Internal thoracic vein (into the brachicephalic vein)
150
What is the venous drainage of the posterior aspect of the thoracic wall?
The azygos system of veins
151
What is the azygos system of veins on the right side of the body?
- 1st posterior intercostal drains into the brachiocephalic vein
- 2nd and 3rd posterior intercostal veins join together to form the superior intercostal vein which then drains into the azygos vein
- 4th through 11th posterior intercostal veins and the subcostal vein drain directly into the azygos vein
152
What is the azygos system of veins on the left side of the body?
- 1st posterior intercostal drains into the brachiocephalic vein
- 2nd and 3rd posterior intercostal veins join together to form the superior intercostal vein which drains into the left brachiocephalic vein
- 9th through 11th posterior intercostal veins and the subcostal vein join to form the hemiazygos vein which drains into the azygos vein
153
What are the nerves of the thoracic wall?
- Intercostal nerve: the anterior primary rami of the first 11 thoracic spinal nerves
- Subcostal nerve: the anterior primary ramus of the 12th thoracic spinal nerve
154
What are the layers of the thoracic wall?
- Skin
- Superficial fasica
- Deep fascia
- Serratus anterior
- External intercostal muscle
- Internal intercostal muscle
- Innermost intercostal muscle
- Endothoracic fascia
- Parietal pleura
- Pleural cavity
- Visceral pleura
- Lung
155
What is the function of the endothoracic fascia?
To prevent the innermost intercostal muscle from rubbing against the parietal pleura.
156
What is the thickening of the fascia over the apex of the lung called?
Suprapleural membrane
157
What are the contents of the typical intercostal space?
Intercostal vein, intercostal artery, intercostal nerve
158
What three cavities does the thoracic cavity divide into?
- 2 pleural cavities, each of which surrounds a lung
| - 1 mediastinum
159
This is the area between the two pleural cavities, which contains the heart, great vessels, trachea, esophagus, etc.
Mediastinum
160
This type of pleura lines the inner surface of the thorax.
Parietal pleura
161
This type of pleura intimately invests the lung
Visceral pleura
162
This is a potential space between the parietal and visceral pleurae.
Pleural cavity
163
This substance lubricates the pleurae to minimize friction between the parietal and visceral layers, facilitating movement of the lungs.
Pleural fluid
164
What are the four parts of the parietal pleura?
- Costal pleura
- Mediastinal pleura
- Diaphragmatic pleura
- Cervical pleura (portion which overlies the apex of the lung)
165
Where does the parietal pleura receive its blood and nerve supply? Visceral pleura?
Parietal pleura from the body wall
| Visceral pleura from the organs they cover
166
This is the space formed where the costal and diaphragmatic pleurae meet. It is located at the midaxillary line.
Costodiaphragmatic recess
167
This is the space formed where the costal and diaphragmatic pleurae meet. It is located at the midaxillary line.
Costomediastinal recess
168
Fluid tends to accumulate in what recess? It can be removed by thoracentesis done at intercostal space 9, during expiration.
Costodiaphragmatic recess
169
What is the blood supply of the parietal pleura of the lungs?
Supplied by the intercostal areteries, internal thoracic artery, and superior phrenic artery
170
What is the blood supply of the visceral pleura of the lungs?
Supplied by the bronchial artery
171
What is the innervation of the parietal pleura of the lungs?
Intercostal nerves, subcostal nerve, and phrenic nerve. The parietal pleura is highly sensitive to pain.
172
What is the innervation of the visceral pleura of the lungs?
No sensory innervation. It is insensitive to pain.
173
This condition is characterized by pleural cavities filling with air. It can be caused by trauma, disease, or a congenital weak spot. A hole is typically present.
Pneumothorax
174
This condition is characterized by pleural cavities filling with air, but instead of a hole being present a flap on the visceral pleura is there resulting in air being unable to leave the pleural cavity.
Tension pneumothorax
175
This condition is characterized by pleural cavities filling with blood.
Hemothorax
176
All types of pneumothorax eventually result in what?
Atelectasis (lung collapse)
177
This is an inflammation of the pleurae which leads to adhesions between parietal and visceral pleura. It produces a sound known as a pleural friction rub, which can be heard on auscultation.
Pleuritis
178
Pain is often referred to the shoulder in pleuritis via what nerve? It can also radiate along the distribution of what other nerves?
Phrenic nerve (C3, C4, C5); supraclavicular nerves (C3, C4)
179
Topographically the sternal angle is an important landmark because it indicates the level of what?
- Boundary between the superior and inferior mediastinum
- Articulation of the second rib with the sternum
- Aortic arch
- Bifurcation of the trachea into the left and right main bronchi
- Upper border of the pulmonary trunk
180
An imaginary plane passed from the sternal angle through the intervertebral disk between ____ and ____ divides the mediastinum into the superior and inferior mediastinum.
T4 and T5
181
What are the contents of the superior mediastinum?
- Superior vena cava
- Brachiocephalic veins
- Arch of the aorta (and its branches)
- Thoracic duct
- Trachea
- Esophagus
- Thymus
- Vagus nerve
- Left recurrent laryngeal nerve
- Phrenic nerve
182
What are the three subdivisions of the inferior mediastinum?
- Anterior mediastinum
- Middle mediastinum
- Posterior mediastinum
183
The anterior mediastinum lies anterior to the pericardial sac and posterior to the sternum. What are its contents?
- Thymus
- Lymph nodes (parasternal nodes are enlarged in breast and lung cancer)
- Sternopericardial ligaments
184
The middle mediastinum is bounded by the pericardial sac. What are its contents?
- Heart
- Pericardium
- Roots of the great vessels
- Main bronchi
- Phrenic nerve
185
The posterior mediastinum lies posterior to the pericardial sac and anterior to T5-T12. What are its contents?
- Esophagus
- Thoracic aorta
- Azygos vein
- Hemiazygos vein
- Thoracic duct
- Vagus nerve
- Splanchnic nerves (from sympathetic trunk)
186
Where does the trachea begin?
At the inferior border of the cricoid cartilage (C6)
187
Where does the trachea bifurcate into the left and right main bronchi?
The level of the sternal angle (T4 and T5)
188
This is a prominent ridge located within the trachea at its bifurcation, which separates the openings of the right and left main bronchi.
Carina
189
The trachea deviates to the right just before its bifurcation at the sternal angle due to what structure?
The aortic arch
190
This bronchus is shorter, wider, and more vertical than the other. It passes under the arch of the azygos vein and gives off the superior lobar bronchus before entering the hilum of the lung. It divides into the middle and inferior lobar bronchi within the hilum.
Right main bronchus
191
The right main bronchus has three lobar bronchi which then divide into how many segmental bronchi?
10
192
This bronchus is longer, narrower, and more horizontal than the other. It passes anterior to the esophagus and divides into superior and inferior lobar bronchi within the hilum of the lung.
Left main bronchus
193
The left main bronchus has two lobar bronchi which then divide into how many segmental bronchi?
10
194
What is the lowest part in the tracheobronchial tree where the cough reflex is mechanically initiated?
Carina
195
Aspiration of foreign objects is more common in which main bronchus?
Right main bronchus due to its wide, short, vertical arrangement
196
What is the blood supply and innervation of the trachea?
Blood supply: inferior thyroid artery and bronchial arteries
| Innervation: Vagus nerve (parasympathetic and pain fibers) and sympathetic trunk
197
The root of the lung is formed by the structures which pass through the hilum. It connects the lungs to what structures?
Heart and trachea
198
What specific structures form the root of the lung?
- Bronchi (posterior)
- Pulmonary vessels (pulmonary arteries (superior) and pulmonary veins (anterior and inferior)
- Bronchial vessels
- Nerves
- Lymphatics
199
The root of the lung is covered with pleura, which is prolonged downward as a double layered membrane called what?
Pulmonary ligament
200
Each lung has how many bronchopulmonary segments?
10
201
How many lobes does the right lung have? Where are they located in relation to the fissures of the right lung?
Three
Superior Lobe: above the horizontal fissure
Middle Lobe: between the horizontal and oblique fissure
Inferior Lobe: below the oblique fissure
202
What are the characteristic features of the right lung?
- Groove for the azygos vein
- Groove for the esophagus
- Cardiac impression (shallow)
- Groove for the superior vena cava
- Groove for the right brachiocephalic vein
203
How many lobes does the right lung have? Where are they located in relation to the fissures of the left lung?
Two
Superior Lobe: above the oblique fissure
Inferior Lobe: below the oblique fissure
204
What are the characteristic features of the left lung?
- Lingula
- Cardiac notch
- Cardiac impression (deep)
- Groove for the aorta
- Groove for the left subclavian artery
205
Bronchopulmonary segments are the functional units of the lung. What are they composed of?
- Segmental bronchus
- Branch of the pulmonary artery
- Segment of lung tissue
- Surrounding septum
206
What is the arterial and venous supply of the lungs?
Arterial: bronchial arteries (from the thoracic aorta)
Venous: bronchial veins (to the azygos and accessory hemiazygos veins)
207
What is the structure and primary tissue of the tracheobronchial tree from biggest to smallest?
```
Trachea: cartilageous rings
Main bronchi: cartilagenous rings
Lobar bronchi: cartilagenous plates
Segmental bronchi: smooth muscle
Bronchioles: smooth muscle
Alveoli: membrane
```
208
Where in the tracheobronchial tree does bronchitis typically occur?
Segmental bronchi
209
Where in the tracheobronchial tree does bronchiolitis typically occur?
Bronchioles
210
Where in the tracheobronchial tree does pneumonia typically occur?
Alveoli
211
What is the innervation of the lungs?
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Vagus (parasympathetic and sensory)
Sympathetic trunk (T2 to T5, sympathetic and sensory)
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212
This type of nervous activation produces bronchial dilation and vasoconstriction. It decreases glandular secretion.
Sympathetic
213
This type of nervous activation produces bronchial constriction and vasodilation. It increases glandular secretion.
Parasympathetic
214
This is an obstructive airway disease characterized by coughing, weezing, and difficulty breathing. It is caused by spasms of the smooth muscle which lies in the segmental bronchi and bronchioles and is often accompanied by excessive secretion of mucus.
Asthma
215
What are the two types of asthma? What are they triggered by?
Extrinsic asthma: triggered by allergies
| Intrinsic asthma: triggered by non-allergenic stimuli such as stress, cold, or exercise
216
Where does lymph from the lungs drain?
Pulmonary and bronchopulmonary nodes located in the hilum, which then drain into the tracheobronchial nodes
217
This is a primary tumor of the bronchus and is directly related to cigarette smoking and air pollution. It is highly metastatic and often causes enlargement of a sentinel node.
Bronchogenic carcinoma
218
Lung cancer may effect what nerves?
Phrenic nerve: resulting in paralysis of half the diaphragm
| Recurrent laryngeal nerve: at the apex of the lung, resulting in paralysis of half the larynx
219
This is a fibromuscular dome-shaped structure with right and left domes. The right dome is slightly higher than the left dome, because it overlies the liver.
Diaphragm
220
What are the two parts of the diaphragm?
- Muscular part (lies around the periphery)
| - Central tendon
221
The muscular part of the diaphragm has three points of origin. What are they?
- Sternal: from the xiphoid process
- Costal: from the lower 6 costal cartilages
- Lumbar: from lumbar vertebrae 1-3 and the medial adn lateral arcuate ligaments
222
What are the openings of the diaphragm?
- Caval opening (foramen)
- Esophageal hiatus
- Aortic hiatus
223
This opening of the diaphragm is located at T8 within the central tendon and transmits the inferior vena cava and the right phrenic nerve.
Caval opening (foramen)
224
This opening of the diaphragm is located at T10 and transmits the esophagus and the anterior and posterior vagal trunks.
Esophageal hiatus
225
This opening of the diaphragm is located at T12 and transmits the aorta, thoracic duct, and azygos vein.
Aortic hiatus
226
What is the blood supply of the diaphragm?
- Musculophrenic artery (from internal thoracic artery)
- Pericardiacophrenic artery (from internal thoracic artery)
- Superior phrenic artery (from the aorta)
- Inferior phrenic artery (from the aorta)
227
What is the innervation of the diaphragm?
- Phrenic nerve (C3, 4, 5): motor to diaphragm as a whole and sensory to central part
- Intercostal nerves: sensory to peripheral part
228
This condition is due to weakness in the diphragmatic wall around the esophageal hiatus.
Hiatal hernia
229
During inspiration, three major movements take place within the thorax which result in an increase in intrathoracic volume and a decrease in intrathoracic pressure. What are they?
- Piston movement
- Bucket handle movement
- Pump handle movement
230
In this major movement during inspiration, the diaphragm contracts, pulling the domes inferiorly into the abdomen. this results in an increase in the vertical diameter of the thorax.
Piston movement
231
In this major movement during inspiration, elevation of the lower ribs (7th to 10th) about an antero-posterior axis occurs. This results in an increase in the transverse diameter of the thorax.
Bucket handle movement
232
In this major movement during inspiration, elevation of the upper ribs (2nd to 6th) about a transverse axis occurs. This results in an increase in the antero-posterior diameter of the thorax.
Pump handle movement
233
The elevation of the ribs in both the bucket handle and pump handle movements is due to the contraction of what muscles?
External intercostal muscles
234
In normal expiration, the diaphragm and external intercostal muscles relax and air is expelled passively. What muscles are involved in forced expiration?
Internal intercostals, innermost intercostals, and the muscles of the anterior abdominal wall.
235
How does intrathoracic volume and pressure change with inspiration? Expiration?
Inspiration: volume increases and pressure decreases
Expiration: volume decreases and pressure increases
236
Hiccups are the result of what?
Spasmodic contraction of the diaphragm due to irritation of the phrenic nerve
237
What are some morbid underlying causes of hiccups (2-3 days)?
Pericarditis, pleuritis, and peritonitis
238
This is the fibroserous sac which encloses the heart and great vessels. It occupies the middle mediastinum, and forms its borders.
Pericardium
239
This is the strong, dense outer part of the pericardium. It blends with the central tendon of the diaphragm, and with the walls of the great vessels which pierce it. It is continuous with the pretracheal fascia above and acts as a "cardiac seatbelt".
Fibrous pericardium
240
This is the part of the pericardium lines the inner surface of the fibrous pericardium.
Parietal layer of the serous pericardium
241
This is the part of the pericardium that is closely adherent to the outer surface of the heart. This layer is also known as the epicardium.
Visceral layer of the serous pericardium
242
This is a potential space between the parietal and visceral layers of the serous pericardium. It contains serous fluid.
Pericardial cavity
243
This structure is equivalent to the visceral layer of the serous pericardium.
Epicardium
244
This structure is composed mainly of cardiac muscle fibers and arranged in a spiral.
Myocardium
245
This structure is the smooth endothelium which lines the inside of the heart.
Endocardium
246
This condition is characterized by fluid leaking rapidly into the pericardial cavity (pericardial perfusion), which can lead to the heart being compressed and venous return being impeded.
Cardiac tamponade (superior vena cava is particularly vulnerable)
247
This is a subdivision of the pericardial sac which lies posterior to the aorta and pulmonary trunk, and anterior to the superior vena cava and left atrium.
Transverse pericardial sinus
248
This is a subdivision of the pericardial sac which lies posterior to the heart. It is surrounded by the left and right pulmonary veins and the inferior vena cava.
Oblique pericardial sinus
249
What is the blood supply to the pericardium?
- Pericardiacophrenic artery (most important)
- Bronchial artery
- Esophageal artery
- Coronary arteries (supply visceral layer of serous pericardium only)
250
What is the innervation of the pericardium?
- Phrenic nerve: sensory
- Sympathetic trunk: vasomotor
- Vagus
251
This condition is characterized by an inflammation of the pericardium and is always serous.
Pericarditis
252
How is a pericardial friction rub distinguished from a pleural friction rub?
Ask the patient to hold their breath. If the sound stops it is a pleural friction rub, if it continues it is a pericardial friction rub
253
This condition is characterized by an obstruction of a pulmonary artery by a blood clot. It forms in the systemic venous system then passes through the venae cavae to the right atrium, right ventricle, pulmonary trunk and finally the pulmonary arteries where it can block blood flow to the lungs. It can result in acute respiratory distress and even heart failure.
Pulmonary embolism
254
What are three reasons for why we do not listen to heart valves directly over them?
- Presence of bone
- Orientation of the heart
- Acoustics of blood flow
255
Valves control the flow of blood through the heart. Each consists of what?
- Valve orifice, surrounded by a
- Fibrous ring (Anulus), to which is attached
- Cusps: flaps which close the valve
256
What are the four major valves in the human heart?
- Pulmonary valve: between the right ventricle and pulmonary trunk. It has three cusps
- Aortic valve: between the left ventricle and aorta. It has three cusps
- Mitral (bicuspid valve): between the left atrium and left ventricle. It has two cusps
- Tricuspid valve: between the right atrium and right ventricle. It has three cusps
257
The heart produces a two-stroke beat ("Lub-Dup"). What produces this sound?
Lub sound: produced by contraction of the ventricles and closure of the tricuspid and mitral valves
Dup sound: produced by closure of the pulmonary and aortic valves
258
This valve is located behind the medial end of the third left costal cartilage and is most audible over the left second intercostal space.
Pulmonary valve
259
This valve is located behind the left half of the sternum medial to the third intercostal space and is most audible over the right second intercostal space.
Aortic valve
260
This valve is located behind the left half of the sternum medial to the fourth costal cartilage and is most audible over the left fifth intercostal space at the midclavicular line.
Mitral valve
261
This valve is located behind the right half of the sternum medial to the fourth intercostal space and is most audible over the left fifth intercostal space at its border with the sternum.
Tricuspid valve
262
What is the orientation of the heart?
It lies obliquely in the thorax. From base to apex, it runs forward, downward, and to the left.
263
This boundary of the heart is formed by the left and right atria.
Base
264
This boundary of the heart lies in the left fifth intercostal space, formed by the left ventricle.
Apex
265
What are the surfaces of the heart?
- Anterior (sternocostal): formed mostly by the right ventricle
- Diaphragmatic: formed by the right and left ventricles
- Left pulmonary: formed mostly by the left ventricle
- Right pulmonary: formed mostly by the right atrium
266
This is an ear-like appendage from the superior aspect of the right atrium.
Right auricle
267
These are prominent parallel ridges located in the anterior atrial wall.
Pectinate muscles
268
This is a vertical muscular ridge which runs from the opening of the superior vena cava to that of the inferior vena cava. It marks the termination of the pectinate muscles and separates the right atrium proper from the sinus of venae cavae.
Crista terminalis, which is marked externally by a vertical groove called the sulcus terminalis
269
This is the smooth-walled area located posterior to the crista terminalis. It represents the embryonic sinus venosus and receives the openings of the superior vena cava, inferior vena cava, coronary sinus, and anterior veins of the right ventricle.
Sinus of venae cavae (sinus venarum)
270
This is a depression which is the remnant of the foramen ovale, an opening between the right and left atrium which closes at birth.
Fossa ovalis
271
What is the sharp border of the fossa ovalis called?
Limbus fossa ovalis
272
This condition is when the foramen ovale persists as a small opening in the superior part of the fossa ovalis. Blood is shunted from the left atrium to the right, causing dilation of the right atrium, right ventricle, and pulmonary trunk.
Atrial septal defect
273
These are interconnecting muscular ridges located in the ventricular wall that act as reinforcements.
Trabeculae carneae
274
These are cone-shaped muscles which originate from the ventricular wall. Their apices are connected to the chordae tendineae.
Papillary muscles
275
These attach the papillary muscles to teh borders of the cusps of the tricuspid and bicuspid valves. They prevent eversion of the valve during ventricular contraction.
Chordae tendineae
276
This is the upper portion of the right ventricle which ends in the pulmonary trunk.
Conus arteriosus
277
This is a thick, muscular ridge which separates the conus arteriosus from the rest of the right ventricle.
Supraventricular crest
278
This is a large trabecula which extends from the interventricular septum to the base of the anterior papillary muscle. It transmits the right bundle branch of the conduction system.
Septomarginal trabecula (moderator band)
279
This is the ear-like appendage of the left atrium
Left auricle
280
This is the smooth-walled portion of the left ventricle, below the cusps of the aortic valve.
Aortic vestibule
281
What are the four parts of the septal wall of the heart?
- Interatrial septum: between the two atria
- Atrioventricular septum: small portion above septal cusp of tricuspid valve and below the anterior cusp of the mitral valve.
- Membranous interventricular septum: thin, smooth, and fibrous in structure
- Muscular interventricular septum: very thick
282
What are two ways that the heart enlarges? Describe each.
- Muscular hypertrophy: elasticity of blood vessels is lost with age, more force is required to push blood through arteries, and the walls grow thicker
- Dilation of a chamber: septal defects and valve incompetency cause regurgitation of blood into other chambers causing a dilation to accommodate the extra volume.
283
What three features do semilunar cusps have?
- Nodules: small central thickenings on the free edge of each cusp
- Lunules: the thin, crescentic part of the cusps
- Pulmonary and aortic sinuses: the spaces between the cusps and the walls of the vessel
284
These form the foundation of each of the heart valves and are component of the fibrous skeleton of the heart.
Fibrous rings (Anuli)
285
These connect the fibrous rings of the fibrous skeleton of the heart together, and represent the strongest part of the fibrous skeleton.
Left and right fibrous trigones
286
What are the functions of the fibrous skeleton of the heart?
- To provide a structural framework for the valves
- To insulate the electrical impulses of the conduction system within the atrial wall from those within the ventricular wall
287
What is the blood supply of the heart?
Right and left coronary arteries
288
What are the branches of the right coronary artery?
- Sinuatrial nodal artery: provides the blood supply to the SA node
- Right marginal artery: runs along the right lower margin of the heart
- Posterior interventricular artery: lies within the posterior interventricular sulcus
289
What are the branches of the left coronary artery?
- Anterior interventricular artery: lies within the anterior interventricular sulcus
- Circumflex artery: passes posteriorly to anastomose with the right coronary artery
- Left marginal artery: runs along the left margin of the heart and supplies the left ventricle
290
What does the right coronary artery typically supply?
- Right atrium
- Most of the right ventricle
- Diaphragmatic surface of the left ventricle
- Posterior 1/3 of the interventricular septum
- Conduction system to proximal parts of the right and left bundle branches
291
What does the left coronary artery typically supply?
- Left atrium
- Most of the left ventricle
- Part of the right ventricle
- Anterior 2/3 of the interventricular septum
292
Where do anastomoses occur in the heart?
- Right coronary and circumflex arteries
| - Anterior and posterior interventricular arteries
293
What is the venous drainage of the heart?
- Coronary sinus
- Anterior veins of the right ventricle
- Venae cordis minimae
294
What are the five tributaries of the coronary sinus?
- Great cardiac vein: accompanies the anterior interventricular artery
- Middle cardiac vein: accompanies the posterior interventricular artery
- Small cardiac vein: accompanies the right coronary artery near the right lower margin of the heart
- Posterior vein of the left ventricle: to the left of the middle cardiac vein
- Oblique vein of the left atrium
295
This condition is characterized by deposition of lipid plaques on the inner walls of arteries, which results in the narrowing of the lumen.
Atherosclerosis
296
This condition is characterized by substernal chest pain upon exertion. It is a symptom of partial occlusion of coronary artery branches and occurs due to insufficient blood flow to the heart tissue.
Angina pectoris
297
This occurs when a coronary artery branch becomes completely occluded. The portion of the heart supplied by the artery dies and is converted to fibrous scar tissue.
Myocardial infarction
298
What are the most common sites for myocardial infarction?
- Anterior interventricular artery (40-50%)
- Right coronary artery (30-40%)
- Circumflex artery (15-20%)
299
What is the lymphatic drainage of the heart?
Subepicardial lymphatic plexus to the tracheobronchial node
300
What is the innervation of the heart?
Innervation for the heart is via the cardiac plexus, which is divisible into the:
- Superficial cardiac plexus: located beneath the arch of the aorta, anterior to the pulmonary trunk
- Deep cardiac plexus: located posterior to the arch of the aorta
301
Where does the heart receive sympathetic innervation?
From the cervical and thoracic cardiac nerves from the sympathetic trunk (T1-T4)
302
Where does the heart receive parasympathetic innervation?
Vagus nerve
303
This part of the conduction system of the heart is the natural pacemaker. It is located at the upper end of the crista terminalis, near the junction of the right atrium with the superior vena cava.
Sinuatrial node
304
This part of the conduction system of the heart is located in the septal wall, above the opening for the coronary sinus in the right atrium.
Atrioventricular node
305
This part of the conduction system of the heart is located within the septal wall and divides into the right and left bundle branches.
Atrioventricular bundle
306
This part of the conduction system of the heart is joined by branches of the left and right bundle branches.
Subendocardial plexus of conduction cells (Purkinje fibers)
307
This is the remnant of the embryonic ductus arteriosus. it connects the arch of the aorta to the left pulmonary artery or pulmonary trunk. It is located at the level of the sternal angle.
Ligamentum arteriosum
308
The esophagus consists of an upper, middle, and lower portion. What is each portion composed of?
- Upper 1/3 is composed of striated muscle
- Middle 1/3 is composed of mixed striated and smooth muscle
- Lower 1/3 is composed of smooth muscle
309
The esophagus begins at the laryngopharynx at what vertebral level?
C6
310
The esophagus enters the abdomen through the esophageal hiatus at what vertebral level?
T10
311
This sphincter is formed by the lower part of the inferior constrictor, sometimes referred to as cricopharyngeus.
Superior esophageal sphincter
312
This sphincter is formed by encircling fibers of the diaphragm at the esophageal hiatus.
Inferior esophageal sphincter
313
What is the blood supply of the esophagus?
- Inferior thyroid artery
- Bronchial artery
- Esophageal artery
- Left gastric artery
- Inferior phrenic artery
314
What is the venous drainage of the esophagus?
- Esophageal veins (into adjacent systemic veins)
| - Left gastric vein (into the portal vein)
315
What is the innervation of the esophagus?
- Vagus nerve (motor fibers for the striated portions and parasympathetics for the smooth muscle portions)
- Sympathetic fibers from thoracic cord levels
- Pain fibers carried in the sympathetic trunk
316
What vertebral level does the thoracic aorta begin?
T4
317
What are the parietal branches (supplies the body wall) of the thoracic aorta?
- 3rd through 11th intercostal arteries
- Subcostal arteries
- Superior phrenic arteries
318
What are the visceral branches (supplies the thoracic viscera) of the thoracic aorta?
- Bronchial arteries (1 right and 2 left)
- Pericardial arteries
- Mediastinal arteries
- Esophageal arteries
319
What are the important anastomoses that occur off the thoracic aorta?
- Between the anterior and posterior intercostal arteries
| - Between the superior and inferior epigastric arteries
320
Most of the lymph of the body reaches the venous system through what structure?
Thoracic duct
321
The thoracic duct begins in the abdomen as a dilation at the junction of three abdominal trunks called what?
Cisterna chyli
322
The thoracic duct crosses over to the left at what vertebral levels?
T5 and T6
323
Where does the thoracic duct empty into?
The junction of the left internal jugular and subclavian veins
324
The thoracic duct drains the lymph of the entire body except what areas?
- Right upper extremity
- Right thoracic cavity
- Right side of the head and neck
325
What are the nerves of the thorax?
- Phrenic nerve (C3, 4, 5)
- Sympathetic trunk
- Splanchnic nerves
- Vagus nerve
- Autonomic Plexuses
326
This is a variation which arises from C5 and which is a branch of the nerve to subclavius. Sectioning of the phrenic nerve will not completely paralyze the corresponding half of the diaphragm when this is present.
Accessory phrenic nerve
327
The sympathetic trunk is connected to the thoracic spinal nerves by what two structures?
- Gray rami communicantes
| - White rami communicantes
328
This structure contains postganglionic sympathetic fibers and are connected to every spinal nerve. Nerve cell bodies are located in the sympathetic trunk
Gray rami communicantes
329
This structure contains preganglionic sympathetic fibers and are limited to spinal cord segments T1 to L2. Nerve cell bodies are located in the lateral horn (intermediolateral cell column) of the spinal cord.
White rami communicantes
330
Splanchnic nerves are the major visceral branches of the sympathetic trunk which supply the abdominal viscera. They include what?
- Greater splanchnic nerve (T5-T9)
- Lesser splanchnic nerve (T10-T11)
- Least splanchnic nerve (T12)
331
All three splanchnic nerves reach the abdomen by piercing what?
The crura of the diaphragm and end in abdominal ganglia
332
The ____ recurrent laryngeal nerve hooks around the right subclavian artery and ascends into the neck between the trachea and esophagus.
Right
333
The ____ recurrent laryngeal nerve hooks around the arch of the aorta posterior to the ligamentum arteriosum and ascends into the neck between the trachea and esophagus.
Left
334
The phrenic nerve passes ____ to the root of the lung, while the vagus nerve passes____ to the root of the lung.
Anterior; posterior
335
This autonomic plexus is related to the arch of the aorta. It controls hart rate and is subdivided into superficial and deep parts.
Cardiac plexus
336
This autonomic plexus is related to the root of the lung.
Pulmonary plexus
337
This autonomic plexus is formed along the esophagus.
Esophageal plexus
338
This autonomic plexus is a delicate network of nerves along the thoracic aorta and its branches
Thoracic aortic plexus
339
Each of the autonomic plexuses of the thorax receives sympathetic fibers from _____ and parasympathetic fibers from _____.
Sympathetic trunk; vagus nerve
340
What are the functional components of the phrenic nerve?
- Motor (to the diaphragm)
- Sensory (pain fibers from the diaphragm, pericardium, pleura, and peritoneum)
- Sympathetic
341
What are the functional components of the vagus nerve?
- Motor (to muscles of the pharynx and larynx only- not to the thorax)
- Sensory (to thoracic and abdominal viscera)
- Parasympathetic (to thoracic and abdominal viscera)
