exam 2

vagus nerve -> superior laryngeal nerve

**The INTERNAL branch of the SNL is larger of the terminal branches supplying Sensory fibers to the Laryngeal Mucous Membrane including the superior surface of the Vocal Cords. **The EXTERNAL branch of the SLN provides motor function to the Cricothyroid Muscles. and extrinsic muscles

Understand the differences among the true, false and floating ribs

**True (vertebrosternal) ribs (1st-7th ribs): They attach directly to the sternum through their own costal cartilages. - False (vertebrochondral) ribs (8th, 9th, and usually 10th ribs): Their cartilages are connected to the cartilage of the rib above them; so, they have an indirect connection with the sternum. -Floating (vertebral, free) ribs (11th, 12th, and sometimes 10th ribs): The cartilages of these ribs do not connect at all, not even indirectly with the sternum; instead, they end in the posterior abdominal musculature.

Learn the elements of the sternum and pertinent landmarks such as notches and angles.

- ** The easily palpated concave center of the superior border of the manubrium is called the jugular notch (or suprasternal notch). BLUE ARROW. - The notch is deepened by the medial (sternal) ends of the clavicles. - Inferolateral to the clavicular notch, the costal cartilage of the 1st rib is tightly attached to the lateral border of the manubrium. - The manubrium and body of the sternum lie in slightly different planes superior and inferior to their junction, forming a projection known as the sternal angle (angle of Louis). BLUE STAR - The body of the sternum is longer, narrower, and thinner than the manubrium, and is located at the level of the T5-T9 vertebrae. - The xiphoid process, the smallest part of the sternum, and is thin and elongated. Its inferior end lies at the level of T10 vertebra.

Determine what constitutes the functional anatomical division and zones of the respiratory system.

- **The conducting zone of the respiratory system includes the organs and structures NOT directly involved in gas exchange. - ** The major functions of the conducting zone are to provide a route for incoming and outgoing air, remove debris and pathogens from the incoming air, and warm and humidify the incoming air. - Several structures within the conducting zone perform other functions as well. The epithelium of the nasal passages, for example, is essential to sensing odors, and the bronchial epithelium that lines the lungs can metabolize some airborne carcinogens. The main bronchus divides into lobar (2nd-order) bronchi, each of which then divides into segmental (3rd-order) bronchi. The portion of lung supplied by a third-order bronchus is known as a bronchopulmonary segment. Each main, or primary bronchus divides into secondary lobar bronchi, two on the left and 3 lobes on the right side. Each lobar bronchus further subdivides into several tertiary segmental bronchi that supply the bronchopulmonary segments **The main function of the bronchi, like other conducting zone structures, is to provide a passageway for air to move into and out of each lung. In addition, the mucous membrane traps debris and pathogens.

There are 11 intercostal spaces and

- 11 intercostal nerves. - The Subcostal space is the space below the 12th rib bc it does not lie between ribs.

Know which muscles are active during inspiration, expiration

- Activation of medulla causes a contraction of the diaphragm and intercostal muscles leading to an expansion of thoracic cavity and a decrease in the pleural space pressure - EXPIRATION: Expiration is a passive event due to elastic recoil of the lungs. - However, when a great deal of air has to be removed quickly, as in exercise, or when the airways narrow excessively during expiration, as in asthma, the internal intercostal muscles and the anterior abdominal muscles contract and accelerate expiration by raising pleural pressure. Inspiration: rib muscles contract (rib cage expends), diaphragm contracted (move down) Expiration: rib muscles relax (rib cage contracts), diaphragm relaxed (move up)

Respiratory Zone

- In contrast to the conducting zone, the respiratory zone includes structures that are directly involved in gas exchange. - The respiratory zone begins where the terminal bronchioles join a respiratory bronchiole, the smallest type of bronchiole, which then leads to an alveolar duct, opening into a cluster of alveoli. - Each respiratory bronchiole gives rise to 2-11 alveolar ducts, each of which gives rise to 5-6 alveolar sacs. To Recap: - The respiratory zone, where gas exchange occurs, is the alveolated region of the lung includes respiratory bronchioles (divided from terminal bronchioles and have only occasional alveoli on their walls) and alveolar ducts (completely lined with alveoli). - The distance from the terminal bronchiole to the distal alveolus is only a few mm, but the respiratory zone makes up most of the lung, its volume being about 2.5 to 3 L.

Describe the components of the pleural cavity

- Pleura is a Greek word that literally means 'side of the body.' - Today, it describes the two thin membranes known as the visceral and parietal pleurae that surround the lungs - The pleural cavity is the potential space between these two membranes that is created when the serous pleura covers the lung and folds back upon itself, to form a two-layered membranous pleural sac. a small pouch or air pocket. Parietal pleura parts: Cervical, costal, diaphragmatic, mediastinal

Analyze the area of the lungs where disease is likely detected on a chest film

- The 2 types of pleural recesses are: COSTODIAPHRAGMATIC (between costal & diaphragmatic pleurae→ most inferior region of pleural cavity,-FREQUENT SITE FOR FLUID ACCUMULATION or PNA) & COSTOMEDIASTINAL recess is between costal & mediastinal pleurae, located adjacent & posterior to sternum; only one location

how the curves change after birth

-In embryos, the spinal cord occupies the whole length of the vertebral canal -During the fetal period, the vertebral column grows faster than the spinal cord; as a result, the cord "ascends" relative to the vertebral canal. -At birth, the tip of the conus medullaris is at the L4-L5 level. Thus, in postnatal life, the spinal cord is shorter than the vertebral column. -The spinal cord typically ends at L1, but in 10% of the population it extends past L2.

-blood flow to the thoraco-lumbar and sacra cord require additional collateral-in-flow

-sacral arteries provide adequate flow to the sacral and lower lumbar regions. -thoracic and upper lumbar areas get their flow from variable collateral sources. - The aorta gives rise to the posterior intercostal artery which supplies the anterior and posterior radicular arteries -The circulation to much of the spinal cord depends on segmental medullary and radicular arteries running along the spinal nerve roots.

The veins of the spinal cord

-the veins that drain the spinal cord, as well as internal vertebral venous plexuses, drain into the intervertebral veins, which in turn drain into segmental veins. -In general, the veins of the spinal cord have a distribution similar to that of the spinal arteries. -There are usually three anterior and three posterior spinal veins. -The veins of the spinal cord join the internal vertebral (epidural) venous plexuses in the epidural space.

spinal nerve endings

1, conus medullaris 2, cauda equina (horse tail) 3, Filum terminale -Filum terminale internus (pia mater) -Filum terminal externus (dura , arachnoid mater)

which three types of spinal arteries

1. One anterior spinal artery (75%) 2. Two posterior spinal arteries (25%) (Right and Left branhces) 3. Small segmental spinal arteries

Cranium is composed of

22 named bones

Describe each region of the vertebral column and

33 vertebra with 24 articulating vertebra and 9 fused ( sacrum, coccyx)

number of vertebrae in cervical spine and name for first two

7, The first cervical vertebrae (C1) is known as the atlas. The second cervical vertebrae (C2) is known as the axis.

The Typical ribs (3rd-9th) have the following components:

A Head: wedge-shaped and has two facets, one facet for articulation with the numerically corresponding vertebra and one facet for the vertebra superior to it. - A Neck: connects the head of the rib with the body at the level of the tubercle. - A Tubercle: located at the junction of the neck and body; - A Body (shaft): thin, flat, and curved. The concave internal surface of the body has a costal groove paralleling the inferior border of the rib, which provides some protection for the intercostal nerve and vessels.

arteries supplying the nose

Anterior and posterior ethmoidal arteries, sphenopalatine artery, greater palatine artery, superior labial artery

Determine the location of the ligaments that provide support for the vertebral column 5

Anterior longitudinal ligament Posterior longitudinal ligament supraspinous ligament (Thickest and broadest in the lumbar region) Interspinous ligament Ligamentum flavum (between adjacent lamina) Intertransverse ligament (A thin, membranous ligament connecting the spinous processes) Facet capsulary ligament ? All ligaments resist flexion except anterior longitudinal resists extension

Learn the name of the largest artery supplying the spinal cord

Artery of Adamkiewicz = largest feeder artery - There is a major vessel coming from the left posterior intercostal artery call the radicular artery of Adamkiewicz - 80% of the time it is fed by the L intercostal artery

forced expiration

By forcible contraction of muscles of anterior abdominal wall - Quadratus lumborum contracts and pulls down the twelfth ribs - Intercostal muscles pulls the ribs together and depress them to the lowered twelfth rib - Serratus posterior inferior and latissimus dorsi are also involved ****during forced expiration, both external and internal intercostal muscle are utilized Muscles of Respiration Mnemonic:Dont Exercise In Quicksand (Diaphragm, External intercostals, Internal intercostals, Quadratus)

important landmarks

C 7 spinous process: most prominent; posterior neck T 7 spinous process: Inferior angle scapula T 12 spinous process: 12th rib attachment. L 4 spinous process: Line between the iliac crests crosses L4 or L4-5 interspaces

how does spinal nerve exit vertebral

C1-7 spinal nerves exit above same numbered vertebra C8 spinal nerve exits between C7 & T1 vertebra All remaining spinal nerves exit below same numbered vertebra

Understand the significance of the subarachnoid space

CSF; radicular, segmental, medullary, and spinal arteries; veins; arachnoid trabeculae

medical term for a nosebleed

Epistaxis

Atlas

It differs from the other cervical vertebrae in that it has no vertebral body and no spinous process. Instead, the atlas has lateral masses which are connected by an anterior and posterior arch

Azygos Vein: Posterior to Esophagus, to the right of the Thoracic Duct

It is an alternate route for the return of venous blood to the heart, rather than through the inferior vena cava. •Intercostal veins empty into the azygos system, from both left and right (via Hemiazygos system) sides. •Azygos vein connects to the inferior vena cava at the level of the kidneys. - Hemiazygos Vein System: Posterior to the descending Aorta on the left side of the vertebral column. •It drains the left intercostal veins. •It drains into the Azygos Vein. The azygos vein is a vein running up the right side of the thoracic vertebral column draining itself towards the superior vena cava. It connects the systems of superior vena cava and inferior vena cava and can provide an alternative path for blood to the right atrium when either of the venae cava is blocked.

Due to the rich blood supply of the nose, this is a common occurrence.It will most likely occur in the anterior third of the nasal cavity - this area is known as the

Kiesselbach area or Littles area. The cause can be local (such as trauma), or systemic (such as hypertension).

Understand the significance of the epidural space

L: space between periosteum lining bony wall of vertebral canal and spinal dural mater C: Fat (loose connective tissue); internal vertebral venous plexuses; inferior to L2 vertebra, ensheathed roots of spinal nerves ◆ Nerve roots ◆ Fat ◆ Areolar tissue ◆ Lymphatics ◆ Arteries ◆ Internal venous plexus of Batson

Identify the major landmarks in the neck for central venous access.

Landmarks for IJL placement include the Sterneocleidomastoid muslces (Sternal head and medial head) and the C6 cervical vertebra - the beginning of the trachea, the cricoid cartilage, inferior to the laryngeal prominence AKA Adam's apple) The clavicle is the primary surface landmark for subclavian cannulation The SCM is the key muscular landmark of the neck. It divides the neck into anterior and lateral cervical regions The SCM can be made to stand out by asking the person to rotate the face toward the contralateral side and elevate the chin

The pharynx is comprised of three parts

Nasopharynx Oropharynx Laryngopharynx.

Nerves of the face: Trigeminal nerve

Ophthalmic: supplies sensory fibers to the lacrimal gland, eyelids, ciliary muscle, nose, forhead, and adjoining parts: External nasal nerve Maxillary nerve: transmits sensory fibers from the maxillary teeth, the skin between the palpebral fissure and the month, and from the nasal cavity and sinuses. Mandibular nerve: supplies sensory fibers to the lower jaw, the lower teeth and supplies motor fibers to the muscles of mastication. Mental nerve

The vertebral column has four main functions:

Protection - encloses and protects the spinal cord within the spinal canal. Support - carries the weight of the body above the pelvis. Axis - forms the central axis of the body. Movement - has roles in both posture and movement.

5 Structures that make up the Hilum

Pulmonary artery, Bronchus, Pulmonary veins, Nerves and Lymphatics The pulmonary alveolus is the basic structural unit of gas exchange in the lung. Due to the presence of the alveoli, the respiratory bronchioles are involved both in air transportation and gas exchange.

vertebral arch

Spinous processes - Transverse processes - each vertebra has two, which extend laterally and posteriorly from the vertebral body. In the thoracic vertebrae, the transverse processes articulate with the ribs. Pedicles - connect the vertebral body to the transverse processes. Lamina - connect the transverse and spinous processes. Articular processes - form joints between one vertebra and its superior and inferior counterparts. The articular processes are located at the intersection of the laminae and pedicles.

The anterior triangle is situated at the front of the neck. It is bounded

Superiorly - inferior border of the mandible (jawbone). Laterally - anterior border of the sternocleidomastoid. Medially - sagittal line down the midline of the neck.

axis

The axis (C2) is easily identifiable due to its dens (odontoid process) which extends superiorly from the anterior portion of the vertebra.

Identify the vessels that form a collateral pathway between major veins

The azygos vein is a vein running up the right side of the thoracic vertebral column draining itself towards the superior vena cava. It connects the systems of superior vena cava and inferior vena cava and can provide an alternative path for blood to the right atrium when either of the venae cava is blocked.

Carotid Triangle

The carotid triangle of the neck has the following boundaries: Superior - posterior belly of the digastric muscle. Lateral - medial border of the sternocleidomastoid muscle. Inferior - superior belly of the omohyoid muscle. The main contents of the carotid triangle are the common carotid artery (which bifurcates within the carotid triangle into the external and internal carotid arteries), the internal jugular vein, and the hypoglossal and vagus nerves.

The three sutures of the skull

The coronal suture separates the frontal and parietal bones, the sagittal suture separates the parietal bones, and the lambdoid suture separates the parietal and temporal bones from the occipital bone

List the elements that are included within the osteocartilaginous thoracic cage

The osteocartilaginous thoracic cage includes the sternum, 12 pairs of ribs and costal cartilages, and 12 thoracic vertebrae and intervertebral discs. The clavicles and scapulae form the pectoral (shoulder) girdle.

Determine the origin and function of the phrenic nerve

The phrenic nerve is a mixed motor/sensory nerve which originates from the C3, C4, C5 spinal nerves in the neck. - The nerve is important for breathing because it provides exclusive motor control of the diaphragm, the primary muscle of respiration.

Compare the differences of the right and left bronchus and lobes of the lungs?

The right lung is divided into upper, middle, and lower lobes by an oblique and a horizontal fissure. - The left lung is divided into upper and lower lobes by an oblique fissure.

Discuss the curves of the vertebral column and

The thoracic and sacral kyphosis (singular = kyphosis) are concave anteriorly the cervical and lumbar lordosis (singular = lordosis) are concave posteriorly. Lordosis is an exaggerated increase in the lumbar curve. Caused by obesity, pregnancy, disk degeneration, congenital defects

Both Phrenic Nerves

They run anterior to the roots of the lungs Phrenic Nerves Both originate from the Nerve roots: Anterior rami C3, C4, C5. Keeps the diaphragm alive. Both Phrenic Nerves are more lateral than the Vagus nerves. As the only source of motor innervation to the diaphragm, this nerve has an important role in breathing. -- Motor functions: Innervates the diaphragm. Sensory functions: Innervates the central part of the diaphragm, the pericardium and the mediastinal part of the parietal pleura

The cervical vertebrae have three main features which distinguish them from other vertebrae:

Triangular vertebral foramen. Bifid spinous process - this is where the spinous process splits into two distally. Transverse foramina - holes in the transverse processes. They give passage to the vertebral artery, vein and sympathetic nerves.

The thoracic vertebrae have four features which distinguish them from other vertebrae:

Vertebral body is heart shaped. Presence of demi-facets on the sides of each vertebral body - these articulate with the heads of the ribs. Presence of costal facets on the transverse processes - these articulate with the tubercles of the ribs. They are present on T1-T10 only. The spinous processes are long and slant inferiorly. This offers increased protection to the spinal cord, preventing an object such as a knife entering the spinal canal.

Describe the functions of the nose

Warm, humidified, and filter The nose serves as the only means of bringing warm humidified air into the lungs. ** It is the primary organ for filtering out particles in the inspired air, and it also serves to provide first-line immunologic defense by bringing inspired air in contact with mucous-coated membranes that contain immunoglobulin A (IgA).

The extrinsic muscles

act to elevate or depress the larynx during swallowing the suprahyoid muscles and the stylopharyngeus elevate the larynx, while the infrahyoid muscles depress the larynx.

Thyroarytenoid

acts to relax the vocal ligament, allowing for a softer voice

Transverse and Oblique Arytenoids

adduct the arytenoid cartilages, closing the posterior portion of rima glottidis. This narrows the laryngeal inlet

Vagus nerve--> recurrent laryngeal nerve---> inferior laryngeal nerve

all intrinsic muscle except cricothyoid muscle a) thyroarytenoid p) posterior cricoarytenoid (only adbuctor muscle) a) lateral cricoarytenoid p) transverse and oblique arytenoid muscles a) vocalis a) aryepiglottic a) thyroepiglottic muscles

again, The motor root of CN VII supplies

all the muscles of facial expression, including the superficial muscle of the neck (platysma), auricular muscles, scalp muscles,

Sacral Cornua

are bony landmarks to help find the Sacral Hiatus & aid in placing a caudal block

facial bones

bones of the face: (lacrimal), mandibular, maxillary, nasal, (vomer), and zygomatic, maxilla

What is the cauda equina?

bundle of nerve roots that occupy the vertebral canal from L2 to S5 A group of lumbar & sacral nerve roots extend beyond the termination of the spinal cord

the number of bones in each region

cervical region: 7 vertebra 8 spinal nerves Transverse foramen Thoracic region: 12 vertebra 12 nerves Long sloping, overlapping spinous process Lumbar region: 5 vertebra 5 nerves. Short, stout, posteriorly directed spine Massive vertebral body Sacral region: 5 fused vertebra 5 spinal nerves Coccyx fusion of the 4 coccygeal vertebrae

What does the orbicularis oculi muscle do?

closes the eyelids and wrinkles the forehead vertically - TOF monitoring

ALL the intrinsic muscles of the larynx (except the....) and

cricothyroid) are innervated by the inferior laryngeal nerve Intrinsic muscles act to move the individual components of the larynx - playing a vital role in breathing and phonation

The neurocranium in adults is formed by a series of eight bones

four singular bones centered on the midline (frontal, ethmoidal, sphenoidal, and occipital), and two sets of bones occurring as bilateral pairs (temporal and parietal

Identify the bones and the cartilages of the neck.

hyoid bone epiglottis cartilage thyroid cartilage cricoid cartilage arytenoid cartilage P corniculate cartilage P cuneiform cartilage P

The lateral nasal wall mostly consists of

inferior and middle turbinates

The thyroid cartilage

is the largest of the cartilages; its superior border lies opposite the C4 vertebra. This projection ("Adam's apple") is well marked in men

The hyoid bone

it lies at the level of the base of the mandible in the front and the third cervical vertebra (C3) behind. Although the larynx is firmly connected to it, the hyoid is not part of the larynx

Lumbar Vertebrae

largest in the vertebral column Lumbar vertebrae have very large vertebral bodies, which are kidney shaped. They lack the characteristic features of other vertebrae, with no transverse foramina, costal facets, or bifid spinous processes

Cricothyroid

muscle stretches and tenses the vocal ligaments, and so is important for the creation of forceful speech. It also has a role in altering the tone of voice (along with the thyroarytenoid muscle), AKA 'singer's muscle'.

during intubation, if the ETT is advanced too far past the vocal cords, then it can go

past the carina and easily placed in the Right Mainstem Bronchi. You will see unequal chest rise, diminished lung sounds on the left, and O2 sats will begin to lower bc of unequal, one-sided ventilation. The ETT is too deep and will need to be withdrawn .

what does the larynx do

respiration, vocalization, protection ** Although most commonly known for its role as the phonating mechanism for voice production, its most vital function is to guard and **PROTECT the air passages, especially during swallowing when it serves as the "sphincter" or "valve" of the lower respiratory tract, thus maintaining a patent airway.

Posterior cricoarytenoid

sole abductors of the vocal folds, and thus the only muscle capable of widening the rima glottidis

The muscles of the larynx can be divided into two groups

the EXTRINSIC (external) muscles and the INSTRINSIC (internal) muscles

The Jaw Thrust Maneuver lifts

the Hyoid bone and tongue away from the posterior pharyngeal wall by subluxating the mandible forward at the ANGLE of the mandible (AKA Gonial angle) located at the posterior border of the Ramus of the mandible

The cricoid cartilage

the cricoid cartilage is thicker and stronger and is the only complete ring of cartilage to encircle any part of the airway

motor innervation to the facial muscles is provided by

the facial nerve (CN VII).

Lateral cricoarytenoid

the major adductors of the vocal folds. This narrows the rima glottidis, modulating the tone and volume of speech

The hard palate (AKA bony palate) is formed by

the palatal processes of the maxillae anteriorly and the horizontal plates of the palatine bones posteriorly.

At the C6 Vertebral level is the junction of

the trachea from the larynx C6 is also the point where the RLN enters the larynx and the area where the pharynx extends to the opening of the esophagus and larynx.

Note that the carotid artery can be compressed against

the transverse process of the C6 vertebra.

The major organs of the respiratory system function primarily

to provide oxygen to body tissues for cellular respiration, remove the waste product carbon dioxide, and help to maintain acid-base balance. - Portions of the respiratory system are also used for non-vital functions, such as sensing odors, speech production, and for straining, such as during childbirth or coughing

Cutaneous (sensory) innervation of the face and anterosuperior part of the scalp is provided primarily by the

trigeminal nerve (CN V),

Structure of a Vertebrae

vertebral body, vertebral arch

Intrinsic muscles control the shape of the rima glottis

which is the opening between the vocal folds/cords and the arytenoid cartilages, and the length and tension of the vocal cords.