Gross Anatomy Exam 3
what are the subcostal muscles?
arise from the inner dorsal surface of a rib and insert onto the second or third rib below (*span more than one intercostal space*); usually poorly developed and sparse in the upper thorax
What is the apex of the lung?
top of lung extends above 1st rib
what is the jugular notch?
top of the manubrium
is the left coronary artery typically long or short?
typically short
can the cardiac conduction system be altered by the ANS?
yes
can the parietal pleura be dissected away?
yes
what are the targets of the sympathetic ganglia where the second release is NE?
cardiac muscle smooth muscle except sweat glands and arrector pili muscles
what are the targets of the ANS?
cardiac muscle, smooth muscle, and glands
What structure does the electrical signal have to pass through in order to get from the atria to ventricles?
cardiac skeleton
what forms an electrical insulator for the heart?
cardiac skeleton
what serves as an electrical insulator between the atria and ventricles?
cardiac skeleton
what are the impressions located on the left lung?
cardiac, arch and thoracic aorta
where are the ANS reflex arcs located?
carotid sinus and aortic arch
what is the ductus arteriosus?
connects pulmonary trunk to arch of aorta bypasses the lungs
what is included in the peripheral nervous system?
cranial and spinal nerves
where is the concave side of the diaphragm?
inferior or abdominal surface
what muscles are included in the third layer of intercostal muscles?
innermost intercostal transversus thoracis subcostal muscle
what is unique about the lumbar vertebrae?
largest body no facets for ribs square spinous process that is shorter than that of the thoracic vertebrae
which vagus nerve forms the anterior vagal trunk?
left vagus nerve
is the trachea found in the posterior mediastinum?
no
what are the sacral splanchnics?
postganglionic sympathetic
what is the pleural cavity?
potential space between parietal and visceral pleurae
what is the location of the costodiaphragmatic recess?
potential space inferior in each pleural cavity- accommodate lung during deep inspiration
what is the location of the costomediastinal recess?
potential spaces anteriorly in each pleural cavity- larger on the left due to heart
what is the sympathetic component of the pulmonary plexus?
preganglionic from IML T1-T6 to cervical ganglia and T1-4 chain ganglia cardiac nerves - postganglionic to targets
What is the parasympathetic component of the pulmonary plexus?
preganglionic from vagal nuclei to ganglia in viscera postganglionic to target
What is the pathway for synapses in the sympathetic nervous system?
preganglionic neurons (nuclei) synapse on post ganglionic neurons (ganglia) and the post ganglionic neurons innervate target
what is the phrenic nerve?
runs with the pericardiacophrenic artery and vein.
what is the pericardiacophrenic artery?
runs with the phrenic nerve
what are the components of the pulmonary plexus?
same as the cardiac plexus parasympathetic (CNX) and sympathetic (cardiac nerves)
what is sinus venarum and where is it located?
smooth posterior wall of the right atrium
Which division of the nervous system is a one neuron system and the cell body is located in the gray matter of the spinal cord?
somatic motor
where does the ascending aorta end?
sternal angle or transverse thoracic plane
what are the surfaces of the heart?
sternocostal (anterior) diaphragmatic (inferior) base (posterior surface) apex right pulmonary surface left pulmonary surface
what are the joints formed between the sternum and the ribs?
sternocostal joints
where is the convex side of the diaphragm?
sticking up into the thoracic cavity
what is the interventricular septum and where is it located?
strong, oblique partition between the ventricles
what is the name for T12?
subcostal nerve
what are the names of the two lobes of the left lung?
superior and inferior
what are the vertebral notches of the vertebrae?
superior vertebral notch and the inferior vertebral notch
where do the thoracic splanchnic nerves arise from?
sympathetic trunk ganglia
what is sensitive to the cough reflex?
the carina
which intercostal muscle does not extend all the way anterior to posterior?
the innermost intercostal muscle is only in the middle whereas the internal and external intercostals have membranes that allow them to extend all the way from one side to the other. THe innermost does not have a membrane
where does rib two form a joint?
the sternal angle
what forms the brachiocephalic veins?
the union of the internal jugular and subclavian veins
where does the accessory hemi-azygos vein collect blood from?
the upper left intercostals
why is the manubriosternal angle called the angle of the sternum?
there is an angle formed between the manubrium and body with the body being more vertical
what must contract in order to increase vertical dimension?
thoracic diaphragm
what is the other name for the sympathetic system and where is it?
thoracolumbar system T1-L2
How many layers of muscles cover the intercostal space?
three
What is contributing to the parasympathetic supply to the heart and cardiac plexus?
Cranial nerve X with the cardiac branches (preganglionic)
true or false: the umbilical arteries carry high O2 content blood back to the fetus?
False, the umbilical vein carries high oxygenated blood
what is the left auricle and where is it located?
It is a small, muscular pouch on the upper corner of the left atrium which helps move oxygenated blood into the left ventricle. extends near the base of the pulmonary trunk
What do the parasympathetic and sympathetic systems do to the pupil?
PS- constrict Sym- dialate
what does the sympathetic cardiac plexus innervate?
SA and AV nodes atria and ventricles blood vessels coronary vessels
what are the branches of the right coronary artery?
SA nodal artery right marginal artery posterior interventricular artery (variable)
what initiates the heartbeat?
SA node
what is also known as the pacemaker of the heart?
SA node
what are the impressions that are located on the right lung?
SVC, arch of azygos vein
What is kyphosis?
Slouch back (shoulders roll forward)
what is the paravertebral chain?
Sympathetic ganglia associated with the spinal cord Connected to spinal cord by preganglionic fibre Paravertebral chain held together by interconnecting fiber
where is the lesser thoracic splanchnic nerve?
T10-T11
where is the least thoracic splanchnic nerve?
T12
what is the vertebral level of the jugular notch?
T2
how many lobes does the right lung have?
3 lobes
how many lobes does the right lung have? fissures?
3 lobes, 2 fissures (oblique and horizontal)
how many cusps does the aortic semilunar valve have?
3, same as the pulmonary semilunar valve
How many coccygeal vertebrae are there?
4 fused
how many lumbar vertebrae are there?
5 (L1-L5)
what is the length of the left primary bronchus?
5 cm long
How many sacral vertebrae are there?
5 fused
where would the mitral valve be auscultated?
5th intercostal space 9-10 cm left of the midline
How many cervical vertebrae are there?
7 (C1-C7)
how many bpm is typical of the SA node?
70 bpm
how many bronchopulmonary segments are there per lung?
8-10
what is the location of the apex of the heart?
9-10 cm left of the midline at the 5th intercostal space
What is the thymus gland?
A gland in the upper chest - large in children, small in adults - that produces hormones that stimulate the growth of the other lymphatic tissues and that screens T lymphocytes for immunocompetence
what is the superior vena cava?
A large diameter, yet short, vein that carries deoxygenated blood from the upper half of the body to the heart's right atrium.
what is the ascending aorta?
A portion of the aorta commencing at the upper part of the base of the left ventricle.
What is the ductus venosus?
A shunt at the end of the umbilical cord which allows blood coming from the placenta to bypass the liver and empty directly into the IVC
what is the AV node?
A small bundle of cells that can receive the electrical impulse from the SA node, and continue the electrical signal down into the ventricles.
What is the AV node and where is it located?
A small bundle of cells that can receive the electrical impulse from the SA node, and continue the electrical signal down into the ventricles. in internal septum near opening of coronary sinus
What is the septomarginal trabecula (moderator band) and where is it located?
A specialized piece of trabeculae carneae located in the right ventricle from the interventricular septum to anterior papillary muscle
What is the foramen ovale?
An opening between the right and left atria in the embryo and fetus. Acts as a shunt
what structures form the root of the lung?
Bronchus, pulmonary artery, 2 pulmonary veins, bronchial vessels, nerves, and lymphatics.
what keeps the diaphragm alive?
C3, C4, C5 (phrenic nerve)
what does the phrenic nerve supply? what are its roots
C3,4,5 keep the diaphragm alive
what is the origin of the phrenic nerves?
C3-5
what is the costomediastinal recess?
Caudal to the pericardium and cranial to the diaphragmatic line of pleural reflection
what is the intervertebral foramen?
Formed by the superior & inferior vertebral notches of each pedicles; permits the passage of the spinal nerves into & out of the vertebral column
what is the diaphragmatic surface of the lung?
Forms the base of the lung
what is the anterior longitudinal ligament?
Front of vertebral bodies from sacrum to C2 (anterior atlanto-occipital is the continuation from atlas to occiput Limits extension
what is the costal margin?
Fused costal cartilage of ribs 7 to 10 extending from the xiphisternal joint
what does the hypothalamus help to control?
Heart rate vasoconstriction digestion sweating
what is the mnemonic to remember the locations of the apertures in the thoracic diaphragm?
I 8 10 Eggs At 12 Inferior vena cava through the caval hiatus at T8 Esophageal hiatus at T10 aortic hiatus at T12
where are the preganglionic cell bodies of the sympathetic pathway located?
IML T1-T6
what are the different preganglionic pathway options?
1. ascend (or descend) to synapse 2. synapse immediately 3. Exit without synapsing (splanchnic nerve)
how many thoracic vertebrae are there?
12 (T1-T12)
What percent of adults have a small patency of the foramen ovale?
15-25% of adults
How many cartilage rings are in the tracheobronchial tree?
16-20 C-shaped rings
What makes up the trachea?
16-20 C-shaped rings
how many cusps does the bicuspid valve have?
2
how many lobes does the left lung have?
2 lobes
what are the anterior cardiac veins
2-3 small vessels that drain the right ventricle and end directly in the right atrium cross over the right coronary artery
what is the length of the right primary bronchus?
2.5 cm long
where does the right coronary artery originate?
ascending aorta
what is the origin of the coronary arteries?
ascending aorta to aortic semilunar valve. in the right and left sinuses
where are the pleura continuous with each other?
at the root of the lung
where is the auscultation of the pulmonary semilunar valve?
auscultated in 2nd intercostal space adjacent to left sternum
where is the auscultation of the aortic semilunar valve?
auscultated in 2nd intercostal space to right of sternum
where is the auscultation of the bicuspid (mitral) valve?
auscultated in 5th intercostal space 9-10 cm left of the midline
where is the auscultation of tricuspid valve?
auscultated in 5th intercostal space just left of sternum
what branch of the nervous system controls the coronary arteries?
autonomic
What are mechanoreceptors involved in reflex archs?
baroreceptors stimulated by stretch
what is the origin of the tracheobronchial tree?
begins at inferior border of cricoid cartilage
what is the azygos vein?
begins at the diaphragm by union of ascending lumbar and right subcostal veins; may receive a vein from the IVC; arches over the root of the right lung to enter the SVC; directly drains intercostal spaces 5 and down space 2 - 4 are done indirectly through the superior intercostal vein
what is the origin of the trachea?
begins at the inferior border of cricoid cartilage
Where is the superior mediastinum?
below the superior thoracic aperture above the transverse plane between sternal angle and T4-5 IVD
where is the inferior mediastinum located?
below transverse plane between sternal angle and T4-5 IVD above the thoracic diaphragm
where is the pericardial cavity found?
between parietal and visceral pericardium
what is the location of the anterior interventricular groove?
between right and left ventricles on sternocostal surface
where do the right and left coronary arteries run?
between the atria and ventricles in the atrioventricular groove
where is the coronary sinus located?
between the left atrium and ventricle in the atrioventricular groove
what is the location of the left vagus nerve?
between the left common carotid artery and left subclavian artery passes anterolaterally over the aortic arch
what is the aortic semilunar valve and where is it located?
between the left ventricle and ascending aorta
What is the pulmonary semilunar valve and where is it located?
between the right ventricle and pulmonary trunk
where does the esophagus enter the middle mediastinum?
between the trachea and vertebrae
where is the pleural cavity?
between visceral and parietal pleura
what is the left atrioventricular orifice and where is it located?
bicuspid valve into the left ventricle
what are muscarinic receptors?
bind muscarine effector tissue (smooth muscle, cardiac muscle, and glands)
what are nicotinic receptors?
bind nicotine ganglia of PS and sympathetic
what do the brachiocephalic veins drain?
blood from the head, neck, and upper extremities
what is ductus arteriosus in fetus?
blood passes from pulmonary artery to aorta via the ductus arteriosus largely bypassing the lungs
what is the foramen ovale in a fetus?
blood passes from right atrium to left atrium bypasses the lungs (mother is oxygenating blood for the fetus)
What are the coronary arteries and where are they located?
blood vessel that supplies the heart with oxygen
What is the pulmonary circuit?
blood vessels that carry blood to and from the lungs
what is the longest part of the sternum?
body
what are the paths of the vagus nerves?
both pass anterior to root of lung between mediastinal pleura and parietal pericardium runs with pericardiacophrenic artery and vein
where do both vagus nerves travel?
both pass posterior to the root of the lung and are now in the posterior mediastinum
what are the branches off of the aortic arch?
brachiocephalic trunk which branches into the right common carotid artery and the right subclavian artery the left common carotid artery left subclavian artery
what are the branches of the aortic arch?
brachiocephalic trunk, left common carotid artery, left subclavian artery
what is included in the central nervous system?
brain and spinal cord
what are the umbilical arteries?
branch off of the iliac arteries return low O2 blood to placenta for reoxygenation
what is the forms the root of the lung?
bronchi pulmonary artery and veins bronchial arteries and veins anterior and posterior plexuses lymphatics
what are the paired visceral branches of the descending thoracic aorta?
bronchial arteries
which arteries supply the lung substance?
bronchial arteries
what is the name for the largest subdivisions of a lobe?
bronchopulmonary segments
what is the most posterior in location in the hilum of the left lung?
bronchus
What are the three targets of parasympathetic ganglia?
cardiac muscle smooth muscle glands
what is the intrinsic conduction system in the heart?
cardiomyocytes largely in SA node embryonic development is distinct specialized with unique gene expression and morphology
what are the sources of the sympathetic ANS of the thorax?
cardiopulmonary splanchnics/cardiac nerves (cervical and thoracic sympathetic ganglia)
what are the systems involved in the ANS?
cardiovascular respiratory digestive urinary reproductive
what are chemoreceptors involved in reflex arcs?
carotid and aortic bodies that detect changes in O2 and CO2 they regulate respiratory activity and can affect blood pressure
what does the umbilical vein do?
carries O2 rich blood to inferior vena cava via ductus venosus - bypasses liver inferior vena cava takes O2 rich blood to right atrium
What does the AV bundle do?
carries signal through membranous interventricular septum passes through cardiac skeleton electrical link between contraction in atria and ventricles
what is the function of the pulmonary veins?
carry high O2 blood to left atrium
what is the function of the pulmonary arteries?
carry low O2 blood to the lungs
what are the pulmonary veins?
carry oxygenated blood from respiratory zones to the heart
what type of joint is the costochondral joint?
cartilaginous
what is the xiphoid process in young people? when does it ossify
cartilaginous, it doesn't ossify until the age of 40
what are the apertures in the thoracic diaphragm?
caval hiatus esophageal hiatus aortic hiatus
What are the prevertebral ganglia?
celiac, superior mesenteric, inferior mesenteric there is one single set (not one on each side like the paravertebrals) associated with the abdominal aorta
what are the divisions of the nervous system?
central and peripheral nervous system
what are the subdivisions of parietal pleura?
cervical (contains the suprapleural membrane) costal diaphragmatic Mediastinal (contains the pulmonary l.)
what are the two secondary curvatures of the vertebral column?
cervical and lumbar
what are the smallest vertebrae in the body?
cervical vertebra
what are the different regions of parietal pleura?
cervical, mediastinal, costal, diaphragmatic
What are reflex arcs?
chains of neurons that create reflexes
what type of ANS receptors accept ACh?
cholinergic
what are some reasons that people would have a sympathectomy?
chronic pain Raynaud's phenomenon hyperhydrosis
What are the head and neck ganglia?
ciliary (III) pterygopalatine (VII) submandibular (VII) otic (IX)
what is the coronary sinus
circulates venous blood from the walls of the heart. located posteromedial to inferior vena cava
What is the ligamentum arteriosum?
circulatory modification between pulmonary trunk and aorta
what are the branches of the left coronary artery?
circumflex artery which has the left marginal artery branching off of it anterior interventricular artery which is also called the left anterior descending (LAD) or widowmaker posterior interventricular artery (variable)
what articulates with the manubrium?
clavicle and first rib rib two at the bottom end of the sternum
what is the visceral pleura?
completely invests lungs
What is the shape of the primary curvatures of the vertebral column?
concave anteriorly
what is the mediastinal surface of the lung?
concave medial surface where the pulmonary root and ligament are located
what is the cardiac notch in the left lung?
concavity that accommodates the heart in anterior margin of superior lobe
what makes up the outer portion of the intervertebral discs?
concentric fibrocartilage rings called the annulus fibrosis
what is the pulmonary ligament?
contained within the mediastinal parietal pleura. Double layer of mediastinal pleura that extends inferiorly from root of the lung
what is the pulmonary ligament and where does it extend from?
contained within the mediastinal parietal pleura. Double layer of mediastinal pleura that extends inferiorly from root of the lung extends inferiorly from the root of the lung
what are the attachments of the parietal pericardium?
continuous with central tendon of diaphragm and tunica adventitia of IVC Continuous superiorly with tunica adventitia of great vessels Ascending aorta pulmonary trunk Superior vena cava pulmonary veins
what is the point of reflection with the visceral pericardium?
continuous with serous layer of parietal pericardium at root of great vessels
what is the shape of the two secondary curvatures of the vertebral column?
convex anteriorly
what do the right and left bundle branches do?
convey impulses to Purkinje fibers
what is the function of the AV node?
conveys impulses to AV bundle
what are considered functional end arteries?
coronary arteries
what do the cardiac veins drain into?
coronary sinus
what openings are found in the sinus venarum?
coronary sinus superior and inferior vena cavas
what forms the costomediastinal recesses?
costal and mediastinal parietal pleura
what forms the costodiaphragmatic recess?
costal and peripheral diaphragmatic parietal pleura
what innervates the parietal pleura?
costal and peripheral diaphragmatic pleura- intercostal nerves mediastinal and central diaphragmatic pleura- phrenic nerve
what is the joint between the tubercle of the rib and the transverse process of the vertebra?
costovertebral joint
what is the name for the joint between the rib and vertebra?
costovertebral joint
what is the location of the visceral pericardium?
covering on external surface of heart- fatty layer
what is the cervical portion of the parietal pleura?
covers area over apex of lung rises above superior thoracic aperture superior to medial 1/3 of clavicle
what is the mediastinal section of the parietal pleura?
covers both sides of the mediastinum
what is the diaphragmatic section of parietal pleura?
covers the superior surface of the diaphragm on either side of the mediastinum
what is the other name for the parasympathetic system?
craniosacral
what is the esophageal hiatus?
created by R crus of diaphragm esophagus at T10 vagal trunks as well
what is the cardiac skeleton?
crisscrossing, interlacing layer of connective tissue
where does the left phrenic nerve sit?
crosses the arch of the aorta; passes over left vagus nerve, and the superior intercostal vein
what are the functions of the parasympathetic cardiac plexus?
decrease blood pressure decrease heart rate constricts coronary vessels
what is expiration?
decrease volume and increases intrathoracic pressure
Does intra abdominal pressure increase or decrease during expiration? what does this allow for?
decreases allows for the elastic recoil of the lungs
what is the location of the hilum?
depression on medial surface of lung
what is the continuation of the arch of aorta?
descending thoracic aorta
what are the contents of the posterior portion of the inferior mediastinum?
descending thoracic aorta esophagus and esophageal plexus anterior and posterior vagal trunks thoracic duct and lymph nodes azygos system of veins thoracic sympathetic trunk and splanchnic nerves
what is the location of the descending thoracic aorta?
descends through thorax on the left side of T5-T12
What are some ways that you can control the ANS?
desensitization biofeedback meditation imagery pet therapy
what do baroreceptors do?
detect changes in blood pressure which helps maintain constant blood pressure
where does the musculophrenic artery travel to?
diaphragm
do the semilunar valve cusps close during systole or diastole?
diastole
where do the anterior cardiac veins drain?
directly into the right atrium
what is the diaphragm?
dome shaped muscle that is the primary muscle of respiration
what is the meaning of the word hilum?
doorway
what innervates the intrinsic muscles of the thorax?
dorsal rami
what is the pericardium?
double-walled sac that encloses the heart
what are the intercostal veins?
drain each intercostal space. Anterior and posterior pattern similar to arteries.
where do the pulmonary veins terminate?
drain into the left atrium
where is the termination of the superior vena cava?
drains into the right atrium terminal part of the superior vena cava in the middle mediastinum
what is the function of the thoracic duct?
drains lymph from entire body except upper right quadrant and inferior lobe of left lung
what is inspiration?
draws air into lungs
What are the parasympathetic brainstem nuclei?
edinger-westphal (III) Superior salivatory (VII) Inferior salivatory (IX) Dorsal nerve of vagus (X)
where does the inferior vena cava terminate?
empties into the right atrium
what is the function of the hilum?
entrance and exit for root structures
What is pneumothorax?
entry of air into the pleural cavity
what is another name for the visceral pericardium?
epicardium of the heart
what is in the middle layer of the intrinsic musculature of the thorax?
erector spinae
where does the pulmonary plexus enter the abdomen?
esophageal hiatus (T10)
the pulmonary plexus communicates with the ___ plexus
esophageal plexus
what does the descending aorta displace to the right?
esophagus
what does the trachea sit anterior to?
esophagus and to the right of the midline
how do multipolar neurons in the autonomic system exist?
exist as groups referred to as nuclei in the central nervous system referred to as ganglia in the peripheral nervous system -anatomic structures -within walls of viscera (clusters/intramural)
where do the postganglionic fibers synapse of splanchnic nerves?
exit the prevertebral ganglia and synapse on target (viscera)
what is the right auricle?
extends anteriorly over base of ascending aorta
which intercostal muscles can you see from an external view?
external and internal
what are the three intercostal muscles?
external, internal, innermost
what is the function of the pericardial cavity?
facilitates frictionless movement of heart
True or false: the muscular interventricular septum is as thick as the wall of the right ventricle
false, it is as thick as the wall of the left ventricle
true or false: the phrenic nerve and pericardiacophrenic vessels pass posterior to the root of the lung
false, pass anterior
what is the intervertebral disc?
fibrocartilage disc that is inserted between the bodies of the vertebrae start at C2-C3 continue until L5-sacrum
what is the esophagus?
fibromuscular tube from the pharynx to stomach
what are the types of parietal pericardium?
fibrous and serous
what does the sympathetic nervous system do?
fight or flight
when does filling of the coronary arteries occur?
fill during diastole, when backflow of blood fills aortic semilunar valve
what is the inferior phrenic artery?
first branches off of abdominal aorta
Is the esophagus flattened? if so, what direction?
flattened anteroposteriorly
what are the movements of the vertebral column?
flexion, extension, lateral bending, and rotation
what are the esophageal plexuses?
formed by nerve fibers from two sources, branches of the vagus nerve, and visceral branches of the sympathetic trunk. The esophageal plexus and the cardiac plexus contain the same types of fibers and are both considered thoracic autonomic plexus.
what forms the right pulmonary surface?
formed primarily by right atrium
what forms the left pulmonary surface?
formed primarily by the left ventricle
what forms the sternocostal (anterior) surface of the heart?
formed primarily by the right ventricle
what is the muscular part of the interventricular septum?
forms the majority of the septum has the same thickness as the left ventricle
what does the foramen ovale become after it closes?
fossa ovalis
what are the pectinate muscles (musculi pectinati)
found in the anterior wall and auricle of the right atrium
how many pulmonary veins are there coming back to the heart?
four
what is the composition of the cardiac skeleton?
four fibrous connective tissue rings. They surround the heart valves
how many pulmonary veins do we have, and what are their names?
four total right inferior right superior left inferior left superior
what is the location of the posterior interventricular groove?
furrow between right and left ventricles on diaphragmatic surface
what is unique about the sacral vertebrae?
fused foramina for spinal nerves
In the parasympathetic there are a series of _________ in the head
ganglia
what are the beads of the paravertebral ganglia?
ganglia
what are the types of nerves involved in the ANS?
general visceral efferent (GVE) innervates viscera (visceromotor)
what is the function of the septomarginal trabecula?
gets papillary muscles contracting before ventricular contraction
what is the landmark for the left recurrent laryngeal nerve?
goes behind ligamentum arteriosum
what are the three thoracic splanchnic nerves?
greater, lesser, least
what is the first part of the costovertebral joint?
head of the rib articulating with the body of the vertebra of the same number plus a joint with the vertebra body of the number above
what are the contents of the middle portion of the inferior mediastinum?
heart pericardium root of great vessels phrenic nerve and pericardiacophrenic artery and vein on the fibrous pericardium
how does gas and nutrient exchange occur in the systemic circuit?
heart via the coronary arteries body via the systemic arteries
what are the results of having patent ductus arteriosus?
high pressure aortic blood passes into pulmonary artery raised blood pressure in pulmonary circulation pulmonary hypertension could lead to right-sided heart failure
What direction are the pulmonary veins exiting the left atrium?
horizontal
flexion of the vertebral column
hunching over forward
What controls the autonomic nervous system?
hypothalamus
what do the umbilical arteries branch off of?
iliac arteries
what is the location of the thymus gland?
immediately posterior to manubrium anterior to pericardium
Where do the parasympathetic neurons largely exist?
in the brain stem with several nuclei or cell columns series of parasympathetic nuclei in the brain that are associated with cranial nerves
where do the sympathetic neurons largely exist?
in the lateral horn of the spinal cord specifically the intermediolateral nucleus
where is the hemi-azygos vein located?
in the posterior mediastinum on the left side inferiorly
where is the azygos vein?
in the posterior mediastinum on the right side
What is the function of the sympathetic cardiac plexus?
increase blood pressure increase heart rate vasodilate coronary vessels
how does inspiration draw air into the lungs?
increases volume and diameter of thoracic cavity. creates negative air pressure
where is the costodiaphragmatic recess?
inferior between thoracic diaphragm and ribs. the pleural fluid sits in here
what does the inferior ganglia of the cardiac nerve give rise to?
inferior cardiac ganglia
what does rib eight articulate with?
inferior costal facet of vertebrae 7 and superior facet of vertebrae 8 (bigger articulation)
where does the esophagus enter the posterior mediastinum?
inferior to the aortic arch
what is the nucleus pulposus?
inner gelatinous nucleus of the intervertebral disc that gives the disc its elasticity and compressibility gel like structure at the center of the vertebrae, accounts for much of the strength and flexibility mostly composed of water, but has some collagen (connective tissue) in it.
what is visceral pericardium?
inner layer of pericardium that is directly on the heart
what is the function of the pulmonary plexus?
innervates bronchial tree and visceral pleura
where are pericardial sinuses located?
inside the pericardial cavity
what must contract to increase transverse and anterior-posterior dimension?
intercostal muscles
what relaxes in order for expiration to occur?
intercostal muscles and thoracic diaphragm
what innervates the costal and peripheral diaphragmatic parietal pleura?
intercostal nerves
what are the strings of the paravertebral ganglia?
interganglionic connections
where can you find the first neuron in the sympathetic nervous system?
intermediolateral nucleus
what does the intercostal neurovascular bundle lie on?
internal intercostal muscles
what is the carina?
internal ridge demarcating tracheal bifurcation
Where does the pericardiophrenic artery come from?
internal thoracic artery
what is the origin of the pericardiacophrenic artery?
internal thoracic artery
where does the internal thoracic artery divide at and what does it divide into?
internal thoracic artery divides at 6th intercostal space into the superior epigastric and musculophrenic arteries.
what is the crista terminalis and where is it located?
internally in the right atrium. ridge separating pectinate muscles from sinus venarum
what holds the vertebrae together and gives them cusion?
intervertebral disc
what is the trabeculae carneae and where is it located?
irregular muscles that line the right ventricle
how can people get valvular heart disease?
it can be congenital or acquired
Does the cardiac plexus contain sympathetic and/or parasympathetic?
it contains both sympathetic and parasympathetic
What is the conus arteriosus (infundibulum) and where is it located?
it is a funnel-shaped smooth area leading to pulmonary trunk in the right ventricle
where is the ligamentum arteriosum located? what is it a landmark for?
it is between the aorta and the pulmonary trunk it is a landmark for the recurrent left laryngeal
where is the crista terminalis found? what landmark corresponds externally?
it is found in the right atrium between the sinus venarum and the pectinate muscle externally the sulcus terminalis
what is the bicuspid valve and where is it located?
it is the left atrioventricular valve and it is also called the mitral valve
what is the location of the atrioventricular groove?
junction between atria and ventricles
where is the SA node located?
junction of superior vena cava and sulcus terminalis
Where is the aortic vestibule?
just before we pass through the aortic semilunar valve. smooth outflow region of the left ventricle
where does the superior vena cava receive the azygos vein?
just superior to entry into the pericardial sac
what are the functions of the cardiac skeleton?
keep valves patent (open) and from being overly distended attachment point for cusps separates atrial and ventricular muscles forms electrical insulator allows them to contact independently
why is surface tension important in the pleural cavity?
keeps the lungs full and in contact with the thoracic wall
what are potential abnormalities in the curvatures of the vertebral column?
kyphosis lordosis scoliosis
what is an example of something controlled by the parasympathetic nervous system only?
lacrimal glands
what is the costal surface of the lung?
large surface that is adjacent to the costal pleura
on which side is the costomediastinal recess larger and why?
larger on the left due to cardiac notch of the left lung
What is scoliosis?
lateral curvature of the spine
where are the preganglionic cell bodies located (sympathetic)?
lateral horn of spinal cord IML T1-T2/3
lateral rotation of vertebral column
leaning left or right so the spine makes a curved shape
which direction does the apex of the heart point?
left
which artery does the great cardiac vein run with?
left anterior interventricular artery
where do the pulmonary veins drain?
left atrium
what are the steps in the systemic circuit?
left atrium left ventricle through the bicuspid valve aorta through the aortic semilunar valve systemic arteries capillary beds of body tissues systemic veins/vena cava (back to right atrium)
which chamber primarily forms the base of the heart?
left atrium (a little bit of the right atrium)
what are the two major structures that make up the left side of the heart?
left atrium and left ventricle
what does the left coronary artery supply?
left atrium, most of left ventricle, and most of the interventricular septum (including AV bundle)
which brachiocephalic vein is longer?
left brachiocephalic vein
which of the brachiocephalic veins is longer?
left brachiocephalic vein is twice as long as the right brachiocephalic vein
what surface of the heart creates the cardiac impression on the left lung?
left pulmonary surface
what contributes to anterior esophageal plexus?
left vagus nerve
what gives rise to the left recurrent laryngeal nerve?
left vagus nerve
what forms the apex of the heart?
left ventricle
what is the origin of the ascending aorta?
left ventricle
where is the deep cardiac plexus?
lies between aortic arch and trachea
what is the location of the left coronary artery?
lies between left auricle and pulmonary trunk
where is the superficial cardiac plexus?
lies in concavity of aortic arch
what does the ductus arteriosus become in adulthood?
ligamentum arteriosum
what is the landmark where the left recurrent laryngeal nerve loops around the aortic arch?
ligamentum arteriosum
what is the remnants of a fetal circulatory shunt that can be seen between the pulmonary trunk and the arch of the aorta?
ligamentum arteriosum
what are other sources of control besides the hypothalamus for the ANS?
limbic system (amygdala) brain (reticular formation, PAG, etc) spinal cord (spinal visceral reflexes)
what is parietal pleura?
lines inner surface of each pulmonary cavity.
what is the costal section of the parietal pleura?
lines internal surface of ribs and intercostal spaces
where is parietal pleura found?
lining the entirety of the lung
Where is the ductus arteriosus and what does it do?
located between pulmonary trunk and arch of aorta. Shunting blood from the pulmonary trunk to the aorta
what are the papillary muscles and where are they located?
located in the right ventricle
where is the AV node located?
located on interatrial wall near coronary sinus opening
what kind of bone is the rib?
long bone
what is the shaft or body of the rib?
long curved part of the bony rib
as you go down from rib 1, what happens to the other ribs?
longer and decrease in curvature rotate and twist so they are vertical
what is the location of the left recurrent laryngeal nerve?
loops posteriorly around aortic arch, behind the ligamentum arteriosum
what is the clinical significance of the costodiaphragmatic recess?
low point where fluid/blood may accumulate?
where is the hemi-azygos vein located? where does it drain?
lower left drains into the azygos vein
where does the hemi-azygos vein receive blood from?
lower left side
what does the inferior vena cava drain?
lower limbs, abdomen, and abdominal viscera
what is located in the anterior division of the inferior mediastinum?
lower part of thymic remnant internal thoracic vessels parasternal lymph nodes adipose tissue (retrosternal clear area)
what is contained in the pulmonary cavities?
lung and pleura
what is the origin of the pulmonary veins??
lungs
what are the names of the different parts of the three cusps of the semilunar valve and what are they?
lunule- free edge nodule- bump in the middle of the free edge, this is what will push together with the other cusps' nodules ensuring that there is no gap sinus- outpouching in the wall of the pulmonary trunk. The purpose of this is to make sure the cusps do not get stuck
what is the spinous process of the vertebrae?
makes the bump in your back
what is the broadest part of the sternum?
manubrium
what are the three parts of the sternum?
manubrium, body, xiphoid process
Can you see the fossa ovalis in the left atrium?
may be possible to see indentation on the interatrial septum
what may occur when there is a large patency in the foramen ovale?
may overload pulmonary circulation hypertrophy of right atrium and ventricle
What are some things that can occur after a heart transplant?
may regenerate autonomic fibers can still respond to humoral factors - catecholamines (from adrenal glands) normal conduction activity
which arcuate ligament arches over the psoas major muscle?
medials
what are the posterior abdominal wall attachments?
median arcuate ligament medial arcuate ligaments lateral arcuate ligaments
what are the contents of the superior mediastinum?
mediastinal lymph nodes thymus brachiocephalic veins superior vena cava arch of aorta vagus, phrenic, and recurrent laryngeal nerves trachea, esophagus, and thoracic duct
what forms the pulmonary ligament?
mediastinal parietal pleura
what portion of the parietal pleura reflects laterally at the root of the lung and becomes continuous with visceral pleura?
mediastinal pleura
where is the hilum of the lung?
mediastinal surface
what is the common site of ventricular septal defects?
membranous part of the interventricular septum
which part of the interventricular septum sits superiorly and posteriorly to the other part?
membranous part sits superiorly and posteriorly to the muscular part
what is the serous parietal pericardium?
mesothelial lining on the inner surface of fibrous parietal layer
what does the middle ganglia of the cardiac nerve give rise to?
middle cardiac nerves
where is the heart located?
middle mediastinum
what is the caval hiatus?
most anterior through central tendon IVC at T8
what is the aortic hiatus?
most posterior surrounded by R/L crura thoracic aorta at T12 thoracic duct and azygos vein as well
What uses norepinephrine as a neurotransmitter?
most sympathetic postganglionic neurons - exceptions are sweat glands, arrector pili muscles
what is the main function of the intrinsic musculature of the thorax?
mostly extension (bilateral) and lateral flexion/rotation (unilateral)
what does the phrenic nerve supply?
motor and sensory to diaphragm
bucket handle movement
movement of the ribs and thoracic cage that occurs as respiratory muscles contract and thoracic volume changes
What kind of neurons are found in the autonomic nervous system?
multipolar
where are the right and left bundle branches located?
muscular interventricular septum
which arteries supply the thoracic diaphragm?
musculophrenic artery superior and inferior phrenic arteries
what is the blood supply for the thoracic diaphragm?
musculophrenic artery superior phrenic artery inferior phrenic artery
Is the preganglionic neuron myelinated or unmyelinated?
myelinated
How does the signal travel from the SA node?
myogenic conduction
what is the neck of the rib?
narrow part distal to the head
what is the structure of the left primary bronchus?
narrower, longer, and more horizontal
what is valvular stenosis?
narrowing failure of the valve to open fully slows blood flow from the chamber can result in turbulance
how are mechanoreceptors regulated?
negative feedback
what is the anterior vagal trunk?
neurons from left vagus nerve emerging from anterior esophageal plexus on anterior surface of esophagus
what is posterior vagal trunk?
neurons from right vagus nerve emerging from posterior esophageal plexus on posterior surface of esophagus
what lies in the costal groove of the rib?
neurovascular bundle
What lies in the costal groove of a rib?
neurovascular bundle VAN anterior or posterior intercostal vein and artery intercostal nerve
What are the two types of cholinergic receptors?
nicotinic and muscarinic
Is the ANS necessary for life?
no
can the visceral pleura be dissected away?
no
does the parasympathetic nervous system discharge as a complete system?
no
is the sympathetic system essential for life?
no
Is the visceral pericardium always the same thickness?
no it can vary
Can you see the SA and AV nodes in lab?
no, they are microscopic
Do the azygos veins have valves?
no, they are valveless
are the coronary arteries always consistant?
no, they can be variable
what happens to the foramen ovale after birth?
normally closes with pressure changes
what happens after birth regarding the ductus arteriosus?
normally it constricts and later closes.
do ribs 11 and 12 have any articulation?
not on the anterior side
what occurs in a herniated intervertebral disc?
nucleus pulposus is displaced from intervertebral space
what are the names of the fissures on the right lung?
oblique and horizontal
what is the name of the fissure in the left lung?
oblique fissure
where do the posterior intercostal arteries come from?
off of descending aorta upper two intercostal from supreme intercostal artery from costocervical trunk off subclavian artery
where do the preganglionic fibers of splanchnic nerves synapse?
on abdominal prevertebral ganglia
what is the difference between the aortic semilunar valve and the pulmonary semilunar valve?
on the aortic semilunar valve there are two little openings in the sinuses that lead to the right and left coronary arteries
where does the thoracic duct lie in relation to the esophagus?
on the left side in the superior mediastinum
How thick is the myocardium on the left ventricle compared to that on the right ventricle?
on the left ventricle, the myocardium is 2-3 times thicker than the right ventricle
Where will splanchnic nerves synapse?
on the prevertebral ganglia
how many fissures are there in the left lung?
one
what is the mediastinum?
one central compartment containing all thoracic structures other than the lungs.
what is the musculophrenic artery?
one of two terminal branches from the internal thoracic artery
Where is pectinate muscle found in the left atrium?
only found in the left auricle
what are the two types of pneumothorax?
open and closed
what are the right and left coronary arteries and where are they located?
open on the aortic side of valve in right and left sinuses of cusps respectively
what is the foramen ovale?
opening between the right and left atria blood shunted from right atrium to left atrium blood then goes to left ventricle
What is the vertebral foramen?
opening for spinal cord
what is the location of the heart?
oriented obliquely behind sternum and medial ends of ribs 3-5 about 1/3 to the right of midline about 2/3 to the left of midline
what is the cisterna chyle?
origin of thoracic duct in abdomen at L1 enters thorax via aortic hiatus at around T4, passes to the left
what is the annulus fibrosus?
outer region of intervertebral disc ring shaped disc of fibrous connective tissue (collagen) that surrounds the nucleus pulposus.
what is the fibrous percardium?
outermost layer of pericardium, very tough
what is the fossa ovalis and where is it located?
oval-shaped depression in interatrial septum remnant of foramen ovale
what are the blood qualities of the blood in the left side of the heart?
oxygen rich
Does the umbilical vein carry oxygenated or deoxygenated blood?
oxygenated
what is the SA node?
pacemaker of the heart
what is the SA node and where is it located?
pacemaker- generates impulses that induce CONTRACTION OF ATRIA deep to the epithelium, located at junction of superior vena cava and crista terminalis
what is the superior phrenic artery?
paired branches from descending thoracic aorta
what are the attachment points for the chordae tendineae?
papillary muscles and the valve cusps
what is the location of the thoracic sympathetic trunk?
parallel vertebral column bilaterally continuous with cervical and lumbar sympathetic trunks
where do you find the first neuron in the parasympathetic nervous system?
parasympathetic nuclei
what are examples of cooperative innervation of the parasympathetic and sympathetic ns?
parasympathetic: erection (vasodilation of clitoris and penis) sympathetic: ejaculation and remission of erect state, peristalsis of the vagina
In the sympathetic nervous system there is a ________ along the spine
paravertebral chain
what are the types of pericardium?
parietal and visceral
What is the chordae tendineae and where are they located?
pass from papillary muscles to cusps in the right ventricle
what is the location of the bronchi?
pass from trachea to root of lungs
what is the transverse pericardial sinus?
passage posterior to ascending aorta and pulmonary trunk but anterior to superior vena cava
what is the arch of azygos impression on the right lung?
passes superior to the root of the right lung and into the superior vena cava
what is open pneumothorax?
penetrating injury to the parietal pleura
what is the name of the space between the parietal and visceral layers of serous pericardium?
pericardial cavity
what is in the pericardial cavity?
pericardial fluid
what attaches to the large central tendon of the diaphragm?
pericardium of the heart
what is the anterior longitudinal ligament continuous with?
periosteum of the bone
what innervates the thoracic diaphragm?
phrenic nerve
what is the site of O2 and nutrient exchange in fetal circulation?
placenta
what is the location of the pericardial neurovascular structures?
plane between fibrous pericardium and mediastinal pleura
what can result in a collapsed lung?
pneumothorax, hemothorax, hydrothorax
what is the aortic arch?
portion of the aorta that contains the 3 main branches of the aorta (IA, LCCA, LSCA)
What are the cardiopulmonary splanchnics?
post ganglionic sympathetic
Which side of the trachea is incomplete?
posterior
is the nucleus pulposus located in the center, posterior, or anterior part of the disc?
posterior
what are the paired parietal branches of the descending thoracic aorta?
posterior intercostal arteries 3rd-11th intercostal spaces
what does the middle cardiac vein run with?
posterior interventricular artery
what are the contents of the posterior interventricular groove
posterior interventricular artery and middle cardiac vein
what is another name of the base of the heart?
posterior surface site opposite of apex
what is the location of the thoracic duct?
posterior to esophagus anterior to thoracic vertebrae between thoracic aorta and azygos vein
what is the location of the right coronary artery?
posterior to pulmonary trunk in atrioventricular groove
where are the vagus nerves in relationship to the root of the lung?
posterior to root of lung
where is the transverse pericardial sinus located?
posterior to the aorta and pulmonary trunk and anterior to the superior vena cava
where is the thoracic duct located?
posterior to the esophagus anterior to the vertebral column sits between the aorta and azygos veins
what is the location of the left atrium?
posteriorly
which side are the C-shaped rings incomplete?
posteriorly
In the sympathetic pathway, when they exit the cervical and thoracic ganglia as cardiac nerves, all are what?
postganglionic
what does the cardiac plexus in the superior mediastinum consist of?
preganglionic parasympathetic fibers from cranial nerve X postganglionic sympathetic fibers from cardiac nerves (cardiopulmonary splanchnics)
what are the pelvic splanchnic nerves?
preganglionic parasympathetic nerves
what are the lumbar splanchnics?
preganglionic sympathetic
what are the thoracic splanchnic nerves?
preganglionic sympathetic
what are the types of neurons in thoracic splanchnic nerves?
preganglionic sympathetic fibers
what kind of fibers are in the thoracic splanchnic nerves?
preganglionic sympathetic fibers
what are some things that can lead to failed closure of the ductus arteriosus?
preterm birth congenital heart issue
what is the function of the tricuspid valve?
prevents backflow of blood into the right atrium
what is the function of the chordae tendineae?
prevents prolapse of cusps during ventricular contraction (systole)
what forms the diaphragmatic surface?
primarily by the left ventricle and a small part by the right ventricle
what is the texture of the interior of the left atrium?
primarily smooth
what forms the base of the heart?
primarily the left atrium with some of the right atrium as well
what is the function of the thymus gland?
primary lymph organ site of T-lymphocyte development undergoes involution (becomes fatty) after puberty
what is the location of the bronchus in the right lung?
primary/lobar posterior in location
what is the inferior articular process of the vertebrae?
projects downward from where the lamina and pedicles meet
what is the superior articular process of the vertebra?
projects upward from where the lamina and pedicles meet
what is the function of the pericardium?
protects and stabilizes heart secretes serous fluid to create friction-free movement of the heart
what are the functions of the fibrous skeleton?
provide a ring for the cusps to attach to (patency) electrical insulation attachment point of the myocardium of the atria and ventricles
what is the purpose of the xiphoid process?
provides attachment for muscles
which end is the head of the rib?
proximal end
which arteries carry blood to the lungs for oxygenation?
pulmonary arteries
where is the pulmonary artery in relation to the bronchus in the right lung?
pulmonary artery is anterior to the bronchus
what is the origin of the pulmonary arteries?
pulmonary trunk
what are the entering vessels into the left atrium?
pulmonary veins
what are the most anteriorly and inferiorly located structures in the root of the right lung?
pulmonary veins
what is most anterior in location in the left lung hilum?
pulmonary veins
what is the sternocostal (anterior) surface of the heart?
puppy dog ears point towards this surface
what is the rough shape of the bronchopulmonary segments?
pyramidal
what is the coronary sinus and where is it located?
receives majority of venous drainage from heart in atrioventricular groove
What is the left atrium and where is it located?
receives oxygenated blood from the lungs
what is the oblique pericardial sinus?
recess on posterior surface of the heart, inferior to pulmonary veins
What are the sources of the parasympathetic ANS of the thorax?
recurrent laryngeal and vagal cardiac branches (cranial nerve X)
what is RALS?
refers to the position of the pulmonary artery in relationship to the bronchus right pulmonary artery is anterior to the bronchus left pulmonary artery is superior to the bronchus
where are parietal and visceral pericardium continuous with each other?
reflect at the root of the great vessels of the heart
what is the function of the cardiac plexus?
regulates rate and strength of contraction not required to initiate beat
What is the major function of the autonomic nervous system?
regulation and maintenance of homeostasis
what is valvular insufficiency?
regurgitation failure of valve to close completely
what are examples of some things controlled only by the sympathetic nervous system?
renin release from kidney constriction of blood vessels epi and NE release from adrenal medulla contraction of arrector pili (hair follicle)
what does the parasympathetic system do?
rest and digest
which rib is the shortest, broad and flat, and it has the greatest curvature (encloses the smallest amount)?
rib 1
what three articulations are associated with the costovertebral joint?
rib with vertebra of same number rib with vertebra of lower number tubercle of rib with transverse process of vertebra
what are true ribs and why are they called this?
ribs 1-7 their costal cartilage attaches directly to the sternum
what does the body of the sternum articulate with?
ribs 2-7
what are the false ribs?
ribs 8-12, lack independent cartilaginous connections to the sternum it does not articulate directly with the sternum
does the right crus or the left crus have more vertebral attachments?
right
which lung is larger?
right
which lung is shorter and wider?
right
What forms the superior vena cava?
right and left brachiocephalic veins
what two structures form the superior vena cava?
right and left brachiocephalic veins
what are the branches of the ascending aorta?
right and left coronary arteries
what are the contents of the atrioventricular groove?
right and left coronary arteries and coronary sinus
what are the branches off of the pulmonary trunk?
right and left pulmonary arteries
how does blood enter the left side of the heart?
right and left pulmonary veins
where does the coronary sinus drain into?
right atrium
where does the superior vena cava terminate?
right atrium
Which chambers of the heart function in the pulmonary circuit? which valves?
right atrium right ventricle pulmonary semilunar valve right atrioventricular (tricuspid)
What are the two major structure that make up the right side of the heart?
right atrium and right ventricle
what does the right coronary artery supply?
right atrium, right ventricle, posterior left ventricle, part of the IV septum, and SA and AV nodes
what are the contents of the septomarginal trabecula?
right bundle branch of AV bundle
where does the SA nodal branch typically originate?
right coronary artery
what does the small cardiac vein run with?
right marginal artery
which bronchus is the wides and the shortest?
right primary bronchus
what splits off after the carina?
right primary bronchus and left primary bronchus
where is the azygos vein located?
right side
which side does the azygos vein receive blood from?
right side
which side is the diaphragmatic surface of the lung deeper concavity on and why?
right side to accommodate liver which is pushing up into it
what contributes to the posterior esophageal plexus?
right vagus nerve
what gives rise to the right recurrent laryngeal nerve?
right vagus nerve
Which has a thicker wall, right atrium or right ventricle?
right ventricle
what is the origin of the pulmonary trunk?
right ventricle
which chambers of the heart function in the pulmonary circuit? Which valves?
right ventricle and atrium tricuspid and pulmonary semilunar valves
rotation of the vertebral column
rotating your upper body around an axis while keeping lower body still
what can lead to valvular insufficiency?
scarring and contraction of cusps or rupture of cords cusps can be overly large or floppy
what is the function of the serous parietal pericardium?
secretes serous fluid
what are the types of cranial and spinal nerves?
sensory (afferent) motor (efferent)
what is the oblique fissure of the right lung?
separates middle and inferior lobes
what is the horizontal fissure of the right lung?
separates the superior and middle lobes
what is it called if the costochondral joint is torn apart?
separation
what is the thoracic sympathetic trunk?
series of paravertebral ganglia linked by preganglionic rami
what type of membrane is the visceral pericardium?
serous
what are the contents of the pleural cavity and what is the function of the contents?
serous fluid which lubricates pleural linings and provides surface tension
what type of membrane is the pericardium?
serous membrane
What kind of membrane is the parietal pleura?
serous membrane which will help to produce fluid and provide lubrication
Which layers of the pericardium are serous?
serous parietal visceral pericardium
what is in the intermediate layer of the extrinsic muscles of the thorax?
serratus posterior
what are the transverse processes of the vertebrae?
serve as muscle attachments for the deep back muscles and form a joint with the ribs in the thoracic region
what is the superior vena cava impression on the right lung?
sits in the superior portion of the lung, and the arch of azygos impression connects with it.
what is the base of the lung?
sits on diaphragm (AKA the diaphragmatic surface)
what is the location of the inferior vena cava?
sits to the right of the aorta
what is the location of the superior vena cava?
sits to the right of the aorta in vertical line with IVC as they enter right atrium
where does the right phrenic nerve sit?
sits to the right of the right brachiocephalic vein and the superior vena cava
which vein runs with the right marginal artery?
small cardiac vein
what is the appearance of the thoracic duct?
small thin-walled, and often beaded due to numerous valves
what are the targets of the sympathetic ganglia where the second release is ACh?
smooth muscle of certain blood vessels in skin and skeletal muscle sweat glands
what spans the gap in the C-shaped rings?
smooth muscles (trachealis)
what is the aortic vestibule and where is it located?
smooth outflow region leading to aortic semilunar valve (left ventricle)
what are the types of motor nerves?
somatic: voluntary Visceral: involuntary
what is the lub sound?
sound heard as AV valves close (systole)
what is the dub sound?
sound heard as semilunar valves close (diastole)
how would you identify the septomarginal trabeculae or the moderator band?
spans between interventricular septum and the anterior papillary muscle in the right ventricle
what is the median arcuate ligament?
spans right and left crura arches over abdominal aorta
what is the function of the pulmonary semilunar valve?
splay toward arterial wall during systole valve closes as pulmonary trunk recoils during diastole forcing blood back to the heart
what is in the superficial layer of the intrinsic musculature of the thorax?
splenius capitus
what level is the carina at?
sternal angle
where does the trachea terminate?
sternal angle (T4-T5)
where does the aortic arch begin and end?
sternal angle anteriorly and ends at sternal angle posteriorly
what are the two aspects of the cardiac plexus in the superior mediastinum?
superficial and deep
where does the arch of azygos pass in comparison to the root of the right lung?
superior
where is the pulmonary artery in relation to the bronchus in the hilum of the left lung?
superior
What are the divisions of the mediastinum?
superior and inferior (anterior, middle, posterior)
what does the superior ganglia of the cardiac nerve give rise to?
superior cardiac nerves
where does the vertebrae articulate with the ribs?
superior costal facet inferior costal facet
where is the lingula located?
superior lobe of left lung
where is the thymus located?
superior mediastinum anterior to brachiocephalic veins
where is the arch of azygos?
superior to the root of the right lung and into the superior vena cava
where does the azygos vein drain into?
superior vena cava
what are the entering vessels into the right atrium?
superior vena cava, inferior vena cava, and coronary sinus
what are the openings that the sinus venarum has?
superior vena cava, inferior vena cava, and coronary sinus
how does blood come into the right side of the heart?
superior vena cava, inferior vena cava, anterior cardiac veins, and coronary sinus
what are the names of the three lobes of the right lung?
superior, middle, and inferior
where are the postsynaptic cell bodies of the sympathetic pathway located?
superior, middle, and inferior cervical ganglia T1-T4 sympathetic ganglia
what are the three cervical ganglion?
superior, middle, and inferior cervical ganglion
what is the function of the bronchial artery?
supply lung substance itself
what do the thoracic splanchnic nerves supply?
supply viscera inferior to the thoracic diaphragm
what is a sympathectomy?
surgical resection of sympathetic afferent nerve fibers
what is the location of the pericardium?
surrounds heart and proximal part of great vessels
what is the xiphoid process?
sword-shaped lower tip of the sternum
What kinds of ganglia are there?
sympathetic and parasympathetic
what are the two divisions of the visceral motor (autonomic)?
sympathetic and parasympathetic
Where do most of the preganglionic axons enter?
sympathetic chain
where do the thoracic splanchnic nerves arise?
sympathetic trunk
what kind of joint are the sternocostal joints?
synovial joints
what is the function of the papillary muscles?
tense the chordae tendineae
what are the segmental branches of the left bronchus?
tertiary (segmental) bronchi to bronchopulmonary segments
what are the contents of the bronchopulmonary segments?
tertiary (segmental) bronchus tertiary (segmental) pulmonary artery autonomic nerves
what is found in a bronchopulmonary segment?
tertiary bronchus, tertiary artery
what are the segmental branches of the right bronchus?
tertiary or segmental bronchi to bronchopulmonary segments
which of the longitudinal ligaments is much stronger and broader?
the anterior
what does the ascending aorta become?
the aortic arch
what does the head of the rib articulate with?
the bodies of the vertebrae
what abuts the esophagus?
the cartilage rings of the tracheobronchial tree
what is costal cartilage?
the cartilage that connects to the rib (bony anterior end of rib)
what occurs with the costal cartilage of ribs 8-10?
the costal cartilage will join with the costal cartilage of the rib below
what happens if you get fluid inside of the fibrous pericardium?
the fibrous pericardium does not expand, and therefore the heart is compressed
what does the intercostal neurovascular bundle dive into/under?
the innermost intercostal muscles
what do the transversus thoracis muscles cover up?
the internal thoracic artery and vein
what is the costochondral joint?
the joint between the cartilage and the rib
what is the costal groove of the rib?
the linear depression on the internal and inferior surface of the body (corpus or shaft)
which heart sound is heard with contraction of the AV valves?
the lub
what separates the pulmonary cavities from each other?
the mediastinum
what are the two parts of the interventricular septum?
the muscular part and the membranous part
is the myocardium very thick in the right ventricle? why?
the myocardium is not very thick because the lungs are closer to the heart, so not as much power is needed here compared to the left ventricle
what is the relationship of the root of the lung to the pericardial neurovascular structures?
the pericardial neurovascular structures pass anterior to the root of the lung
which side of the vertebral column would be more susceptible to a herniation and why?
the posterior side because the posterior longitudinal ligament is not continuous, so it allows for things to push through and around it.
Where are aspirated bodies most likely to end up and why?
the right primary bronchus straight and more direct continuation of the trachea
which side has longer posterior intercostal arteries and why?
the right side because the aorta sits on the left side, therefore the right must pass over the vertebral column
what is the trabeculae carneae like in the left compared to right ventricle?
there is more trabeculae carneae in the left ventricle compared to the right
How is the sympathetic system affected by a heart transplant?
they don't usually connect the autonomic system, but the patients do fine without it
what is characteristic of the thoracic vertebrae?
they have a very long spinous process which is angled inferiorly to overlap the vertebra beneath it which provides protection.
what is the process of a heart transplant?
they must remove some of the autonomic otherwise they can get in the way 1. After the recipient is placed on cardiopulmonary bypass, the heart is removed 2. the posterior walls of the recipient's left and right atria are left intact 3. the left atrium of donor heart is anastomosed to the recipients residual posterior atrial walls, and the other atrial walls, the atrial septum, and the great vessels are joined
what does a functional end artery mean?
they supply a certain area, they don't have anastomosis, so if there is a fast blockage, it can be a problem
where do the brachiocephalic veins terminate?
they unite to form the superior vena cava
what is the membranous part of the interventricular septum?
thin membrane sits superiorly and posteriorly to muscular part
Why do we need the white and gray rami?
this is how the autonomic fibers are getting off the spinal nerve, entering the sympathetic chain to synapse and return to the spinal nerve to reach their final target
what does it mean for blood flow that there are no valves in the azygos veins? what is a benefit of this?
this means that blood can flow in any direction a benefit of this would be that if there is a blockage, the blood can backflow around it
Are the bodies of the thoracic or cervical vertebrae larger?
thoracic
What are the two primary curvatures of the vertebral column?
thoracic and sacral
what is the origin of the bronchial arteries?
thoracic aorta
what does the inferior vena cava pierce before it reaches the heart?
thoracic diaphragm
Where do the azygos veins drain back?
thoracoabdominal walls and mediastinal viscera
how many cusps does the aortic semilunar valve have?
three
how many cusps does the pulmonary semilunar valve have?
three
how many lobar branches are there off the right primary bronchi?
three
how many papillary muscles are found in the right ventricle?
three papillary muscles
what is the lingula?
tongue-like tail on superior lobe of the left lung
what structures are adjacent to the the apex of the lung?
trachea and esophagus are right left common carotid and left subclavian
what is the systemic circuit?
transports blood to and from the rest of the body
what is unique about the cervical vertebrae?
transverse foramina, spinous process is usually bifid they are each different from each other and small
What are the borders of the inferior mediastinum?
transverse plane between sternal angle and T4-5 IVD thoracic diaphragm inferiorly
what is in the deep layer of the intrinsic musculature of the thorax?
transversospinalis
what is in the superficial layer of the extrinsic muscles of the thorax?
trapezius and latissimus dorsi
what is the right AV orifice and where is it located?
tricuspid valve (right atrioventricular valve) inferior in right atrium
True or False: the sympathetic trunk runs the entire length of the vertebral column bilaterally
true
True or false: the ventricles shorten and contract during systole
true
what is the name of the bump on the rib that articulates with the transverse process of the vertebra of the same number?
tubercle of the rib
what creates a heart murmur?
turbulence created by valvular stenosis valvular insufficiency
how many fissures are there on the right lung?
two
how many lobar bronchi does the left lung have?
two
what is the origin of the pulmonary veins?
two from each lung right superior/inferior left superior/inferior
what are the pulmonary cavities?
two individual compartments containing lungs and pleurae
what makes up the vertebral arch of the vertebra?
two pedicles and two lamina
how many lobar branches are there of the left bronchus?
two secondary bronchi
where do the true ribs attach to the sternum?
two vertebral levels below where they originate example: second rib inserts at T4
where is the termination of the thoracic duct?
typically drains into left venous angle junction of left subclavian and left internal jugular veins
what are the umbilical cord contents?
umbilical vein and umbilical arteries
what forms the brachiocephalic veins?
union of subclavian and internal jugular veins
what forms the superior vena cava?
union of the right and left brachiocephalic veins
what forms the inferior vena cava and where is this union located?
union of the right and left common iliac veins near the pelvis
Is the postganglionic neuron myelinated or unmyelinated?
unmyelinated
what is the significance of the transverse pericardial sinus?
used to access great vessels for heart bypass
where does the hemi-azygos vein usually travel?
usually crosses over around T9 to drain into azygos vein
what is the tricuspid valve and where is it located?
valve between the right atrium and the right ventricle
What is valvular heart disease?
valves are compromised and do not open or close properly increased workload for the heart
is the azygos system of veins variable or not variable?
variable
what is the function of the sympathetic pulmonary plexus?
vasoconstriction bronchodilation decreased mucus secretion
what is the function of the parasympathetic pulmonary plexus?
vasodilate bronchoconstriction increased mucus secretion
what innervates the extrinsic musculature of the thorax?
ventral rami
what are the intercostal nerves?
ventral rami of thoracic spinal nerves (T1-T12)
what is diastole?
ventricular elongation and filling
What is systole?
ventricular shortening and contraction
what do the splanchnic nerves innervate?
viscera
in addition to the sympathetic and parasympathetic nervous systems, what other nervous is present?
visceral afferent
what innervates the visceral pleura?
visceral afferents (run with sympathetics)
which division of the nervous system is a two neuron system with one neuron in the CNS and one neuron outside the CNS?
visceral motor
What causes the lung to be shiny?
visceral pleura
Auscultations of Heart Sounds
way to characterize heart sounds
What is a patent foramen ovale?
when the foramen ovale does not properly close, blood is abnormally shunted between the R and L atria
what causes the cusps of the pulmonary semilunar valve to close?
when the ventricle relaxes, and the pulmonary trunk is relaxing, there is a small backflow of blood that fills up the cusps which causes them to close
where is the angle of the rib?
where the rib changed directions and begins to project anteriorly posterior
what is the location of the base of the heart?
where the superior vena cava, inferior vena cava, and pulmonary veins enter the heart
what is the carina?
where the trachea bifurcates (internal)
what are the differences between the white ramus and gray ramus?
white is more lateral and is myelinated gray is more medial and unmyelinated
what is the structure of the right primary bronchus?
wider, shorter, and more vertical
what joint is formed between the body of the sternum and the xiphoid process?
xiphisternum joint
what are the attachments of the thoracic diaphragm?
xiphoid process lower 6 ribs and costal cartilages posterior body wall via arcuate ligaments vertebrae via crura Left crus- bodies of L1-2/3 right crus- bodies of L1-3/4
what are the attachment points of the diaphragmatic crura?
xiphoid process ribs upper lumbar vertebral column
Can ganglia be located in the walls of the viscera?
yes
does the sympathetic nervous system discharge as a complete system?
yes
is the autonomic nervous system usually antagonistic?
yes
is the parasympathetic system localized?
yes
is valvular stenosis usually chronic?
yes
is there the possibility of the sternocostal joint to dislocate?
yes, but it is not very common
are the superior and inferior vena cavas connected?
yes, if you put a probe in the top of the superior vena cava, it will come out the bottom on the inferior vena cava
do ribs 11 and 12 have costal cartilage?
yes, on their tip, but they end in the musculature of the body wall
Can there be clusters of cell bodies in end organs?
yes, these would be considered ganglia
what is the external intercostal membrane?
Muscles that thin out and become a membrane at/near the costochondral junction
what are the qualities of the blood in the right side of the heart?
O2 poor blood from the body and heart
What is patent ductus arteriosus?
PDA is failure of the fetal ductus arterioles (artery connecting the aorta and the pulmonary artery) to close within the first weeks of life.
What do the parasympathetic and sympathetic systems do to the coronary vessels?
PS- constrict Sym- dialate
What do the parasympathetic and sympathetic systems do to the lungs?
PS- constrict Sym- dilate
What do the parasympathetic and sympathetic systems do to the heart?
PS- decreases HR Sym- increase HR
What do the parasympathetic and sympathetic systems do to the blood vessels?
PS- dialate Sym- constrict
What do the parasympathetic and sympathetic systems do to the GI tract?
PS- increase digestion Sym- decrease digestion
What do the parasympathetic and sympathetic systems do to the glands?
PS- increase secretion Sym- decrease secretion
What do the parasympathetic and sympathetic systems do to the urinary tract?
PS- increase urine Sym- decrease urine
How can you remember the right and left lung anatomy?
RALS
What is the left ventricle and where is it located?
Region of the heart that pumps blood to the body.
what is the fossa ovalis?
Remnant of the foramen ovale which was a fetal shunt between the right and left atrium
What are the steps of the pulmonary circuit?
Right atrium Right ventricle through the tricuspid valve pulmonary trunk through the pulmonary semilunar valve pulmonary arteries capillary beds of lungs (oxygenated) pulmonary veins
what does the parasympathetic cardiac plexus innervate?
SA and AV nodes Artia (less in ventricles) coronary vessels (somewhat)
what is the right atrium?
Segment of the heart that receives deoxygenated blood
what is the pulmonary trunk??
Short blood vessel that gives rise to the right and left pulmonary arteries
What are papillary muscles?
Small muscles that anchor the heart strings or cords. chordae tendineae attaching cusps to papillary muscles
what is the trachealis muscle?
Smooth muscle in the trachea that connects the ends of the "C rings" together abuts esophagus
What is lordosis?
Swayback (the butt sticks out)
what is the aortic hiatus?
T12 behind thoracic diaphragm descending aorta passes through and becomes the abdominal aorta
what is the vertebral level of the sternal angle?
T4
what are the borders of the posterior portion of the inferior mediastinum?
T5-12, posterior to pericardium between pulmonary cavities
which spinal levels contribute to the greater thoracic splanchnic nerve?
T5-9
where is the greater thoracic splanchnic nerve?
T5-T9
what is the vertebral level of the xiphisternal joint?
T9
where can you typically find a communicating vein that goes from the hemi-azygos vein to the azygos vein?
T9
What is the cardiac plexus?
The cardiac plexus is a plexus of nerves situated at the base of the heart. It is formed by cardiac branches derived from both the sympathetic and parasympathetic nervous systems. conduction system modified by autonomic nervous system
What are the pericardial sinuses?
They are pericardial redundancies where the pericardium folds over itself. They exist where the great vessels are entering or leaving the heart. It is a landmark for surgerons. They slide their finger into the superior vena cava
What are the cardiac veins?
They drain the deoxygenated blood from the heart tissue and drain into the coronary sinus. coronary sinus anterior cardiac veins great cardiac vein middle cardiac vein small cardiac vein
What are the cardiopulmonary splanchnic nerves and where do they originate from?
They originate from superior, middle, and inferior cervical ganglia as well as T1-T4 sympathetic chain ganglia
How many autonomic plexi are in the thorax and what are they?
Three: cardiac pulmonary esophageal
What are the brachiocephalic veins?
Two largest veins, carry all the blood from the upper extremities, head, and neck; Subclavian veins; Internal jugular veins
what are the right and left bundle branches?
Two pathways in the interventricular septum that carry the impulses toward the apex of the heart
what is the internal intercostal membrane?
Where the internal intercostal muscles, that extend from the sternum anterior to angles of the rib posteriorly, thin out in the intercostal spaces and become a membrane
what is the costodiaphragmatic recess?
Where the plurae extends about 3 cm below the level of the lines forming this it is a potential space when it abnormally fills with Air or fluid it compromises lung expansion
what are the two sections of the pulmonary plexus and where are they located?
anterior pulmonary plexus- anterior root of the lung posterior pulmonary plexus- posterior root of the lung
where is pectinate muscle found?
anterior right atrium and the left auricle of the left atrium
what is the location of the right vagus nerve?
anterior to right subclavian artery passes through the superior mediastinum to the right of the trachea
what are the three regions of the inferior mediastinum?
anterior, middle, posterior
what pushes the trachea to the right of the midline?
aorta
where do the anterior and posterior intercostal arteries anastomose?
approximately at the axillary line
what are the medial arcuate ligaments?
arch over psoas major and minor muscles
what are the lateral arcuate ligaments?
arch over quadratus lumborum muscles
extension of vertebral column
arching spine back (backbend)
what does the great cardiac vein run with?
anterior interventricular artery
what are the contents of the anterior interventricular groove?
anterior interventricular artery and great cardiac vein
which of the longitudinal ligaments is more broad?
anterior longitudinal ligament
What are the three divisions of the inferior mediastinum?
anterior middle and posterior
what surface of the heart to the auricles point towards?
anterior or sternocostal surface
what are the vertebral levels for the diaphragmatic hiatuses?
I 8 10 Eggs At 12
What uses acetylcholine?
All PS preganglionic neurons all ps postganglionic neurons all sympathetic preganglionic preganglionic neurons some sympathetic postganglionic neurons -sweat glands, arrector pili muscles
what carries the impulse (signal) from the AV node to the right and left bundle branches?
AV bundle or bundle of HIS
What are the two major autonomic nervous system neurotransmitters?
Acetylcholine (ACh) and Norepinephrine (NE)
What type of ANS receptors accept NE?
Adrenergic
what is the hilum?
Area in lung where blood vessels and bronchi enter
what is the posterior longitudinal ligament?
Back of the vertebral bodies (anterior part of the canal) Wider in cervicals Thinner in lumbars Thinnest at L5
What is the manubriosternal joint? what is it also known as?
Between manubrium and body of sternum Slight movements during respiration also known as the angle of the sternum
pump handle movement
Elevation of the Sternal End of the Rib, increasing the anterior to posterior diameter of the Thorax
what are the anterior and posterior longitudinal ligaments?
The Anterior Longitudinal Ligament attaches to the front (anterior) of each vertebra. This ligament runs up and down the spine (vertical or longitudinal). The Posterior Longitudinal Ligament runs up and down behind (posterior) the spine and inside the spinal canal. they allow for flexion and extension while keeping vertebrae aligned. The anterior limits extension. The posterior prevents hyperflexion.
What is a preganglionic neuron?
The first neuron of the ANS; its cell body is in the nucleus of brainstem (parasympathetic) or spinal cord (sympathetic)
what is the apex of the heart?
The inferior, conical end. It projects slightly anteroinferiorly towards the left side of the body.
What is a postganglionic neuron?
The nerve opposite the preganglionic neuron on the other side of the ganglionic synapse that receives the impulse.
what is the tubercle of the rib?
The prominence on the outer surface of the rib that articulates with the numerically corresponding facet for the tubercle of the rib on the transverse process of the vertebrae
The pulmonary plexus is continuous with the _______ at the ________.
The pulmonary plexus is continuous with the deep cardiac plexus at the tracheal bifurcation
What are rami communicantes?
They are branches off of the ventral ramus that form the sympathetic trunk ganglia.
in the posterior intercostal space, what is the order of the neurovascular bundle?
VAN vein, artery, nerve
what is the origin of the phrenic nerve?
VPR C3-5
What are the types and subdivisions of pericardium?
Visceral and parietal fibrous pericardium Serous parietal
what is closed pneumothorax?
air leakage from damage to respiratory system itself
what does the superior vena cava drain?
all structures superior to the thoracic diaphragm except the heart and lungs
what is the purpose of an auricle?
allows for expansion in order to hold more blood
what is the sulcus terminalis?
an external groove on the right atrium that corresponds to the crista terminalis
which of the longitudinal ligaments is continuous?
anterior
what are intercostal arteries?
anterior and posterior intercostal arteries upper spaces off of the internal thoracic artery. lower spaces off of musculophrenic artery
what is the location of the pulmonary trunk?
anterior and to the left of ascending aorta
what are the only cardiac veins that do not drain into the coronary sinus?
anterior cardiac veins
what makes up the inner portion of the intervertebral discs?
a cartilaginous component (gelatinous) that is not very fibrous called the nucleus pulposus
what is the trachea?
a large membranous tube reinforced by rings of cartilage, extending from the larynx to the bronchial tubes and conveying air to and from the lungs; the windpipe.
what is the inferior vena cava?
a large vein carrying deoxygenated blood into the heart
what is the suprapleural membrane?
a layer of fascia arching over each lung and extending up into the thoracic inlet Strengthens cervical pleura
what is the other name for the thoracic splanchnic nerve?
abdominopelvic splanchnic nerves
what azygos vein can you sometime have on the upper left side?
accessory hemi-azygos vein
what is hemothorax?
accumulation of blood in the pleural cavity
what is hydrothorax?
accumulation of fluid in pleural cavity