Unit 2- Larynx And Thorax Flashcards
(393 cards)
1
Q
What structure connects the lower part of the pharynx to the trachea?
A
Larynx
2
Q
What does the larynx connect?
A
Lower part of the pharynx to the trachea
3
Q
What is the larynx primarily made up of?
A
Cartilage
4
Q
What are three functions of the larynx?
A
- Prevent passage of food into the airway during swallowing 2. Regulate flow of air into the lungs 3. Vocalization
5
Q
About how long is the larynx in an adult?
A
5 cm
6
Q
Between what cervical vertebral does the larynx lie?
A
Between CV3 and CV 6
7
Q
How many cartilages make up the larynx?
A
6
8
Q
List the 6 cartilages of the larynx.
A
- Thyroid 2. Cricoid 3. Epiglottic 4. Arytenoid 5. Corniculate 6. Cuneiform
9
Q
T/F. The thyroid cartilage of the larynx is a single cartilage.
A
True
10
Q
The thyroid cartilage of the larynx presents what 7 structures?
A
- Superior thyroid notch 2. Inferior thyroid notch 3. Laryngeal prominence 4. Superior horn (attached to greater horn of hyoid bone) 5. Inferior horn (articulates with cricoid cartilage) 6. Laminae 7. Oblique Line
11
Q
The oblique line located on the external surface of the lamina provides attachment for what three muscles?
A
- Inferior constrictor 2. Sternothyroid 3. Thyrohyoid muscles
12
Q
What does cricoid mean in Greek?
A
Ring
13
Q
T/F. The Cricoid Cartilage is the most superior of the laryngeal cartilages.
A
False; most inferior (CV 6)
14
Q
T/F. The cricoid cartilage consists of a narrow anterior arch and a broad, posterior lamina.
A
True
15
Q
The epiglottic cartilage is a single spoon shaped cartilage that lies where?
A
Behind the root of the tongue and body of the hyoid bone
16
Q
The lower end of the epiglottic cartilage is attached to the back of the laryngeal prominence of the thyroid cartilage via what structure?
A
Thyroepiglottic ligament
17
Q
T/F. The arytenoid cartilage is a single cartilage.
A
False; paired and pyramidal in shape
18
Q
The bases of the arytenoid cartilage articulate with what other laryngeal cartilage?
A
Cricoid cartilage
19
Q
Each arytenoid cartilage presents what two structures?
A
- Vocal process 2. Muscular process
20
Q
The corniculate cartilages are paired cartilages and are closed within what structure?
A
Aryepiglottic folds
21
Q
T/F. The cuneiform cartilages are paired cartilages which lie in the aryepiglottic folds posterior to the corniculate cartilages.
A
False; anterior
22
Q
From a clinical standpoint, the corniculate and cuneiform cartilage can ossify and also be mistaken for _________.
A
A fracture
23
Q
There are two joints of the larynx. What are they and what are their classifications?
A
- Cricothyroid joint 2. Cricoarytenoid joint
Synovial joints
24
Q
What type of synovial joint is the cricothyroid joint?
A
Hinge
25
Where is the location of the cricothyroid joint?
Between the side of the cricoid cartilage and the inferior horn of the thyroid cartilage
26
What type of motion does the cricothyroid joint permit?
Rotation of the thyroid cartilage around the horizontal axis
27
What type of synovial joint is the cricoarytenoid joint?
Planar, arthroidial
28
Where is the location of the cricoarytenoid joint?
Between the upper border of the cricoid cartilage and the base of the arytenoid cartilage
29
What motion does the cricoarytenoid joint permit?
Gliding and rotation of the arytenoid cartilage on the cricoid cartilage
30
List the 5 ligaments of the larynx.
1. Thyrohyoid membrane 2. Median cricothyroid ligament 3. Vocal ligament 4. Conus Elasticus 5. Quadrangular membrane
31
The thyrohyoid membrane extends from the thyroid cartilage to the hyoid bone and is pierced on each side by what two structures?
Internal laryngeal nerve and superior laryngeal vessels
32
The median cricothyroid ligament extends from what two cartilages?
Arch of the cricoid cartilage to the thyroid cartilage
33
Since the vocal ligament extends from the thyroid cartilage in front to the vocal process of the arytenoid cartilage behind, it is considered the ________ vocal cord.
True vocal cord
34
Where is the location of the conus elasticus?
Extending upward from the cricoid cartilage to the vocal ligament
35
What ligament forms the free edge of the conus elasticus?
Vocal ligament
36
What does the quadrangular membrane connect?
Epiglottic cartilage to the arytenoid cartilage
37
What do the superior and inferior margins of the quadrangular membrane form?
S- aryepiglottic ligament within the aryepiglottic fold
| I- vestibular ligament within the vestibular fold
38
Name the two pairs of folds that the larynx contains.
1. Vestibular folds (false vocal cords)
| 2. Vocal folds (true vocal cords)
39
The vocal folds contain the vocal ligament and what muscle? (This muscle forms the bulk of the vocal fold)
Vocalis muscle
40
What is the name of the space between the vestibular folds (false vocal cords)?
Rima Vestibuli
41
What is the name of the space between the vocal folds (true vocal cords)?
Rima Glottidis
42
T/F. The Rima Vestibuli is the narrowest part of the laryngeal cavity.
False; Rima Glottidis
43
T/F. The Glottis includes the Rima Glottidis and vocal folds.
True
44
What are the names of the three cavities in which the larynx is divided into?
1. Laryngeal Vestibule
2. Laryngeal Ventricle
3. Infraglottic Cavity
45
Which cavity of the larynx extends from the vocal folds to the inferior border of the cricoid cartilage?
Infraglottic cavity
46
Which cavity of the larynx lies between the false and true vocal cords?
Laryngeal ventricle
47
Which cavity of the larynx extends from the laryngeal inlet to the false vocal cords?
Laryngeal vestibule
48
What structure contains glands that lubricate the vocal folds (aka "oil can" of the vocal cords)?
Laryngeal saccule
49
Which laryngeal fold is responsible for initiating the cough reflex?
False vocal cord
50
Do the intrinsic or extrinsic muscles of the larynx move the larynx as a whole? What two categories can they be divided into?
Extrinsic
| Depressors and elevators
51
What are the six elevators of the larynx?
1. Thyrohyoid
2. Stylohyoid
3. Mylohyoid
4. Digastric
5. Stylopharyngeus
6. Palatopharyngeus
52
What are the three depressors of the larynx?
1. Omohyoid
2. Sternohyoid
3. Sternothyroid
53
What is the origin and insertion of the cricothyroid muscle?
O: cricoid cartilage
I: inferior horn and lower lamina of thyroid cartilage
54
What is the nerve supply to the cricothyroid muscle?
External laryngeal nerve
55
What is the function of the cricothyroid muscle?
Tilts thyroid cartilage downward or cricoid cartilage upward thereby tensing the vocal cords
56
What is the origin and insertion of the posterior cricoarytenoid muscle?
O: posterior surface of lamina of cricoid cartilage
I: muscular process of arytenoid cartilage
57
What is the nerve supply to the posterior cricoarytenoid muscle?
Recurrent laryngeal nerve
58
What is the function of the posterior cricoarytenoid muscle?
Abducts the vocal folds
59
What is the origin and insertion of the Lateral Cricoarytenoid Muscle?
O: arch of cricoid cartilage
I: muscular process of arytenoid cartilage
60
What is the nerve supply to the Lateral Cricoarytenoid Muscle?
Recurrent laryngeal nerve
61
What is the action of the Lateral Cricoarytenoid Muscle?
Adducts the vocal cords (whispering)
62
What is the origin and insertion of the Transverse Arytenoid Muscle?
O: posterior surface of arytenoid cartilage
I: posterior surface of opposite arytenoid cartilage
63
What is the nerve supply to the Transverse Arytenoid Muscle?
Recurrent laryngeal nerve
64
What is the action of the Transverse Arytenoid Muscle?
Adducts the vocal folds (coughing)
65
What is the origin and insertion of the Oblique Arytenoid Muscle?
O: muscular process of arytenoid cartilage
I: apex of opposite arytenoid cartilage
66
What is the nerve supply to the Oblique Arytenoid Muscle?
Recurrent laryngeal nerve
67
What is the action of the Oblique Arytenoid Muscle?
Adducts the vocal folds (coughing)
68
What intrinsic laryngeal muscle(s) function in coughing? Whispering?
Coughing: Transverse and Oblique Arytenoid
Whispering: Lateral Cricoarytenoid
69
What is the origin and insertion of the Aryepiglottic Muscle?
O: apex of arytenoid cartilage
I: side of epiglottic cartilage
70
What is the nerve supply to the Aryepiglottic Muscle?
Recurrent laryngeal nerve
71
What is the action of the Aryepiglottic Muscle?
Closes the laryngeal inlet
72
What muscle is a continuation of the oblique arytenoid and lies within the aryepiglottic fold?
Aryepiglottic Muscle
73
What is the origin and insertion of the Thyroepiglottic Muscle?
O: inner surface of thyroid lamina
I: lateral margin of epiglottis
74
What is the nerve supply to the Thyroepiglottic Muscle?
Recurrent laryngeal nerve
75
What is the action of the Thyroepiglottic Muscle?
Opens the laryngeal inlet
76
The Thyroepiglottic Muscle is the antagonist muscle to which muscle?
Aryepiglottic Muscle
77
What is the origin and insertion of the Thyroarytenoid Muscle?
O: inner surface of thyroid lamina
I: arytenoid cartilage
78
What is the nerve supply to the Thyroarytenoid Muscle?
Recurrent laryngeal nerve
79
What is the action of the Thyroarytenoid Muscle?
Shortens and relaxes vocal folds by drawing the arytenoid cartilages forward (decreases the pitch of voice)
80
What is the origin and insertion of the Vocalis Muscle?
O: inner surface of thyroid lamina
I: vocal process of arytenoid cartilage
81
What is the nerve supply to the Vocalis Muscle?
Recurrent laryngeal nerve
82
What is the action of the Vocalis Muscle?
Adjusts tension on the vocal cords during phonation (fine tuning of vocal cord)
83
All of the intrinsic muscles of the larynx are supplied by the recurrent laryngeal nerve except ________.
Cricothyroid Muscle (external laryngeal nerve)
84
What folds are important in phonation because they control the stream of air passing through the rima glottidis?
Vocal Folds
85
The Vocal Folds are important in phonation because they control the stream of air passing though which space?
Rima Glottidis
86
What are the shapes of the Rima Glottidis during inspiration and then expiration/phonation?
Inspiration- wide
| Expiration/Phonation- narrow and wedge shaped
87
To raise the pitch of the voice, what muscle will have increased tension?
Cricothyroid Muscle
88
To lower the pitch of the voice, tension will be decreased on what muscle(s)?
Thyroarytenoid and Vocalis muscles
89
Voice dimorphism is determined by what three factors?
1. length of vocal cords
2. size of resonating chamber
3. thickness of vocal cords- respond to androgens
90
What nerve is the motor nerve to all of the intrinsic muscles of the larynx except the cricothyroid?
Recurrent laryngeal nerve
91
The recurrent laryngeal nerve is sensory to what to what structure?
Mucosa of the larynx below the vocal fold
92
The internal laryngeal nerve is a branch of what nerve?
Superior laryngeal nerve
93
The internal laryngeal nerve is sensory to what structures?
1. Mucosa of the larynx above the vocal folds
| 2. Superior laryngeal artery as it pierces the thyrohyoid membrane to enter the larynx
94
The external laryngeal nerve is a branch of what nerve?
Superior laryngeal nerve
95
The external laryngeal nerve is motor to what muscle(s)?
1. Cricothyroid
| 2. Inferior constrictor muscles
96
What are the two arteries that supply the the larynx? What artery do they branch from?
Arteries- Superior and Inferior laryngeal artery
Branch:
S- superior thyroid artery
I- inferior thyroid artery
97
What are the three main function of the lymphatic system (of the head and neck)?
1. Picks up protein molecules from tissue fluid which are too large to pass through capillaries and transports them to the bloodstream
2. Returns excess tissue fluid to the bloodstream
3. Produces lymphocytes
98
What is the term for the swellings found along the lymphatic system?
Lymph nodes
99
What are the functions of lymph nodes?
1. Produce lymphocytes
| 2. Act as filters for the lymph, preventing foreign bodies from entering the bloodstream
100
What lymph vessel drains lymph to a node?
Afferent
101
What lymph vessel drains lymph from a node?
Efferent
102
How is lymph moved?
Skeletal muscle contraction
103
T/F. Exercise clears toxins from tissues.
True
104
What are the superficial nodes of the head?
1. Occipital
2. Mastoid
3. Parotid
105
Lymph nodes contain what type of tissue?
Reticular tissue
106
What are the superficial nodes of the neck?
1. Submandibular
2. Submental
3. Anterior cervical
4. Superficial cervical
107
T/F. The superficial cervical chain of nodes can be located on the external surface of the platysma.
False; external surface of the sternocleidomastoid
108
The superficial cervical nodes of the neck follow the course of what vein?
External jugular vein
109
T/F. The deep cervical nodes are located within the carotid sheath, and follow the course of the internal jugular vein.
True
110
Name the two largest deep cervical nodes.
1. Jugulodigastric Node
| 2. Jugulo-omohyoid Nodes
111
The two largest deep cervical nodes drain what structure?
The tongue
112
Match the location to the node.
A. Jugulodigastric Node
B. Jugulodigastric-omohyoid Node
1. Intermediate tendon of the onto hyoid
2. Posterior belly of the digastric muscle
A. 2
| B. 1
113
The jugulodigastric node and what tonsil drain the tongue?
Palatine tonsil
114
During tonsillitis, what deep cervical node is enlarged?
Jugulodigastric Node
115
T/F. Efferents of the deep cervical nodes form the superior and inferior jugular trunks.
False; right and left jugular trunks
116
The right jugular trunk of the deep cervical nodes drains into the junction of what two veins?
Internal jugular and subclavian veins
117
The left jugular trunk of the deep cervical nodes drains into what structure?
Thoracic duct
118
With clinical considerations in mind, what is the lymphatic system very important for?
Tracking the spread of cancer cells
119
The Submental nodes drain what three structures?
1. Lower lip
2. Floor of the mouth
3. Tip of the tongue
120
The Submandibular nodes drain what 6 structures?
1. Cheek
2. Side of the nose
3. Upper lip
4. Lateral part of the lower lip
5. Gums
6. Margin of the tongue
121
What is the term for the spread of cancer via the lymphatic system.
Lymphogenous Metastasis
122
What is the name of an enlarged supraclavicual are node, usually on the left side?
Signal (sentinel) Node
123
What is a Signal (sentinel) Node usually the 1st indication of?
Visceral tumor of thorax/abdomen
124
What is the name of the primary tumor of the lymph nodes?
Lymphoma
125
What are two types of lymphoma? Which one has a poorer prognosis?
1. Hodgkin's Disease
| 2. Non-Hodgkin's Lymphoma- poorer prognosis
126
A tender or painful enlarged lymph node usually indicates ______.
Infection
127
A hard and painless enlarged lymph node usually indicates _________ or _________.
Cyst development or cancer
128
What is the term for parasitic infection of the lymphatic system (worms)?
Filariasis
129
T/F. The great is an epidermally derived structure which consists of mammillary glands, fat, and fibrous tissue.
False; mammary glands*
130
The breast is located between what two ribs?
Second and Sixth rib
131
What is the name of vertical line dividing the armpit into anterior and posterior halves?
Midaxillary Line
132
The nipple I'd usually located at the level of what intercostal space?
Fourth
133
What is the term for the ring of pigmented skin which surrounds the nipple?
Areola
134
What is the term for the portion of the breast which extends back into the armpit and is a frequent site for cancer?
Axillary Process (Tail)
135
What ligaments support the breast and runs through the breast from the skin to the deep layer of superficial fascia?
Suspensory Ligaments of Breast
136
T/F. The mammary gland is a modified sweat gland located in the superficial fascia.
True
137
Each mammary gland has how many lobes of glandular tissue?
15-20 lobes
138
Each lobe of glandular tissue of a mammary gland opens onto the tip of the nipple though what structure?
Lactiferous Duct
139
What is the term for an expansion of the lactiferous duct, which serves as a reservoir for milk during lacation?
Lactiferous Sinus
140
What are the four arteries that supply blood to the breast?
1. Internal thoracic artery
2. Thoracoacromial artery
3. Lateral thoracic artery
4. Intercostal arteries
141
T/F. 75 % of the lymph from the breast drains to the parasternal nodes.
False; the axillary nodes
142
What is the most common type of cancer in women?
Breast cancer
143
T/F. Breast cancer spreads to the bloodstream 1st before entering the lymphatics.
False; spreads to the lymphatics 1st before entering the blood stream
144
The posterior intercostal veins drain to ______ and _________ systems.
Azygos and Hemiazygos
145
T/F. Connections to the vertebral venous plexus allows spread of breast cancer to vertebral column and brain.
True
146
What are the three clinical signs for breast cancer?
1. Dimpling (due to invasion of suspensions ligament)
2. Inverted nipple (due to invasion of lactiferous duct)
3. Leathery thickening of skin (like orange due to invasion of dermis and lymphatics)
147
Breast cancer is one cause of A. Upper B. Mid C. Low thoracic pain in females.
B. Mid thoracic
148
What bone contains bone marrow and is a major site for RBC formation?
Sternum
149
What are the three parts of the sternum?
1. Manubrium
2. Body
3. Xiphoid process
150
What part of the sternum is the widest and thicket part?
Manubrium
151
The upper border of the manubrium forms the ___________.
Jugular notch
152
The body of the sternum articulates with what 2 coastal cartilages?
Second and Seventh
153
The costal cartilage of the second rib articulates directly with what joint?
Manubriosternal Joint
154
T/F. The Xiphoid process is cartilaginous at birth and rapidly ossifies to support the rib cage.
False; slowly ossifies throughout life.
155
What part of the sternum is sometimes broken during CPR?
Xiphoid Process
156
T/F. The sternum can sometimes have a bifid xiphoid process or a xiphoid foramen.
True
157
What two parts of the sternum form the sternal angle?
Manubrium and the Body
158
The sternal angle is found at the level of the intervertebral disc between what two vertebrae?
TV4 and TV5
159
The superior thoracic aperture (thoracic inlet) is shaped like a
A. Circle
B. Triangle
C. Kidney
C. Kidney
160
The superior thoracic aperture is the superior opening of the thoracic cage and is bounded by what three structures?
1. Manubrium
2. Fist rib
3. First thoracic vertebra
161
The inferior thoracic aperture (thoracic outlet) is the inferior opening of the thoracic cage and is bounded by what 5 structures?
1. Xiphoid process
2. Costal margin
3. Twelfth rib
4. Distal end of the 11th rib
5. Twelfth thoracic vertebra
162
How many pairs of ribs are there? How many are true? False?
12 pairs of ribs
True: ribs 1-7
False: ribs 8-12
163
Why are Ribs 1-7 called true ribs?
Because they articulate with the sternum directly through their own costal cartilages
164
Of the false ribs, which ribs are not connected to the sternum at all and are referred to as "floating ribs"?
Ribs 11 and 12
165
T/F. Ribs 8-10 articulate with the sternum directly by attaching to the costal cartilage of the rib below.
False; rib above
166
Matching.
A. Typical
B. Atypical
1. Rib 1
2. Rib 2
3. Ribs 3-9
4. Rib 10
5. Rib 11
6. Rib 12
1. B
2. B
3. A
4. B
5. B
6. B
167
The typical ribs have the same morphology. Name the 6 structures that group ribs 3-9 into the typical rib category.
1. Head
2. Neck
3. Tubercle
4. Angle
5. Shaft
6. Costal groove
168
List the three functions of the thoracic cage.
1. Protection of thoracic and upper abdominal organs
2. Muscle attachments
3. Respiration
169
List the 5 muscles of the thoracic wall.
1. External intercostal
2. Internal intercostal
3. Innermost intercostal
4. Transversus thoracis
5. Subcostalis
170
What muscle of the thoracic wall is the 2nd most important muscle of inspiration?
External intercostal
171
What is the origin and insertion of the external intercostal muscle?
O: lower border of ribs 1-11
I: upper border of ribs 2-12
172
What is the nerve innervation of the external intercostal muscle?
Corresponding intercostal nerve
173
What is the function of the external intercostal muscle?
Elevates the ribs in inspiration
174
The external intercostal muscles begin at the tubercle of the rib and end at the ________ joint, where they are replaced by the external intercostal membrane.
Costochondral
175
What direction do the fibers of the external intercostal muscle run?
Downward and forward ("hands in pockets")
176
What is the origin and insertion of the internal intercostal muscle?
O: upper border of ribs 2-12
I: lower border of ribs 1-11
177
What is the nerve innervation to the internal intercostal muscle?
Corresponding intercostal nerve
178
What is the function of the internal intercostal muscle?
Depress the ribs in forced expiration
179
T/F. The internal intercostal muscles begin at the sternum and end at the angle of the ribs, where they are replaced by the internal intercostal membrane.
True
180
What direction do the fibers of the internal intercostal muscle run?
Downward and backward ("hands in armpits")
181
What is the origin and insertion of the innermost intercostal muscle?
O: upper border of ribs 2-12
I: lower border of ribs 1-11
182
What is the nerve innervation to the innermost intercostal muscle?
Corresponding intercostal nerve
183
What is the function of the innermost intercostal muscle?
Depress the ribs in forced expiration
184
What direction do the innermost intercostal muscles run?
Downward and backward
185
T/F. All intercostal muscles function to prevent the pushing in or drawing out of intercostal spaces during respiration.
True
186
What is the origin and insertion of the subcostalis muscle?
O: inner surface of ribs near their angles
I: muscle crosses a rib without inserting and then inserts into the rib above that
187
What is the nerve innervation to the subcostalis muscle?
Intercostal nerve (corresponding)
188
What is the function of the subcostalis muscle?
Depress the ribs in forced expiration
189
What is the origin and insertion of the transversus thoracis muscle?
O: posterior surface of the lower sternal body and xiphoid process
I: inner surface of costal cartilages 2-6
190
What is the nerve innervation to the transversus thoracis muscle?
Intercostal nerve (corresponding)
191
What is the function of the transversus thoracis muscle?
Depress the ribs in forced expiration
192
All of the muscle of the thoracic wall depress the ribs during forced expiration except ___________.
External intercostal muscle
193
The anterior aspect of the thoracic wall is supplied by what artery?
Internal thoracic artery and its branches
194
The internal thoracic artery comes from what artery?
Subclavian artery
195
What are the four branches of the internal thoracic artery?
1. Pericardiacophrenic artery
2. Anterior intercostal arteries
3. Musculophrenic artery
4. Superior epigastric artery
196
What branch of the internal thoracic artery accompanies the phrenic nerve, supplies the pleura, pericardium, and diaphragm?
Peri-cardia-cophrenic artery
197
What branch of the internal intercostal artery supples the upper 6 intercostal spaces, anastomose with the posterior intercostal arteries?
Anterior intercostal arteries
198
What branch of the internal intercostal artery is the lateral terminal branch?
Musculophranic artery
199
What branch of the internal intercostal artery is the medial terminal branch?
Superior epigastric artery
200
The posterior aspect of the thoracic wall is supplied by what three arteries?
1. Supreme (superior) intercostal artery
2. Third through eleventh posterior intercostal arteries
3. Subcostal artery
201
Where does the supreme (superior) intercostal artery arise from? What does it branch into?
From the costocervical trunk
| Branches into the 1st and 2nd posterior intercostal arteries
202
The third through eleventh posterior intercostal arteries arise directly from __________.
Thoracic aorta
203
Where does the subcostal artery arise from? Where does it lie?
From the thoracic aorta
| Lies below the 12th rib
204
The anterior aspect of the thoracic wall is drained by what vein?
Internal thoracic vein (into the brachiocephalic vein)
205
The posterior aspect of the thoracic wall is drained by what vein?
Azygos system of veins
206
What does Azygos mean in Greek?
Unpaired or unyoked
207
T/F. The 1st posterior intercostal of the Azygos system drains into the brachiocephalic vein on both the right and left side.
True
208
On the right side, the 2nd and 3rd posterior intercostal veins join together to form what vein? What does it drain into?
Superior intercostal vein
| Drains into the Azygos vein
209
On the right side, the 4th through 11th posterior intercostal veins and the ________ vein drain directly into the Azygos vein.
Subcostal vein
210
On the left side, the 2nd and 3rd posterior intercostal veins join together to form what vein? Where does it drain into?
Superior intercostal vein
| Drains into left brachiocephalic vein
211
On the left side, The 4th through 8th posterior intercostal veins join together to form what vein? Where does it drain?
Accessory Hemiazygos vein
| Drains into the Azygos vein
212
On the left side, The 9th through 11th posterior intercostal veins and the subcostal vein join to form what vein? Where does it drain?
Hemiazygos vein
| Drains into the Azygos vein
213
T/F. On the left side, the Azygos and the Hemiazygos veins represent the thoracic continuation of the right and left ascending lumbar veins.
True
214
What nerve is the anterior primary rami of the first 11 thoracic spinal nerve?
Intercostal nerves
215
What nerve is the anterior primary ramus of the 12th thoracic spinal nerve?
Subcostal nerve
216
Name the 12 layers of the thoracic wall.
1. Skin
2. Superficial fascia
3. Deep fascia
4. Serratus anterior
5. External intercostal muscle
6. Internal intercostal muscle
7. Innermost intercostal muscle
8. Endothoracic fascia
9. Parietal pleura
10. Pleura cavity
11. Visceral pleura
12. Lung
217
What is the function of the endothoracic fascia?
Prevent the innermost intercostal muscle from rubbing against the parietal pleura
218
What is the term for the thickening of the fascia over the apex of the lung?
Suprapleural membrane
219
What three structures will be found in a typical intercostal space?
1. Intercostal vein
2. Intercostal artery
4. Intercostal nerve
220
The intercostal vein, artery, and nerve lie within the costal groove on the lower, internal surface of each rib and are sandwiched between what two muscles?
Internal and Innermost intercostal muscles
221
T/F. The thoracic cavity is subdivided into two smaller cavities.
False; three smaller cavities
222
What are the three smaller cavities in which the thoracic cavity is divided into? What do they contain?
2 pleura cavities- each of which surrounds a lung
| 1 mediastinum- area between the two pleura cavities which contains the hearts, great vessels, trachea, esophagus, etc.
223
What is the term for a thin membrane which lines the inner surface of the thoracic cavity and covers the surface of the lung?
Pleura
224
What type of pleura lines the inner surface of the thorax?
Parietal pleura
225
What type of pleura intimately invests the lung?
Visceral pleura
226
The parietal pleura reflects back to become the visceral pleura at what part of the lung?
Root of the lung
227
Is the pleural cavity a real or potential space between the parietal and visceral pleura?
Potential space
228
T/F. Parietal fluid lubricates the pleurae to minimize friction between the parietal and visceral layers, facilitating movement of the lungs.
False; pleural fluid
229
The parietal pleura consists of 4 parts. What are they?
1. Costal pleura
2. Mediastinal pleura
3. Diaphragmatic pleura
4. Cervical pleura
230
What is the term for the spaces found between two folds of parietal pleura? What are their functions?
Pleural recesses
| Fxn: allow expansion of the lung during inspiration
231
Which pleural recess is located at the midaxillary line?
Costodiaphragmatic recess
232
Where is the costodiaphragmatic recess formed?
Where the costal and diaphragmatic pleurae meet
233
Where is the costomediastinal recess formed?
Where the costal and mediastinal pleurae meet
234
Fluid tends to accumulate in the costodiaphragmatic recess. How can it be removed?
By thoracentesis at intercostal space 9 during expiration
235
What artery supplies the parietal pleura?
Intercostal arteries, internal thoracic artery, and superior phrenic artery
236
What artery supplies the visceral pleura?
Bronchial artery
237
T/F. The visceral pleura is sensitive to pain while the parietal pleura is insensitive to pain.
False; parietal pleura= sensitive to pain, visceral pleura= insensitive to pain
238
What nerve(s) innervate the parietal pleura?
Intercostal nerves, subcostal nerve, and phrenic nerve
239
What nerve(s) innervate the visceral pleura?
NONE (no sensory innervation)
240
What are the three causes of pneumothorax?
1. Trauma (sucking chest wound)
2. Disease (bronchitis, emphysema, TB)
3. Congenital weak spot (tall people)
241
T/F. Pneumothorax occurs when pleural cavities fill with air.
True
242
In tension pneumothorax, instead of a hole, a _______ is present on visceral pleura.
Flap
243
T/F. In pneumothorax, air enters the pleural cavity on inspiration, but cannot exit on expiration.
True
244
How does hemothorax differ from pneumothorax?
Hemothorax- pleural cavity fills with blood
| Pneumothorax- pleural cavity fills with air
245
T/F. Hemothorax and pneumothorax- both conditions are present, simultaneously.
True
246
Hemothorax and pneumothorax will result in ________.
Atelectasis (lung collapse)
247
Define pleuritis.
Inflammation of pleura
248
What does pleuritis lead to?
Adhesions between parietal and visceral pleura
249
What pleura causes pain in pleuritis?
Parietal pleura
250
Pain in pleuritis is often refer to the shoulder via the _______ nerve (C3,4,5).
Phrenic nerve
251
During pleuritis, pain radiates along distribution of ________ nerves (C3,4).
Supraclavicular
252
Pleuritis produces a sound known as _________, which can be heard on auscultation.
Pleural friction rub
253
What is the space between the pleural cavities?
Mediastinum
254
The mediastinum contains all of the structures of the thorax except _______ and ________.
Lungs and pleurae
255
Topographically, the sternal angle is an important landmark because it indicates the level of what 5 structures?
1. Boundary between the superior and inferior mediastinum
2. Articulation of the second rib with the sternum
3. Aortic arch
4. Bifurcation of the trachea into the left and right main bronchi
5. Upper border of the pulmonary trunk
256
What are the contents of the superior mediastinum? (10)
1. Superior vena cava
2. Brachiocephalic veins
3. Arch of the aorta (and its branches)
4. Thoracic duct
5. Trachea
6. Esophagus
7. Thymus
8. Vagus nerve
9. Left recurrent laryngeal nerve
10. Phrenic nerve
257
What are the subdivisions of the inferior mediastinum?
1. Anterior mediastinum
2. Middle mediastinum
3. Posterior mediastinum
258
T/F. The anterior mediastinum lies anterior to the pericardial sac and posterior to the sternum.
True
259
What are the contents of the anterior mediastinum?
1. Thymus
2. Lymph nodes (parasternal)
3. Sternopericardial ligaments
260
What lymph nodes in the anterior mediastinum drain breast and lung cancer?
Parasternal nodes
261
What is the middle mediastinum bounded by?
Pericardial sac
262
What are the contents of the middle mediastinum?
1. Heart
2. Pericardium
3. Roots of the Great Vessels
4. Main bronchi
5. Phrenic nerve
263
The posterior mediastinum lies posterior to the pericardial sac and anterior to what thoracic vertebrae?
TV 5 through 12
264
What are the contents of the posterior mediastinum?
1. Esophagus
2. Thoracic aorta
3. Azygos Vein
4. Hemiazygos vein
5. Thoracic duct
6. Vagus nerve
7. Splanchnic nerves (from sympathetic trunk)
265
The trachea begins at the inferior border of what cartilage?
Cricoid cartilage (CV6)
266
The trachea consists of how many c-shaped cartilaginous rings?
15-20
267
The c-shaped cartilaginous rings of the trachea open anteriorly or posteriorly to prevent the trachea from collapsing?
Posteriorly
268
What muscle spans the posterior gap of the cartilaginous rings of the trachea? Is it skeletal or smooth muscle?
Trachealis muscle
| Smooth muscle
269
T/F. The trachea is 9-15 cm in length.
True
270
Where does the trachea bifurcate into the right and left main bronchi?
At the level of the sternal angle (intervertebral disc between TV 4 and 5)
271
What is the term for a prominent ridge located within the trachea at its bifurcation, which separates the openings of the right and left main bronchi?
Carina
272
Why does the trachea deviate to the right just before its bifurcation at the sternal angle?
For passage of aortic arch
273
Of the two main bronchi, which is shorter, wider, and more vertical?
Right
274
The right main bronchus passes under what vein?
Azygos vein
275
T/F. The right main bronchus gives off the superior lobar bronchus within the hilum of the lung.
False; before entering the hilum of the lung
276
T/F. The right main bronchus divides into the middle and inferior lobar bronchi within the hilum.
True
277
The 3 lobar bronchi of the right main bronchus divide into how many segmental bronchi?
10
278
Of the two main bronchi, which one is longer, narrower, and more horizontal?
Left main bronchus
279
Does the left main bronchus divide into superior and inferior lobar bronchi before entering the hilum or within the hilum of the lung?
Within the hilum of the lung
280
The 2 lobar bronchi of the left main bronchus divide into how many segmental bronchi?
10
281
T/F. It is not that common for a child to aspirate a small object such as a peanut or button.
False; it is common
282
When an object is aspirated, what primary bronchus will the object enter? Why?
Right main bronchus
| Due to its wide, short, vertical arrangement
283
When an object is aspirated, what will mechanically initiate the cough reflex?
Carina (covered with a sensitive mucous membrane)
284
What two arteries supply the trachea?
1. Inferior thyroid artery
| 2. Bronchial arteries
285
What two nerves innervate the trachea?
1. Vagus nerve (parasympathetic and pain fibers)
| 2. Sympathetic trunk
286
What are the three surfaces of the lungs?
1. Costal
2. Mediastinal
3. Diaphragmatic
287
What are the three borders of the lungs?
1. Anterior
2. Posterior
3. Inferior
288
The hilum, which is an opening through which the vessels, nerves, and bronchi pass, is on what surface of the lung?
Mediastinal
289
The root of the lung is formed by the structures which pass through the hilum. What are the structures?
1. Bronchi (posterior)
2. Pulmonary vessels (arteries and veins)
3. Bronchi vessels
4. Nerves
5. Lymphatics
290
T/F. The root of the lung connects the lung to the heart and trachea.
True
291
The root of the lung is covered with pleura, which is prolonged downward as a double layered membrane called the ____________.
Pulmonary ligament
292
Each lung has how many bronchopulmonary segments?
10
293
How many fissures does the right lung have? Name them.
1. Oblique
| 2. Horizontal
294
How many lobes does the right lung have? Name them.
1. Superior lobe
2. Middle lobe
3. Inferior lobe
295
Right Lung Matching
1. Superior Lobe
2. Middle Lobe
3. Inferior Lobe
A. Between the horizontal and oblique fissure
B. Above the horizontal fissure
C. Below the oblique fissure
1. B
2. A
3. C
296
Each lobe of the right lung is supplied by what kind of bronchus?
Corresponding lobar bronchus
297
T/F. The corresponding lobar bronchus divide into segmental bronchi, each of which supplies a bronchopulmonary segment.
True
298
How many fissures does the left lung have? Name them.
1. Oblique
299
How many lobes does the left lung have? Name them.
1. Superior lobe
| 2. Inferior lobe
300
Match the lung to the characteristic. A. Right B. Left
1. Groove for the Azygos vein
2. Cardiac impression (shallow)
3. Cardiac impression (deep)
4. Lingula
5. Groove for the esophagus
6. Groove for the aorta
7. Groove for right brachiocephalic vein
8. Groove for superior vena cava
9. Cardiac notch
10. Groove for left subclavian artery
1. A
2. A
3. B
4. B
5. A
6. B
7. A
8. A
9. B
10. B
301
What are the functional units of the lung?
Bronchopulmonary segments
302
Each bronchopulmonary segment consists of what four structures?
1. Segmental bronchus
2. Branch of the pulmonary artery
3. Segments of lung tissue
4. Surrounding septum
303
T/F. Bronchopulmonary segments can be surgically removed without affecting the functioning of adjacent segments.
True
304
What arteries supply the lungs? Veins?
```
Bronchial arteries (from the thoracic aorta)
Bronchial veins (drains to the Azygos and accessory Hemiazygos veins)
```
305
Trachea rocha Tree matching (primary tissue to structure)
1. Trachea
2. Main bronchi
3. Lobar bronchi
4. Segmental bronchi
5. Bronchioles
6. Alveoli
A. Cartilage rings
B. Cartilage plates
C. Smooth muscle
D. Membrane
1. A
2. A
3. B
4. C
5. C
6. D
306
What three structures of the tracheobronchial tree can result in inflammation?
Segmental bronchi, bronchioles, alveoli
307
The anterior and posterior pulmonary plexuses that innervate the lungs are formed by fibers from what two nerves?
1. Vagus (parasympathetic and sensory)
| 2. Sympathetic trunk (T2 to T5, sympathetic and sensory)
308
Sympathetic activation of the lungs will produce bronchial ______ and _________.
Will it increase or decrease glandular secretion?
Dilation and vasoconstriction
| Decrease
309
Parasympathetic activation of the lungs will produce bronchial ______ and _______.
Will it increase or decrease glandular secretion?
Constriction and vasodilation
| Increase glandular secretion
310
What is the pathology described as an obstructive airway characterized by coughing, wheezing, and difficulty breathing?
Asthma
311
What is asthma caused by?
Spasms of smooth muscle which lies in the segmental bronchi and bronchioles; accompanied by excessive secretion of mucus
312
What are the two types of asthma?
1. Extrinsic
| 2. Intrinsic
313
What type of asthma is triggered by allergens?
Extrinsic
314
What is intrinsic asthma triggered by?
Non allergenic stimuli- cold, stress, exercise
315
T/F. Chiro clinicians have noted that asthma is often associated with upper thoracic subluxation.
True
316
What thoracics supply the adrenal medulla? What does the adrenal medulla secrete?
T9-11
| Epinephrine (bronchodilator)
317
T/F. There has been chiro research that demonstrates a positive effect for the adjustment on asthma symptoms.
False; has NOT demonstrated a positive effect
318
Lymph from the lungs drains into what two nodes? Where are the located?
Pulmonary and bronchopulmonary nodes, which drain into the tracheobronchial nodes
Located in the hilum
319
What structure moves mucus and dirt through the larynx?
Mucocillary clearance
320
What is the term for the primary tumor of the bronchi?
Bronchogenic Carcinoma
321
T/F. Bronchogenic carcinoma is indirectly related to cig. Smoking and air pollution.
False; directly related
322
Lung cancer (bronchogenic carcinoma) may effect what two nerves? What does it result in?
1. Phrenic nerve- resulting in paralysis of 1/2 diaphragm
| 2. Recurrent laryngeal nerve- at the apex of lung resulting in paralysis of 1/2 larynx
323
Why is the right dome of the diaphragm slightly higher than the left dome?
Because it overlies the liver
324
What are the two parts of the diaphragm?
1. Muscular part
| 2. Central tendon
325
T/F. The muscular part of the diaphragm takes origin from a number of bony sources, and inserts into the central tendon.
True
326
What are the three points of origin of the muscular part of the diaphragm?
1. Sternal: from the xiphoid process
2. Costal: from the lower 6 costal cartilages
3. Lumbar: from lumbar vertebrae 1-3 and the medial and lateral arcuate ligaments
327
Match the level to the opening.
1. Caval opening
2. Esophageal hiatus
3. Aortic hiatus
A. TV 10
B. TV 12
C. TV 8
1. TV 8
2. TV 10
3. TV 12
328
The caval opening is within the central tendon and transmits what two structures?
Inferior vena cava
| Right phrenic nerve
329
The esophageal hiatus transmits what structures?
Esophagus and the anterior and posterior vagal trunks
330
What structures does the aortic hiatus transmit?
Aorta, thoracic duct, Azygos vein
331
What four arteries supply the diaphragm?
1. Musculophrenic artery
2. Pericardiacophrenic artery
3. Superior phrenic artery
4. Inferior phrenic artery
332
What is the motor supply as a whole and central part to the diaphragm?
Phrenic nerve
333
What is the sensory innervation to the peripheral part of the diaphragm?
Intercostal nerves
334
What injury is due to a weakness in the diaphragmatic wall around the esophageal hiatus?
Hiatal hernia
335
T/F. The upper part of the stomach of a person 50+ years old slides up into the thoracic cavity through the opening during a Hiatal Hernia.
True
336
What injury is a major cause of gastroesophageal reflux? Symptoms include belching and epigastric pain.
Hiatal hernia
337
What technique could help a hiatal hernia?
Part of SOT technique
338
What are the three major movements during inspiration that take place within the thorax and result in an increase in intrathoracic volume and a decrease in intrathoracic pressure?
1. Piston movement
2. Bucket handle movement
3. Pump handle movement
339
What movement during inspiration, will result in an increase in the vertical diameter of the thorax?
Piston movement
340
What movement during inspiration will increase the transverse diameter of the thorax?
Bucket Handle Movement
341
What movement during inspiration will result in an increase in the anterior-posterior diameter of the thorax?
Pump handle movement
342
The elevation of the ribs in both bucket handle (7-10) and pump handle (2-6) is due to the contraction of what muscles?
External intercostal muscles
343
During forced expiration, what muscles contract?
| During normal expiration, what muscles contract?
Forced: Internal intercostals, innermost intercostals, muscles of the anterior abdominal wall
Normal: none, diaphragm and external intercostal muscles relax
344
T/F. Contraction of the diaphragm during inspiration has the opposite effect on the abdomen that is has on the thorax. (Abdominal volume is decreased while intra-abdominal pressure is increased)
True
345
What are hiccups a result of? What nerve is irritated?
Spasmodic contraction of the diaphragm
| Phrenic nerve
346
What structure is a fibroserous sac that encloses the heart and great vessels? What mediastinum does it occupy?
Pericardium
| Middle mediastinum
347
What is the strong, dense outer part of the pericardium also known as the "cardiac seatlbelt"?
Fibrous pericardium
348
The fibrous pericardium is continuous with what fascia?
Pretracheal fascia
349
The fibrous pericardium is connected to the back of the sternum by what ligaments?
Sternopericardial ligaments
350
What are the three layers of the serous pericardium?
1. Parietal layer
2. Pericardial cavity
3. Visceral layer
351
What part of the serous pericardium lines the inner surface of the fibrous pericardium?
Parietal layer
352
What layer of the serous pericardium is also known as the epicardium?
Visceral layer
353
What layer of the heart is composed mainly of cardiac muscle fibers?
Myocardium
354
What layer of the heart is the smooth endothelium which lines the inside of the heart?
Endocardium
355
How many chambers are in the human heart?
4
356
In cardiac tamponade, what blood vessel is particularly vulnerable?
Superior vena cava
357
Since fluid is rapidly leaking into the pericardial cavity in cardiac tamponade, what vein will become prominent eventually leading to all veins of the face and neck becoming engorged?
External jugular vein
358
Which pericardial sinus lies posterior to the aorta and pulmonary trunk, and anterior to the superior vena cava and left atrium?
Transverse pericardial sinus
359
Which pericardial sinus lies posterior to the heart and is surrounded by the left and right pulmonary veins and inferior vena cava?
Oblique pericardial sinus
360
What four arteries supply the pericardium?
1. Pericardiocophrenic artery
2. Bronchial artery
3. Esophageal artery
4. Coronary arteries
361
Of the four arteries that supply blood to the pericardium, which is the main blood supply?
Pericardiacophrenic artery
362
What nerves innervate the pericardium?
1. Phrenic nerve (sensory)
2. Sympathetic trunk (vasomotor)
3. Vagus
363
T/F. The phrenic nerve passes between the parietal pleura and fibrous pericardium.
True
364
T/F. The pericardium is less sensitive to pain than the pleura.
True
365
How would you distinguish pericardial friction rub from pleural friction rub?
Have the patient hold their breath
| If sound stops: pleura
366
What is the pathology for an obstruction of a pulmonary artery by a blood clot?
Pulmonary embolism
367
During a pulmonary embolism, the embolus blocks what artery?
Pulmonary artery or one of its branches
368
What will a pulmonary embolism result in?
Acute respiratory distress, which leads to dilation of r-vent and r-atrium, resulting in heart failure and death can occur in minutes
369
Valves control the flow of blood through the heart and consist of what three structures?
1. Valve orifice; surrounded by -
2. Fibrous ring; to which is attached-
3. Cusps: flaps which close the valve
370
What are the four major valves of the human heart?
1. Pulmonary
2. Aortic
3. Mitral (bicuspid)
4. Tricuspid
371
Where will you find the pulmonary valve? How many cusps does it have?
```
Between the right ventricle and pulmonary trunk
3 cusps (A, L, R)
```
372
Where will you find the aortic valve? How many cusps?
```
Between the left ventricle and aorta
3 cusps (L, R, P)
```
373
Where will you find the mitral (bicuspid) valve? How many cusps?
Between the left atrium and left ventricle
| 2 (A, P)
374
Where will you find the tricuspid valve? How many cusps?
Between the right atrium and right ventricle
| 3 (A, P, Septal)
375
Which two valves make up the semi-lunar valves? Atrio-Ventricular Valves?
```
Semi-lunar= pulmonary and aortic
Atrio-Ventricular= Bicuspid and Tricuspid
```
376
The "Lub" sound of the heart is produced by the contraction of ______ and closure of the _______ and ______ valves.
Ventricles; tricuspid; mitral
377
The "Dup" sound is produced by the closure of the _______ and _______ valves.
Pulmonary and aortic
378
Match the location to the valve.
1. Pulmonary valve
2. Aortic valve
3. Mitral valve
4. Tricuspid valve
A. Behind the left half of the sternum medial to the third intercostal space
B. Behind the medial end of the third left costal cartilage
C. Behind the right half of the sternum medial to the fourth intercostal space
D. Behind the left half of the sternum medial to the fourth costal cartilage
1. B
2. A
3. D
4. C
379
What is the orientation of the heart in the thorax?
Oblique; forward, downward, and to the left
380
What forms the boundaries of the base of the heart?
Left and right atria
381
What forms the boundaries of the apex of the heart?
Formed by the left ventricle
382
What are the four surfaces of the heart? What forms them?
1. Anterior (sternocostal)- right ventricle
2. Diaphragmatic- right and left ventricle
3. Left pulmonary- left ventricle
4. Right pulmonary- right atrium
383
What are the 5 structures located within the chambers of the heart?
1. Right auricle
2. Pectinate muscles
3. Crista terminalis
4. Sinus of venae cavae
5. Floss ovalis
384
What does pectinate mean in Latin?
Comblike
385
The crista terminalis is marked externally by a vertical groove called the _______.
Sulcus terminalis
386
What embryonic structure does the sinus of venae cavae represent?
Sinus venosus
387
The fossa ovalis is a depression which is the remnant of the _________.
Foramen ovale
388
What is the term of the sharp border of the fossa ovalis?
Limbus fossa ovalis
389
What is the pathology where the foramen ovale persists as a small opening in the superior part of the fossa ovalis?
Atrial septal defect
390
When the foramen ovale defect is small, what is it called?
Probe patent foramen ovale
391
T/F. Atrial septal defect in most cases is clinically significant.
False; not clinically significant
392
In atrial septal defect, blood is shunted from the left atrium to the right atrium causing dilation of what three structures?
1. right atrium
2. Right ventricle
3. Pulmonary trunk
393
What are the 5 openings in the right atrium?
1. Superior vena cava
2. Inferior vena cava
3. Coronary sinus
4. Anterior veins of right ventricle
5. Right ventricle
