Unit 1 Study Guide PDF

Unit 1 Study Guide Module 1 Core Concepts for Quiz 1 and Exam 1 MLO 1.1 Define anatomical terminology relating to position and movement (CLO 1) Recognize anatomical position: The person stands erect, facing forward, with arms at the sides and palms facing forward. Define the 3...

Unit 1 Study Guide Module 1 Core Concepts for Quiz 1 and Exam 1 MLO 1.1 Define anatomical terminology relating to position and movement (CLO 1) Recognize anatomical position: The person stands erect, facing forward, with arms at the sides and palms facing forward. Define the 3 planes of the body: o Sagittal Plane: Divides the body into left and right sections. o Frontal (Coronal) Plane: Divides the body into anterior (front) and posterior (back) sections. o Transverse Plane: Divides the body into superior (upper) and inferior (lower) sections. Define the following locational terms: Medial: Closer to the midline of the body. Lateral: Farther from the midline of the body. Proximal: Closer to the point of attachment or origin. Distal: Farther from the point of attachment or origin. Anterior: Toward the front of the body. Posterior: Toward the back of the body. Superficial: Closer to the surface of the body. Deep: Farther from the surface of the body. Ipsilateral: On the same side of the body. Contralateral: On the opposite side of the body. MLO 1.2 Recognize features of the integumentary system and fascial layers (CLO 1) Identify characteristics of the dermis and epidermis; be able to differentiate these features Dermis and Epidermis: Epidermis: The outermost layer of skin, composed mainly of keratinized stratified squamous epithelium. Dermis: The inner layer of skin, containing connective tissue, blood vessels, nerve endings, and glands. Define the following terms: Apocrine gland: Sweat glands found in specific areas like armpits and groin, which become active during puberty. Eccrine gland: Sweat glands found all over the body, responsible for regulating body temperature. Sebaceous gland: Oil-producing glands found in the skin. Arrector pili muscle: Small muscles attached to hair follicles, causing hair to stand upright when contracted. Hair follicle: The sheath surrounding the hair root.  Fascia: connective tissue within the body: important in containing infection to a localizatied area o Superficial: beneath the skin, tends to be loose (contain fat) o Deep: denser, found around major structures (compartments found around structures ex. Muscles, nerves, organs) o Investing fascia: deep fascia found between individual muscles and neurovascular bundles MLO 1.3 Identify the divisions of the skeleton and the primary bones found in each (CLO 1) Recognize bones as belonging to either the axial or appendicular skeleton Axial Skeleton: Includes the skull, vertebral column, and rib cage. Appendicular Skeleton: Includes the limbs and girdles (shoulder bones and pelvis). MLO 1.4 Classify joints based on shape and motions permitted (CLO 1) Define the following motions: Flexion/Extension: Decreasing/increasing the angle between two bones. - Flexion: Reduces angle between bones (bending) - Extension: Movement that increases the angle between bones (straightening) - Plantar flexion: angle between foot and leg is increased (extension) - Palmar flexion: angle between the palmar side of the hand and anterior forearm is reduced Abduction/Adduction: Moving a limb away from/toward the midline of the body. - Abduction: pull away from midline - Adduction: Pulls towards the midline Protraction/Retraction: Moving a part of the body forward/backward. - Protraction: moves structure anteriorly - Retraction: moves them posteriorly  Supination – radius and ulna parallel Pronation – radius and ulna twist Joints: two skeletal elements (bones) meet or articulate o Solid joins: bones are joined together by connective tissue – little movement permitted between bones o Fibrous joints: solid joints where we find the bones connected by sutures o Ligaments – fibrous connective tissues that connect bones to other bones o Cartilaginous joins – solid joints where bones are separated by cartilaginous structures (symphyses) o Synovial joints: more complicated than solid joints, allow for motion to occur between the bones Articular cavity: space between bones Joint capsule – wrapped around bone → Two layers o Fibrous membrane: thick connective tissue o Synovial membrane: viscous lubricating fluid – Synovial fluid  MLO 1.5 Recognize the three types of muscle (skeletal, smooth, and cardiac), including their general locations in the body (CLO 1) Give general definition of each type of muscle and where it is found in the body Recognize what portion of the nervous system (e.g. somatic or autonomic) innervates each type of muscle Skeletal Muscle: Attached to bones, responsible for voluntary movements. Innervated by the somatic nervous system. Smooth Muscle: Found in walls of internal organs and blood vessels, responsible for involuntary movements. Innervated by the autonomic nervous system. Cardiac Muscle: Found in the heart, responsible for pumping blood. Innervated by the autonomic nervous system. Trabecular (spongy bone) – found at the ends of bones in joints Hard Cortical (compact bone) – found at the center of long bone shafts within the Medullar cavity, involved in production of red blood cells MLO 1.6 Recognize the anatomical and functional differences between arteries and veins (CLO 1) Define the following terms Capillary: Smallest blood vessels where exchange of gases, nutrients, and waste occurs. Anastomose: A connection between two blood vessels or other tubular structures. Valve: Structures within veins that prevent backflow of blood. Recognize major differences between arteries and veins Arteries: Thicker walls, carry oxygenated blood away from the heart. Veins: Thinner walls, carry deoxygenated blood toward the heart, contain valves. MLO 1.7 Identify the basic function and organization of the lymphatic system (CLO 1) Define the following terms Left venous angle: Junction where the thoracic duct empties lymph into the bloodstream.  - The lymph from three-quarters of the body (left arm, lower body, and left side of the head and neck) drains into the left venous angle. Thoracic duct: Main lymphatic vessel draining lymph from the body. The thoracic duct represents the confluence of all the lymph from the lower body and thorax. Lymph node: Small, bean-shaped structures that filter lymph and store white blood cells. MLO 1.8 Recognize the general organization and function of the nervous system and its components (CLO 1) Differentiate between the tissues targeted by the somatic and autonomic nervous systems Recognize differences between signals picked up by the somatic and visceral sensory nerve fibers Somatic Nervous System: Controls voluntary movements by targeting skeletal muscles. Autonomic Nervous System: Controls involuntary functions by targeting smooth muscle, cardiac muscle, and glands. Signal differences: Somatic sensory nerve fibers: Carry information from skin and muscles to the central nervous system. Visceral sensory nerve fibers: Carry information from internal organs to the central nervous system. Label the core components of a typical spinal nerve on a diagram (blank diagram included at end of guide) Core components of a spinal nerve: Dorsal root (sensory), ventral root (motor), dorsal root ganglion (contains sensory neuron cell bodies). Identify where cell bodies are found for each type of nerve fiber o Somatic motor cells bodies = ventral horn o Somatic sensory cell bodies = dorsal root ganglion o Sympathetic cell bodies = Intermediate grey matter Recognize potential pathways nerve fibers take through typical spinal nerves for the following: Somatic motor: From spinal cord to skeletal muscles. Somatic sensory: From skin/muscles to spinal cord. Sympathetic motor: From spinal cord to organs (via sympathetic trunk). Visceral sensory: From organs to spinal cord. Define the following terms Myotome: Group of muscles innervated by a single spinal nerve. Dermatome: Area of skin innervated by a single spinal nerve. Sympathetic trunk/chain: A chain of ganglia running alongside the vertebral column.  White rami communicans: Pathways connecting the spinal nerve to the sympathetic trunk. o Preganglionic sympathetic fibers exit the white ramus communicantes Gray rami communicans: Pathways connecting the sympathetic trunk back to the spinal nerve. o Postganglionic sympathetic fibers exit the sympathetic chain ganglion via Grey ramus communicantes Splanchnic nerves: Nerves that convey information about the internal organs. Blank Diagrams Typical Spinal Nerve Module 2 Core Concepts for Quiz 2 and Exam 1 MLO 2.1 Recognize the key bony features and movements of the vertebral column (CLO1) Identify location of spinal ligaments: o Anterior longitudinal: Runs along the anterior surface of the vertebral bodies from the base of the skull to the sacrum. o Posterior longitudinal: Located along the posterior surface of the vertebral bodies within the vertebral canal. o Ligamentum flava: Connects the laminae of adjacent vertebrae. o Supraspinous ligament: Runs along the tips of the spinous processes from C7 to the sacrum. o Interspinous ligament: Found between the spinous processes of adjacent vertebrae. Know the primary and secondary curvatures of the back and where they occur along the spinal column Primary curvatures (present at birth): Thoracic and sacral regions (kyphosis). Secondary curvatures (develop postnatally): Cervical (develops when infants lift their head) and lumbar (develops with standing and walking) regions (lordosis). Know numbers of vertebrae for each portion of the spinal column and any specific distinguishing features found on those vertebrae. Be able to recognize each type of vertebrae from images o Cervical (7: C1 – C7) : Small body, transverse foramen, bifid spinous process (except C7) → Vertebral arteries run through the transverse foramen ▪ Know specific features of the C1 and C2 vertebrae ▪ C1 (Atlas): No body or spinous process; anterior and posterior arches  vertebrae holds up and supports our skull. It has a ring-like shape and is missing or has very reduced versions of the typical vertebrae features. It completely lacks a vertebral body and a spinous process Occipital condyle facets where it articulates with the occipital bone (atlanto-occipital joint) allows for upward and downward nodding motion of head ▪ C2 (Axis): Dens (odontoid process) projects superiorly superior projection from its body known as the dens process o Thoracic (12: T1 – T12): Larger body, costa facets for rib articulation, long spinous processes angled downward ▪ Long and slant inferiorly and help to prevent over extension of the back ▪ Articular facets allows for rotation, but limits flexion, extension and lateral flexion o Lumbar (5 : L1 – L5): Large, kidney-shaped body; thick and short (robust) spinous processes  ▪ Articular facets face medially and laterally so they permit flexion and extension, and lateral flexion when limiting rotation. o Sacral (5 fused): Forms the sacrum; articulates with ilium ▪ 4 anterior and posterior sacral foramina – allow the ventral and dorsal rami of sacral spinal nerves to exit the sacrum ▪ Sacral canal is a continuation of the vertebral canal, and terminates inferiorly at the sacral hiatus o Coccyx (3-4 fused): tailbone, small and triangular ▪ Created by 3-4 tiny coccygeal vertebrae ▪ Important site for muscle attachments of the pelvis  Recognize location of general vertebral features o Lamina: These connect the transverse process to the spinous process o Pedicle: These act to connect the vertebral body to the transverse processes o Body: the body is the weightbearing portion of the vertebrae o Transverse process: these are lateral projections that are a site of muscle attachment o Spinous process: This is a posterior projection that serves as a site of muscle attachment o Vertebral canal: This arch is created by the pedicle, transverse processes, lamina, and spinous process in articulation. The spinal cord is contained within the vertebral canal o Intervertebral foramen: When two vertebrae articulate they form an intervertebral foramen, where the spinal nerves exit the vertebral column o Superior and inferior articular processes: facilitate articulation between vertebrae o Superior and inferior vertebral notches: exist near the pedicles. Form the intervertebral foramen o Intervertebral disks: sit between vertebral bodies. Act to distribute weight and allow for some movement of the vertebral column MLO 2.2 Identify features of the spinal cord and associated meninges (CLO 1) Define the following terms o Cauda equina: the collection of nerves associated with the lower lumbar, sacral, and coccygeal spinal levels o Filum terminale: is a structure composed of condensed pia mater that extends from the conus medullaris down to the tip of the coccyx (tail bone). o Conus medullaris: the end of the spinal cord we observe the conus medullaris, or the tip of the spinal cord o Cervical enlargement: associated with the nerves that move the upper limbs o Lumbosacral enlargement: associated with the nerves that move the lower limbs o Dura mater: a tough, thick membrane o Arachnoid mater: has a spiderweb like appearance o Pia mater: is transparent and delicate, and is found directly adhering to the spinal cord and brain o Denticulate ligaments: are small structures formed from pia matter that anchor onto the dura mater to help stabilize the spinal cord.  Recognize where the spinal cord typically terminates in adults o Adult spinal cord terminates between L1 and L2 vertebral levels o Infant spinal cord terminates around L3 vertebral level MLO 2.3 Identify the muscles of the back, including actions and innervation pathways (CLO1) Recognize superficial back muscles in images  Recognize erector spinae group muscles in images Table of Back Muscles: Muscle Motor innervation Attachment sites Primary action(s) Trapezius CN XI Scapular spine and Upper portion: Spinal accessory acromion process, elevate scapula nerve lateral clavical Middler portion: adduct scapula Lower portion: depress scapula Upper + Lower together: rotate scapula Latissimus dorsi Thoracodorsal nerve Proximal humerus Extend, adduct, and medially rotate humerus Rhomboid major Dorsal Scapular Medial border of Retract and elevate nerve scapula scapula Rhomboid minor Dorsal Scapular Medial border of Retract and elevate nerve scapula scapula Levator scapulae Dorsal scapular Medial border of Elevate scapula nerve scapula Serratus posterior Ventral rami Ribs 2-5 Elevates ribs 2-5 superior Serratus posterior Ventral rami Ribs 9-12 Depresses ribs 9-12 inferior Splenius capitus Dorsal rami Mastoid process, Extend the neck via occipital bone bilateral contraction and both laterally flex and rotate the neck to the ipsilateral side during unilateral contraction Splenius cervicis Dorsal rami Transverse Extend the neck via processes of cervical bilateral contraction vertebrae and both laterally flex and rotate the neck to the ipsilateral side during unilateral contraction Iliocostalis Dorsal rami Sacrum/pelvis, ribs Bilateral contraction – extend the trunk and laterally flex Unilateral contraction – laterally flex and rotate the trunk of ipsilateral side Longissimus Dorsal rami Transverse Bilateral processes contraction – extend the trunk and laterally flex Unilateral contraction – laterally flex and rotate the trunk of ipsilateral side Spinalis Dorsal rami Spinous processes Bilateral contraction – extend the trunk and laterally flex Unilateral contraction – laterally flex and rotate the trunk of ipsilateral side Semispinalis Dorsal rami Between the Bilateral transverse and contraction – pulls spinous processes head posteriorly Unilateral contraction– pulls head posteriorly while rotating  towards ipsilateral side Multifidus Dorsal rami Between the Bilateral transverse and contraction – pulls spinous processes head posteriorly Unilateral contraction– pulls head posteriorly while rotating towards ipsilateral side Rotatores Dorsal rami Between the Bilateral transverse and contraction – pulls spinous processes head posteriorly Unilateral contraction– pulls head posteriorly while rotating towards ipsilateral side MLO 2.4 Identify the bones, bony features, cartilages, and joints of the thorax (CLO1) Recognize the different types of ribs (true, false, floating) and general features of ribs o True Ribs: 1-7 – Independent costa cartilage that connect the sternum o False ribs: 8-10 – Share common cartilaginous connection to the sternum o Floating ribs 11-12 – do not connect to the sternum  Recognize how costal cartilage differs between types of ribs o Costal cartilage functions to allow for movement of the thoracic wall during breathing. The costal margin, which denotes the inferior boundary of the anterior thorax, is formed by the medial borders of the costal cartilages associated with ribs 7-10. o Features of the ribs: ▪ 1) Head, articulates with the costal facets of the vertebral bodies ▪ 2) Turbercle, articulates with the transverse process of the vertebrae at the costotransverse joint ▪ 3) Rib angle – rib begins to curve (distal from the head) ▪ 4) Costal groove - inferior surface of the rib angle Identify the components of the sternum o Features of the sternum: ▪ 1) Manubrium: (Ribs 1 + 2) Jugular notch Two lateral clavicular notches: small depressions where the costal cartilages articulate with the sternum ▪ Sternal angle: joint between the manubrium and sternal body ▪ 2) Sternal body (ribs 2 – 7): articulate with the costal cartilages associated with ribs 2-7 (Interchondral joints) ▪ 3) Xiphoid process: joins the sternal body at the xiphisternal joint  - Sternal angle = joint between manubrium and sternum - Xiphisternal joint = joint between sternum and xiphoid process - Intercondral joint = where rib cartilages articulate with sternal body - Zygapopysial joint = Between superior and inferior articular process of vertebrae MLO 2.5 Recognize the major features of the thoracic wall, including muscles, nerves, and vessels (CLO 1) Identify the three layers of intercostal muscles including differences between them and innervation o Intercostal space: space between ribs – numbered based on the rib superior to the space o Intercostal muscles: space between ribs – three overlapping layers: most of these muscles are innervated by the intercostal nerves. Functions to help stabilize the movement of the ribs during respiration. ▪ 1) External muscles – obliquely oriented fibers (inferoanterior angle) ; posteriorly these originate near the rib tubercle and extends to the end of the rib bone (does not attach onto cartilage) External intercostal membrane – thin, translucent sheath that extends distally from the muscles to the sternum. Muscles are most active during inhalation. ▪ 2) Internal muscles – obliquely oriented in the opposite direction (inferoposterior angle) Posteriorly they begin at the rib body and then extends all the way to the sternum anteriorly Internal intercostal membrane – thin, translucent sheath that extends proximally back towards the rib tubercle. This muscle is most active during exhalation. ▪ 3) Innermost muscles – run perpendicular between the ribs, and appear similar in their fiber orientation to the internal intercostals. The muscle covers the rib angle, and terminates before the bony section of the rib ends, making it the smallest of the intercostal muscles. These muscles are not associated with a membrane. ▪ Intercostal muscle Movement: motions produced by intercostal muscles help to stabilize the ribs during respiration Ribs/Sternum: go up during inspiration Diaphragm: responsible for the majority of respiration  Recognize features of the transversus thoracic muscles and the subcostal muscles o Subcostal muscles: relatively small and found on the lower ribs (7-12) and connect the inferior internal aspect of one rib to the superior internal surface of the second and third rib beneath it. o Transversus thoracis muscle “star shaped muscle”: found on the internal aspect of the of the sternal body and radiate out of the ribs. Very weak role in respiration  Recognize the pathway of the intercostal neurovasculature between the layers of intercostal muscles o Intercostal nerves are the ventral rami of thoracic spinal nerves T1 – T11 – carry somatic motor, somatic sensory, and sympathetic fibers o 1) Posterior intercostal arteries: arise from the thoracic Aorta o 2) Anterior intercostal arteries: with anastomose ▪ 3) Anterior intercostal arteries arise from Internal thoracic arteries, found running down on either side of the sternum o 4) Posterior intercostal veins: drain into the azygous system of the posterior thorax o 5) Anterior intercostal veins: drain into the internal thoracic veins o Main intercostal Vain, arteries, nerves (VAN): runs along costal groove T8 nerve runs with rib 8 costal groove o Collateral VAN: split off and travel superior to next rib down : T8 collateral runs above rib 9 MLO 2.6 Recognize the borders and contents of the mediastinum (CLO 1) Recognize the divisions of the mediastinum and where structures occur within the mediastinum o Mediastinum: conceptual space within the thorax which contains all the thoracic organs except for the lungs. ▪ 1) Superior mediastinum → Superior thoracic aperture: superiorly the mediastinum is bounded by the manubrium, 1 st ribs and the T1 vertebrae Contains: Esophagus, trachea, thoracic duct, thymus, sympathetic trunk, phrenic nn, vegus nn. , recurrent laryngeal nn, Aortic arch + branches, Brachiocephalic vv and Superior vena cava ▪ 2) Inferiorly mediastinum: bounded by the Diaphragm muscle. Anterior mediastinum – no major structures  Middle Mediastinum – Heart and pericardium, roots of the great vessels, Phrenic nn. Posterior mediastinum – Esophagus, descending aorta, vegus nn, Azygos and hemiazygos vv. Thoracic duct, Sympathetic chain and splanchnic nn o Azygos system: receives blood from thoracic wall, right side of the body o Hemiazygos and accessory hemiazygos: left side of the body ▪ Both systems (azygos and hemiazygos) drain into the superior vena cava (SVC) o Thoracic duct: found between the thoracic aorta and azygos vein → primary site if collecting lymph from the lower limbs and returning them to the left venous angle o Sympathetic trunk: runs along vertebral bodies ▪ 3) Transverse plane: Separates the superior and inferior mediastinum o Inferior mediastinum = anterior mediastinum rests anterior to the pericardial sac of the heart o Posterior mediastinum = sits posterior to the paricardial sac of the heart o Middle Mediastinum = area of the pericardial sac and its contents Describe the pathway of the Vagus nerve through the mediastinum including the asymmetry between the branching patterns of the right and left recurrent laryngeal nerves  o The vagus nn. course down through the neck and into the mediastinum, giving off a derivative known as the recurrent laryngeal nerve on each side. The right recurrent laryngeal nerve wraps around the right subclavian artery and then travels superiorly up to structures in the neck. The left recurrent laryngeal nerve wraps around the arch of the aorta before ascending back into the neck. o This asymmetry between the pathways of the recurrent laryngeal nerves is a product of development and has important clinical significance. The aorta is prone to dilation and aneurysm (bulging); this can compress the left recurrent laryngeal nerve and cause patients to experience symptoms in their throat such as having a hoarse voice. Aneurysms are generally asymptomatic and rupture of the aorta is often fatal, so knowing this clinical sign can be critical for early detection and treatment of this condition. o The right and left vagus nn. continue on after giving off the recurrent laryngeal nn. and travel posterior to the root of the lung on either side. These send of fibers that contribute to the cardiac plexus, pulmonary plexuses, and the esophageal plexus. The vagus then ‘rides’ the esophagus down into the abdomen. o Summary of Vegus nn through mediastinum: ▪ Right Vegus n → sends off right recurrently laryngeal n that wraps around R. subclavian artery ▪ Left Vegus n → sends off left recurrent laryngeal n that wraps around the aortic arch ▪ Both Vegus nn continue through the mediastinum on the esophagus o Structures of the mediastinum: Esophagus – gastrointestinal structure, muscular tube connecting the pharynx in the throat to the stomach. This travels from the superior mediastinum through the posterior mediastinum and into the abdomen. Thoracic duct – lymphatic vessel that runs up through the posterior mediastinum and into the superior mediastinum. This is found between the aorta and the azygos vein. It collects lymph from the lower limbs, the abdomen, and thorax, and returns it into the venous system at the left venous angle (formed where the left subclavian and internal jugular veins join, see Lesson 2.5 Heart). Thymus – gland situated just posterior to the manubrium. Plays immune role in early development, and tends to atrophy in adults. Sympathetic Trunk – First introduced in Module 1, Lesson 1.6, the sympathetic trunk is a chain of paraganglia that runs down the left and right sides of the anterior vertebral bodies. It crosses from the thorax down into the abdomen behind the diaphragm. Greater, lesser, and least splanchnic nerves come off of the sympathetic trunk to deliver preganglionic sympathetic nerve fibers to the prevertebral ganglia of the abdomen; these travel from the thorax into the abdomen through small holes in the diaphragm.  Azygos and Hemiazygos veins – The azygos system is a network of veins in the posterior mediastinum that drain blood away from the thoracic body wall. The azygos vein typically sits to the right of midline and receives blood from the right intercostal veins. It sends blood into the superior vena cava. The hemiazygos and accessory hemiazygos veins are variably present to the left of the midline and receive blood from the left intercostal veins before dumping into the azygos vein. In the absence of the hemiazygos veins, the left intercostal veins would go directly to the azygos vein. The Vagus Nerves (CN X) – The vagus nerves originate in the brain and serves many functions that will be discussed in Modules 7 and 8. It plays a critical role in the thorax and abdomen by carrying preganglionic parasympathetic fibers to the viscera in these regions. The Phrenic Nerves – The phrenic nerve is formed from the ventral rami of spinal nerves C3, C4, and C5 and carries somatic motor and sensory fibers. Travels down through the middle mediastinum and anterior to the root of the lungs. MLO 2.7 Recall major features and functions of the lungs and associated structures (airway, pleurae, vessels) (CLO 1) Identify key features of the left and right lungs o Lung: orangs of respiration and function to oxygenate the blood ▪ Right lung: 3 lobes, 2 fissures Superior lobe Inferior lobe Middle lobe ▪ Left lung: 2 lobes, 1 fissure, cardiac notch, lingula Superior lobe Inferior lobe Cardiac notch: near the heart  Lingula: tongue like projection anteriorly o Oblique fissure: between the superior and inferior lobes of both lungs o Horizontal fissure: between the superior and middle lobes of the right lobe o Root: on the medial surface of the lung where the structures enter and exit the lung ▪ Main stem bronchi ▪ Pulmonary arteries ▪ Pulmonary veins (2): ▪ Inferior lobe o Pulmonary circulation: oxygen poor blood from the heart reaches the lungs from the pulmonary trunk then move to the right and left pulmonary arteries from the → split into lobular and then segmental arteries (branches) → After blood is oxygenated, it returns to the heart via segmental, then lobar, then left and right pulmonary veins (2 on each side) carry oxygen rich blood away from the lungs back to the heart Recognize branching patterns of the airway and arteries inside the lungs o Airway: ▪ Trachea: airway that connects the pharynx to the lung (travels from neck to the superior mediastinum Trachea branches into the left and right main stem bronchi o Main stem bronchi: is slightly asymmetrical (right is wider, shorter than left side) → more likely to go to right main stem bronchi than the left The main stem bronchi enter and divide into the lobar bronchi o Lobar bronchi (3 in right lung , 2 in the left lung) o Lobar bronchi give rise to smaller segmental bronchi o Each lung features 10 bronchopulmonary segments (smallest unit of the lung that can be individually removed)  Recognize function of the pulmonary vs bronchial arteries and veins o Blood supply of the Lung: ▪ Bronchial arteries: lung tissues receive blood which come off of the thoracic aorta ▪ Bronchial veins: deoxygenated blood is returned from the veins → then enter into the azygous or intercostal veins Differentiate between sympathetic and parasympathetic motor affects on the airway o Airway autonomics: ▪ Parasympathetic nervous system – delivered by Vagus N (CN X) promotes bronchoconstriction (shrinking) ▪ Sympathetic nervous system – delivered by spinal nerves, promotes bronchodilation (widening) Define different types of pleura, including the locations they occur, and innervation pathways o Pleura Cavities: space between the visceral and parietal pleura ▪ Pleura = serous sac that surrounds the lung on each side Two layers: o Parietal pleura (against the thoracic wall): adhering to the walls of the thoracic cavity ▪ Parietal pleura – receives somatic sensory innervation from a combination of intercostal and phernic nerves (signal pain, temperature, and touch) o Visceral pleura (against the lung): adhered to the lungs and invests into the fissures \ ▪ Visceral pleura – receives autonomic nervous system  Costodiaphragmatic recess: area where the lungs and pleura can expand into during inhalation Pleural effusion: build up of fluid in a pleural recess as the result of injury or disease ▪ Left and right lungs are independent → damage to one lung may not necessarily cause damage to another (ex: Pneumothorax – which air enters the pleural cavity and causes the lung to collapse, only one side will be impacted) MLO 2.8 Recognize the structure, function, and innervation of the diaphragm (CLO 1) Know the 3 openings of the diaphragm and structures that pass through each o Diaphragm: large, skeletal muscle that creates the inferior border of the thorax and acts as a boundary between the thorax and abdomen. Primary muscle that drives respiration. ▪ Innervated by the phrenic nerves (spinal levels C3-C4-C5) “keeps the diaphragm alive” Attaches to the anteriorly xiphoid process and costal margin, and posteriorly to ribs 11 and 12.  Two crura extend down posteriorly to attach onto L1 and L2 Vertebrae ▪ Contraction: increases thoracic volume, allows for inhalation ▪ Relaxation: decreases thoracic volume, allows for exhalation o Openings of the diaphragm: ▪ Caval opening → travels through inferior vena cava → T8 ▪ Esophageal hiatus → Esophagus and CN X (vagus n.) → T10 ▪ Aortic hiatus → Aorta, thoracic duct, azygos vein → T12 o When diaphragm contracts (flattens out) allowing lungs to expand and suck air in (inhalation) ; when diaphragm relaxes, air is forced back out (exhalation) o Intercostal muscles: function to help stabilize the movements of the ribs during inspiration and exhalation Recognize which nerves provide somatic motor innervation to diaphragm o Diaphragm receives somatic motor innervation from the phernic nerves (C3, C4, C5) MLO 2.9 Identify features and functions of the heart and pericardium (CLO 1)  Define the function and layers of the pericardium including innervation pathways o Pericardium: membrane that surround the heart ▪ External layer: fibrous pericardium attaches onto central tendon of diaphragm. Sends Somatic sensory information ▪ Internal layer: serous pericardium Parietal layer: lays against the fibrous pericardium; sends somatic sensory information Visceral layer: lays against the surface of the heart; sends visceral sensory information Pericardial cavity: space between these layers, contains serous fluid o Pericarditis = irritation of the pericardium which can result in sharp chest pains ▪ Pericardial Sinuses: Vessels associated with the heart enter and exit the pericardium creates spaces referred to as sinuses Oblique sinus – created between the left and right pulmonary veins Transverse sinus – created between the superior vena cava and the pulmonary trunk Identify muscles and structures associated with each chamber of the heart o Auricles: auricle, contains pectinate muscles - Small, ear-like muscular pouch on the external surface of the atrium that increases its capacity. o Pectinate muscle – Parallel ridges of muscle found in the anterior wall of the atrium and auricle o Papillary muscle - Cone-shaped muscles that attach to the chordae tendineae to prevent valve prolapse during contraction. o Trabeculae carnae - Irregular muscular ridges lining the walls of the ventricle. o Moderator band - A muscular band that crosses the ventricular cavity, carrying part of the right bundle branch of the conduction system. o Chordae tendinea - Tendinous cords connecting papillary muscles to the tricuspid valve and bicuspid leaflets, preventing them from inverting. o Tricuspid valve: found in the right atrium (3 flaps) avoids backflow of blood back to the right atrium from the right ventricle o Bicuspid valve - Located between the left atrium and left ventricle; prevents backflow into the atrium. o Aortic semilunar valve - Located between the left ventricle and the aorta; prevents backflow into the ventricle after contraction o Pulmonary semilunar valve - Located between the right ventricle and pulmonary trunk; prevents backflow into the ventricle. o Fossa ovale: remnant of the fetal opening (foramen ovale) that connected the right and left atria during development o Crista terminalis: thick ridge separating the auricle from the smooth posterior atrial wall Heart Chambers:  o Right Atrium: ▪ Receives oxygen poor blood from SVC, IVS and coronary sinus ▪ Accessory flap = the auricle, contains pectinate muscles ▪ Crista terminalis = thick ridge separating the auricle from the smooth posterior atrial wall ▪ Fossa ovalis = remnant of the fetal opening (foramen ovale) that connected the right and left atria during development ▪ Right atrium drains into the right ventricle via the right atrioventricular (AV) valve = called tricuspid valve because it is composted of 3 flaps ▪ Chordae tendineae: connect the AV valve flaps to papillary muscles Valve shuts when the ventricle fills with blood Contraction of the papillary muscles keeps valves from opening into the artium ▪ Trabeculae carneae: thick meaty rod like muscle of the ventricular wall ▪ Moderator band: helps control cardiac conduction (found on the right side) ▪ Blood leaves the right ventricle via the pulmonary valve Semilunar cusps fill with blood, shutting the valve and prevent backflow ▪ Blood travels through pulmonary trunk, then pulmonary arteries to lungs o Interventricular septum: separate the left and right ventricles from each other o Left Atrium: ▪ Oxygenated blood enters the left atrium via 4 total pulmonary veins ▪ Blood travels through the left atrioventricular (AV) valve – Bicuspid or mitral valve (2 flaps) ▪ Left ventricle has 2 sets of papillary muscles and chordae tendinae, and trabeculae carneae ▪ NO moderator band ▪ Thick walls promote forceful contractions, sends blood through the aortic valve and out to the rest of the body Know blood flow pathways to and from the heart 1. Oxygen poor blood is returned from the head and arms via the SVC and from the rest of the body through the IVC. 2. Oxygen poor blood enters the right atrium. 3. Oxygen poor blood passes through the tricuspid valve to enter the right ventricle. 4. Oxygen poor blood passes through the pulmonary valve to enter the pulmonary trunk. 5. Oxygen poor blood is delivered to the lungs via the pulmonary arteries. 6. Oxygen rich blood is returned to the heart from the lungs by the pulmonary veins. 7. Oxygen rich blood enters the left atrium. 8. Oxygen rich blood passes through the bicuspid valve to enter the left ventricle. 9. Oxygen rich blood passes through the aortic valve to enter into the ascending aorta and ultimately out to the rest of the body. o Identify the great vessels of the heart (blank diagram at end of guide) ▪ Ascending ▪ Aortic arch ▪ Brachiocephalic trunk ▪ Left common carotid a. ▪ Left subclavian a. ▪ Right and left brachiocephalic vv. ▪ Superior vena cava ▪ Inferior vena cava ▪ Pulmonary trunk ▪ Left and right pulmonary aa. ▪ Left and right pulmonary vv. o Oxygen poor blood moving through vessels ▪ Brachiocephalic vv. ▪ Superior vena cava (SVC) ▪ Inferior Vena cava (IVC) ▪ Pulmonary trunk  ▪ Pulmonary aa o Oxygen rich blood moving through vessels ▪ Pulmonary vv. ▪ Ascending aorta ▪ Aortic arch ▪ Brachiocephalic trunk ▪ Left common carotid a. ▪ Left subclavian a. Recognize major coronary vessels and the location where they are found o Right and left coronary artery o Left anterior descending artery o Posterior interventricular artery o Right marginal artery o Circumflex artery o Coronary sinus o Small cardiac vein o Middle cardiac vein o Great cardiac vein Coronary circulation: heart tissues receive oxygenated blood from the aorta via the coronary arteries, and send oxygen poor blood back to the right atrium via the cardiac veins o Right and left coronary aa: branch off the ascending aorta as it leaves the left ventricle o Right coronary a. give off the SA node branch, right marginal a., and posterior interventricular a. o Left coronary a. give off the anterior interventricular a (also called the left anterior descending or LAD) and the circumflex a o Cardiac veins found running alongside the coronary aa. o Small cardiac v and right marginal a. o Middle cardiac v and posterior interventricular a. o Great cardiac v and anterior interventricular a. All drain into the coronary sinus and into the right atrium - Great cardiac vein occupies → anterior interentricular groove - Middle cardiac vein occupies → Posterior interventricular groove (along side posterior interventricular branch of right coronary artery) - Small cardiac vein found in → Coronary groove Blank Diagrams Heart Note: the left pulmonary artery in this diagram is depicted as splitting, which it does after entering the hilum of the lung.