Parizi Exam 3

What is located within the posterior mediastinum?

(DATES) -descending aorta -azygous and hemiazygous veins -thoracic duct -esophagus -sympathetic chain/ganglia -splancnic nerves -lower end of vagus

What is the round ligament?

(aka ligamentum teres hepatis) remnant of fetal umbilical vein and inferior portion of the falciform ligament

Describe the pathway of the Lesser Petrosal Nerve

(part of CN X Glossopharyngeal) -goes to otic ganglion and synpases -post gang parasymp travel with the auriculotemporal nerve to the parotid gland -uses foramen ovale to end up in the infratemporal fossa

What branches does the external carotid artery give off?

(some anatomists like freaking out poor medical students) Superior thyroid Ascending pharyngeal Lingual Facial Occipital Posterior auricular Maxillary Superficial Temporal

How are the qudriceps supplied?

**not the femoral artery itself the branches of the deep femoral artery -lateral and medial circumflex femoral arteries (main for head of femur)

What is the innervation of the GI tract?

-Vagus nerve from esophagus to 2/3 of transverse colon -pelvic splancnic (S2-S4) do parasympathetic innervation after this

What are the main veins of the pelvis and lower limbs

-deep share name with acompanying artery -superficial: great saphenous vein empties into femoral vein small saphenous vein empties into the popliteal vein (small runs in calf)

What drains into the middle meatus?

-frontal, ethmoid, and maxillary sinuses

What are the important structures in the large intestine?

-haustra: allow for expension -teniae coli: longitudinal muscles that aid in peristalsis -epiploc appendicies: sacs of fat with an unknown function

What does the glossopharyngeal nerve do?

-motor branch to stylopharyngeus muscle -general sensation to tympanic membrane -taste and general sensation to posterior 1/3 of tongue -sensory info to cartoid body and carotid sinus

What is the purpose of the duodenum? is it retroperitoneal and intraperitoneal

-recieves digestive enzymes from pancreas, received bile from liver and gall bladder -first part is intraperitoneal, the rest is retroperitoneal

How is the larynx innervated?

-recurrent laryngeal branch does all intrinsic larynx muscles (except the cricothyroid) and sensory below the vocal folds -internal laryngeal branch does sensory above the vocal folds (and is accompanied by the superior laryngeal artery)

Explain the vascular supply of the larynx

-superior thyroid artery (from external carotid) gives rise to sup. laryngeal artery and supplies tissues above vocal folds -inferior thyroid artery (from thyrocervical trunk) gives rise to inf. laryngeal artery and supplies tissues below vocal folds

What does the chorda tympani do?

1. carries taste fibers from the anterior 2/3 of the tongue 2. has pregang parasymp. at the submandibular ganglion, post gang travel with the lingual nerve to go to the submandibular and sublingual glands

What are the major functions of the lympahtic system (4)?

1. collect excess water and proteins from interstital fluid 2. fat transport 3. short term immune responses 4. development of long term immunity

What are the two major attachments to the duodenum?

1. hepatoduodenal ligament 2. suspensory ligament of Treitz (holds up the duodenal-jejunal flexure)

How does the rectum recieve blood supply?

1. inferior mesenteric - superior rectal a. 2. internal illiac - midle rectal 3. internal pudental - inferior rectal

explain the pathway of the autonomics of CN VII

1. preganglionics synapse at pterygopalantine ganglion 2. zygomatic nerve carries postganglionics into the orbit 3. parasympathetics jump onto the lacrimal nerve (branch of V1) 4. postganglionic parasympathetics get carried to lacrimal gland

Where does the axillary artery run?

1st rib to teres major

Describe the parasympathetics of the head and neck

4 glands found near palate and nasal passages(lacrimal, parotid, submandibular, sublingual) -involved in gland secretion, pupil constriction, and increasing lens diameter (near vision)

Explain the brachial artery branches

@shoulder it gives off the deep brachial branch that pierces the triceps and travels with the radial nerve @cubital fossa it gives off the radial and ulnar arteries

Why would a pituitary gland tumor affect vision?

Because the pituitary gland is close to the optic chiasm

What are the cranial nerves?

CN I olfactory CN II optic CN III occulomotor CN IV Trochlear CN V Trigeminal (Opthalamic, maxillary, mandibular) CN VI Abducens CN VII Facial CN VIII Vestibulocochlear CN IX Glossopharyngeal CN X Vagus CN XI Accessory CN XII Hypoglossal

what are the purely afferent cranial nerves?

CN I olfactory, CNII optic, CN VIII Vestibulocochlear

Which nerve is an extension of the brain?

CN II optic

What nuclei are associated with CN III occlomotor, CN VII facial, and CN IX glossopharyngeal?

CN III - Edginer Westfall CN VII - superior salvatory nucleus CN IX - inferior salvatory nucleus

What do the parasympathics of the head travel with and what cranial nerves are they?

CN III, VII, IX -travel with one of the branches of the trigeminal nerve

What are the purely efferent cranial nerves?

CN IV Trochlear , CN VI Abducens, CN XI Accessory, CN XII Hypogossal

Which nerves exit the skull through the jugular foramen?

CN IX, X, XI

Which branch of the trigeminal nerve goes through the inferior orbital fissue?

CN V2 Maxillary

What are the branches of the thoracoacromial artery?

Cadavers Are Dead People Clavicular Acromial Deltoid Pectoral

Descibe the names of the aorta as it descends

Descending aorta (aortic arch to T5) Thoracic aorta (T5 to T12) Abdominal aorta (T12 to L4) divides into L/R common iliac arteries

What nerve provides sensory innervation to all of the face?

Facial Nerve

Where does CN V-3 enter Mandibular? Is is sensory or motor?

Foramen Ovale - Sensory AND motor

Where does CN V-2 Maxillary enter? Is it sensory or motor?

Foramen Rotundum - Sensory only

What two nerves form the vidian nerve (nerve of the pterygoid canal)?

Greater and deep petrosal nerve

Where is the trigeminal ganglion? is it motor or sensory?

In the middle cranial fossa - sensory

Which artery is nicknamed the "widowmaker" and what does is supply?

LAD supplies: interventricular septum most of the left ventricle apex of the heart

What are the CN V1 branches and what are the responsible for?

NFL - Nasalcilary, Frontal, lacrimal (oribital structures, skin of forehead, eyebrows)

What branches does the internal carotid artery give off in the neck?

NONE it just goes to the brain

Where do the olfactory bulbs sit?

On the cribriform plate

What are the parts of Tetralogy of Fallot?

PROV pulmonary valve stenosis right ventricular hypertrophy over-riding aorta ventricular septal defect

How do you tell the difference between the lungs from their hilums?

Parts: pulmonary artery, pulmonary vein, primary bronchi RALS for pulmonary artery compared to bronchus - right anterior left superior

What are the sympathetics of the pelvic viscera?

Pre-gang: lumbar splancnics lat horn of L2 synapse at plexus around aorta bifurcation (superior hypogastric plexus) and descend to inferior hypogastric plexus (mix of symp and parasymp).

Describe the sympathetic innervation of the heart

Presynaptic: T1-T4 Postsynaptic: cervical ganglia post synaptic nerves - cardiopulmonary splancnics

What are coronary arteries?

RCA, LCA, LAD, L marginal A, R marginal A, circumflex branch of LCA

What are the lobes of the lungs?

Right- upper, middle, lower (horizontal and oblique fissues) Left- upper, lower (oblique fissure and cardiac notch)

What are the retroperitoneal organs?

SADPUCKER -suprarenals -aorta/IVC -duodenum (parts 2 and 3) -pancreas (except the tail) -ureters -colon (ascending and desceding) -kidneys -esophagus -rectum

What are the branches of the axillary artery?

Save The Lions And Protect Species Supreme Thoracic Thoracoacromial Lateral throacic (runs with long thoracic nerve) Anterior humeral circumflex Posterior humeral circumflex Subscapular

Where does CN V-1 Opthalamic enter? Is it sensory or motor?

Superior Orbital Fissure - Sensory only

Where is the sternal angle and what happens there?

T4/T5 -aortic arch starts and ends -trachea bifurcates

What structures pierce the diaphragm and at what levels?

T8 - inferior vena cava T10 - esophagus T12 - descending aorta

What are the important features of the right ventricle?

Trabeculae carneae, papillary muscle, chordae tendinae

How does the trachea bifurcate?

Trachea -> primary bronchi -> secondary bronchi

What is the clinical importance of the costodiaphragmatic recess?

Where pleural taps are performed (due to excess fluid from cancer, surgery, etc)

What are the CN V2 branches and what do they innervate?

Zygomatic, Infraorbital, nasal, palantine, superior alveolar branches (upper lip, upper jaw, palate, portions of pharynx)

What is a coronary angioplasty?

a cathether up an artery (usually femoral), up the ascending aorta, into the R or L coronary artery and into its affected branch (which is narrowed or blocked by a plaque buildup)

What is the coronary sinus?

a large vein on the posterior of the heart, receives blood from cardiac veins

What is the moderator band?

a thick band of muscle that goes from the anterior papillary muscle to the ventricular septum and facilitates the condiction between the AV bundle to the papillary muscles

What are the borders of the superior mediastinum?

above sternal angle, posterior to sternal/manubrium junction, anterior to T4-T5 vertebrae

How is the pupillary light reflex associated with cranial nerved

afferent: CN II efferent: CN III (parasympathetics of occulomotor)

How is the gag reflex involved with crainal nerves?

afferent: glossopharyngeal efferent: vagus

How is the corneal (blink) reflex involved with cranial nerves?

afferent: nasociliary of opthalamic (trigeminal) efferent: temporal and zygomatic of facial

What is Callot's triangle?

aka hepatobiliary triangle or cystohepatic duct medial: common hepatic duct lateral: cystic duct superior: inferior border of the liver

What is the hepatopancreatic ampulla?

ampulla of vater

pterogopalantine fossa surroundings

anterior - infraorbital fissure lateral - pteryogomaxillary fissure medial - sphenopalantine fossa posterior - foramen rotundum, vidian canal

What arteries make up the Circle of Willis?

anterior cerebral anterior communicating posterior cerebral posterior communicating internal carotids

Where does the optic tracts intersect?

anterior to the pituitary gland and infundibulum

What is located within the superior mediastinum?

aortic arch, brachiocephalic artery, thoracic parts of subclavian and common carotid, trachea, esophagus, trachea, vagus, thoracic duct, brachiocephalic vein

What are the paired cartilages of the larynx?

arytenoid (hyaline), corniculate (elastic), cuneiform (elastic)

Where do the cephalic and basilic vein drain?

axillary vein

What are the main veins of the thorax?

azygous vein, hemiazygous vein, and accessory hemiazygous veins

What are the superficial veins of the arm and forearm?

basilic, cephalic, and antecubital veins

Where does the thoracic duct emerge from?

between the left subclavian vein and the left internal jugular vein

Where does the right lymphatic duct emerge from?

between the right subclavian vein and right internal jugular vein

What is deep vein thrombosis?

blood clot in deep vein (often popliteal) -often results in pain, swelling, and engorged superficial veins -risk factors: old age, orthopedic surgery

What are the deep veins of the upper limb?

brachial, axillary, subclavian

What is the auriculotemporal nerve a branch of and what does is innervate?

branch of V3 innervates: auricle, exernal acoustic meatus, tympanic membrane, temporomandibular joint

What is the middle meningeal artery a branch of and where can it be found?

branch of the maxillary artery and is found in the infratemporal fossa between the two roots of the auriculotemporal nerve supplies the dura and calvaria **under the pterion so it is susceptible to epidural hematomas

Which 3 parasympathetic nerves are no preganglionic?

chorda typani, greater petrosal, lesser petrosal

What are the two main branches of the LCA?

circumflex branch and anterior interventricular branch

Where is ligamentum arteriosum?

connecting the arch of aorta and the left pulmonary artery

What is the role of the pharynx and what are its parts?

connects nasal cavity and mouth -nasopharynx (down to soft palate) -oropharynx (soft palate to epiglottis) -laryngeopharynx (epiglottis and down)

What does the nerve of the pterygoi canal (vidian nerve) contain?

contains greater petrosal nerve (preganglionic parasympathetics) and the deep petrosal nerve (postgang symp. on their way to the pterygopalantine ganglion)

Describe the parasympathetic contribution to the pelvic plexus (inf. hypogastric plexus)

contribute to parasymp with cell bodies of pregang (lat horn L2-L4)

What is CABG?

coronary artery bypass graft (to bypass artherosclerotic arteries) often uses: saphenous vein gastoepiploic artery radial artery

What are the sulci of the heart?

coronary sulcus (b/w left atrium and ventricle), anterior interventricular sulcus, posterior interventricular sulcus

What are the pleura of the lungs and their innervations?

costal and cervical pleura - infercostal nerves mediastinal and diaphragmatic pleura - phrenic nerve

How are the thigh muscles supplied?

deep femoral artery (profunda femoral)

What does the cisterna chyli do?

drain lymph from the lower limbs and intestines

What do lesions on CN XI accessory nerve cause?

drooping shoulders (SCM dysfuntion)

How might the main pancreatic duct become obstructed?

due to gallstone in hepatopancreatic ampulla that results in bile being backed up to the pancreas

What is pleural effusion?

excess fluid in the pleural space, can impair expansion of lungs and impair breathing -hydrothorax: serous fluid -hemothorax: blood -pyothorax: pus *often due to heart failure or cirrhosis

How is the cricothyroid innervated?

external laryngeal branch of superior laryngeal branch of vagus nerve **also does inferior laryngeal constrictor muscles

What are the deep veins of the lower limb?

femoral vein, deep femoral vein, popliteal vein, ant/post tibial veins

What brings sensory innervation to the posterior 1/3 of the tongue?

glossopharyngeal nerve

what is the largest pancreatic artery?

great pancreatic artery (make sure to review all the other arterial gut stuff but it's not in the quizlet)

What is a myocardial infarction?

heart attack (ischemia of the heart)

Is there anastomoses between coronary arteries?

heck no

Where is the portal triad located?

hepatoduodenal ligament

Where are the kidneys located?

high on the posterior wall of the abdominal cavity, behind the parietal peritoneum at the level of ribs 11 and 12

What are septal defects and what are the types?

holes in the heart types: atrial and ventricular

Where does portacaval anatomoses occur?

inferior esophagus, inferior rectum, and umbilicus

What do the different branches of the superior mesenteric artery supply?

inferior pancreaticoduodenal artery: pancreas and duodenum jejunoileal arteries: jejunum and ileum right colic a: ascending colon middle colic a: transverse colon illeocolic a: appendix, cecum, ilium

What is the most important branch of the thyrocervical trunk?

inferior thyroid artery (there is also transverse cervical and suprascapular)

What nerves does the maxillary branch of trigeminal give rise to?

infraorbital, zygomatic, greater and lesser palantine nerves, posterior superior alveolar nerve

What supplies most of the internal structures of the face? What about the superficial?

internal - mandibular superficial - facial

What is the relation of the jugular veins to the sternocleidomastoid?

internal is deep and external is superficial

What is the best artery for a CABG and what does it supply?

internal mammary artery -supplies anterior chest walls and breats

What is the clinical relevance of the piriform recess?

it is where food can get stuck

What is the most posterior part of the heart?

left atrium

What structure forms the apex of the heart?

left ventricle

What are the CN V3 branches and what do they innervate?

lingual, inferior alveolar, auriculotemporal (gums, manibular teeth, anterior 2/3 of tongue

What is liver cirrhosis?

liver cells are progresively destoryed and replaced with fatty or fibrous cells, tissue impedes blood circulation throughout liver. -caused by alcohol abuse, hepatitus, and posion ingestion -can result in portal hypertension, esophageal varicies, and hemorrhids

What are the accessory digestive organs?

liver, gallbladder, pancreas

Explain the course of the vagus nerve on the left side of the body

loops around arch of aorta, behind the root of the lung

Explain the course of the vagus nerve on the right side of the body

loops around subclavian artery

What is another name for the antecubital vein and what is its medical purpose (besides draining blood)?

median cubital vein -used to obtain blood or administer IV fluids

What are the important internal features of the right atrium?

musculi pectinati, crista terminalis, fossa ovalis

What drains into the inferior meatus?

nasolacrimal duct

What are the layers surrounding the heart?

parietal and visceral pericardium (sensory by phrenic nerve)

Where is the gastrosplenic ligament and what are its parts?

part of the greater omenum connecting the greater curvature of the liver to the spleen -contains the short gastric and left gastroepiploc vessels

What is the purpose of the hepatic portal system?

picks up digested nutrients and takes them to liver processing main aspects: hepatic portal vein, superior mesenteric vein, inferior mesenteric vein

How does blood get from the portal vein to the IVC?

portal vein -> hepatocyte filtration ->central vein -> hepatic veins -> IVC

What are the sympathetic innervations of the heart?

post ganglionics from upper thoracic and cervical chain ganglia.

Which muscles are responsible for the larynx's respiratory functions and what is special about it?

posterior cricoarytenoid muscle - only abductor of the vocal folds (rotate arytenoids laterally) - only muscle to open true vocal cords

What drains into the superior meatus?

posterior ethmoidal air cells

Where is the transverse sinus?

posterior to pulmonary trunk and aorta, anterior to superior vena cava

How is the superficial palmar arch formed?

primarily by the ulnar nerve and completed by the superficial branches of the radial artery

How does the pectoralis minor seperate the axillary artery?

proximal, posterior, distal

How are the lungs innervated?

pulmonary plexus: parasympathetics - CN X - bronchocontriction sympathetics - T1-T4 post gang fibers - bronchodilation

What does the cricothyroid muscle do?

raises the pitch of the voice by elongating and tensing the vocal folds

What do dural venous sinuses do?

recieve blood and CSF from the brain to drain into the internal jugular vein can be injured by trauma and result in epilepsy, neuronal defects or death

Where do inhaled objects go?

right main bronchi because it is shorter and wider

Where is the moderator band located?

right ventricle

What parts of the heart form the sternocostal surface?

right ventricle and right atrium

What are the lobes of the liver?

right, left, caudate, quadrate *ligamentum teres is a continuatuon of ligamentum venosum

Where does the popliteal artery run and what branch does it give off?

runs between the two heads of the gastric -gives off fibular artery

Where does the vagus nerve originate?

sensory: from organs motor: medulla oblongata

What is the function of the vagus nerve?

sensory: info from organs in neck (larynx, palate, pharynx) motor: sends info to organs in neck (larynx, tongue, pharynx, and palate) also goes from heart and GI system to left colic flexure

What is the pupillary light reflex?

shining a light into the eye causes the pupil to contract

What are the two major superficial veins in the leg?

short saphenous and long saphenous vein

What are the branches of the Right Coronary Artery?

sinoatrial artery, right marginal artery (acute marginal artery)

How is the blood of the brain drained?

sinuses drain into the internal jugular vein

What do the motor branches of the facial nerve innervate?

stapedius and posterior digastric muscle

Describe the sympathetics of the head and neck

superior cervical ganglion is involved in pupil dilation and decreasing of lens diameter - has cell bodies of post ganglionic sympathetics

What does the Posterior Interventricular artery supply?

supplies right atrium, right ventricle, SA node, and AV node

What is the purpose of the peritoneum?

support structure and provide neurovascular bundles (mesentary)

What are the branches of the facial nerve?

temporal, zygomatic, buccal, marginal mandibular, cervical

What does a "right dominant heart" mean?

the PDA usually arises from the RCA but a small percentage of the time it arises from the LCA

What forms the base of the heart?

the atria

What is relevant about the quadrangular space?

the axillary nerve and the posterior humeral circmflex artery run together

What are the first branches of the aorta?

the coronary arteries

Where is the vocal ligament?

the free end of the conus elasticus

Where are all the branches of the mandibular branch of trigeminal found?

the infratemporal fossa (they get there through foramen ovalle) -lingual -inferior alveolar -auriculotemporal

How do radiologists identify the right ventricle in prenatal ultrasounds?

the moderator band

What is the epiploic foramen?

the opening in the lesser omentum that connects the lesser sac to the greater sac

Where does the optic nerve emerge?

the prosencephalon aka forebrain

What does "water under the bridge" refer to?

the ureters passing under the gonadal vessels **asymmetrical drainage (L renal vein is longer)

What are the parasympathetic innervations of the heart?

the vagus nerve

What are the intraperitoneal organs surrounded by?

the visceral peritoneum

What are the unpaired cartilages of the larynx?

thyroid (hyaline), cricoid (hyaline), epiglottis (elastic)

What do lesions on CN XII Hypoglossal cause?

tongue deviation (to the side of injury)

What is esophageal poracaval anastomoses?

uses azygos vein instead of left gastric vein -results in esophageal varicies (potential bleeding)

What is rectal portacaval anastomoses?

uses middle and inferior epigastric veins instead of superior epigastric veins -results in (painless) hemorhhoids

What is umbilicus portacaval anastomoses?

uses superficial epigastric veins instead of paraumbilical veins -results in caput medusa

What are the branches of the subclavian artery?

vertebral (joins circle of willis), internal thoracic, thyrocervical trunk, costocervical trunk

What are the layers of the lungs and their innervations?

visceral - autonomics Partietal - phrenic and intercostal nerves

Does the appendix have a mesentery?

yes