2 - Splanchnology

Question 1

22. Layers of the thoracic wall

Answer 1

1. Skin
2. Superficial + deep fascia
3. Intercostal m.
   
   • external
   • internal
   • innermost
4. Endo•thoracic fascia
5. Parietal pleura
   
   • Pleural cavity
6. Visceral pleura

Question 2

23. Intercostal space - Structure, items

Answer 2

• intercostal muscles:
  
  • external
  • internal
  • innermost
• intercostal art. and veins
• intercostal lymph nodes
• intercostal nerves

Question 3

24. Mediastinum - Definition, Borders, Divisions

Answer 3

Definition: visceral department in the middle of the thoracic cavity, between right and left pleural cavity

Borders:

• Anterior: Sternum
• Posterior: Vertebral Column
• Lateral: Mediastinal pleura (Lungs)
• Superior: Thoracic inlet (to neck)
• Inferior: Diaphragm

Divisions:

• superior mediastinum → 6 layers
• inferior mediastinum
  
  • anterior, middle and posterior

→ dividing plane: “transthorscal plane”, from sternal angle to T4 and T5 vertebral discs

Question 4

25. Layers of the superior mediastinum (6x)

Answer 4

Definition:

lies superior to the horizontal plane between the sternal angle and approximately the T4-T5 intervertebral disc

Layer 1:

• Thymus (retrosternal adipose body)

Layer 2:

• Superior vena cava
• brachiocephalic veins

between: Phrenic + Vagus nerves

Layer 3:

• Aortic arch
• brachiocephalic trunk
• left common carotid- + left subclavian artery
• recurrent Laryngeal nerves

Layer 4:

• Trachea

between: Esophageotracheal groove: recurrent laryngeal nerves

Layer 5:

• Esophagus: Thoracic duct

Layer 6:

• Posterior Thoracic wall: veins, sympathetic trunk

Question 5

26. Layers of the inferior mediastinum

Answer 5

Anterior

• sternopericardiac ligaments
• internal thoracic vessels
• parasternal lymph nodes

Middle

• heart + pericardium
• initial parts of great vessels: ascending aorta, pulmonary trunk
• last parts of great vessels: superior + inferior vena cava, pulmonary + azygos veins
• phrenic nerves
• pericardiophrenic vessels
• root of lung
• bronchopericardiac membrane

Posterior

• Esophagus (C4-T11)
• vagus nerves
• thoracic aorta + parietal and viceral branches
• azygous + hemiazygous vein w/ tributaries
• thoracic duct
• symphathetic trunk
• thoracic splanchnic nerves

Question 6

27. Chest X-ray: Identification of the contours of the heart

Answer 6

Question 7

28. Anatomy of the heart valves

Answer 7

Semilunar valves

• Pulmonary valves
• Aortic valves

Cuspid valves (w/ chorda tendinae)

• Right atrio•ventricular valve → Tricuspid valve
• Left atrio•ventricular valve → Bicuspid valve

Question 8

29. Impulse generating and conducting system of the heart

Answer 8

Intrinsic:

• SA node → AV node → bundle of HIS → right + left bundle branches → Purkinje fibers

Extrinsic: innervate nodes + coronary vessels

1. Vagus nerve - parasympathetic innervation
2. Sympathetic nerve

Question 9

30. Branches and supply area of the right coronary artery

Answer 9

1. SA nodal art.
2. AV nodal art.
3. right marginal art.
4. post. interventricular art.

Question 10

31. Branches and supply area of the left coronary artery

Answer 10

1. ant. interventricular art.
   
   • anastomosis with post. interventricular art.
2. circumflex art.
   
   • anastomosis with right coronary art.

Question 11

32. Proper veins of the heart

Answer 11

• Coronary sinus (collecting point)
• cardiac veins:
  
  • great
  • middle
  • small
  • smallest
  • oblique
  • anterior

Question 12

33. Anatomical parts of the aorta

Answer 12

1. ascending aorta
   
   • right + left coronary art.
2. aortic arch
3. descending aorta
   
   • thoracic aorta
   • abdominal aorta

Question 13

34. Branches of the aortic arch

Answer 13

• brachiocephalic trunk
  
  • right common carotid art.
  • right subclavian art.
• left common carotid art.
• left subclavian art.

Question 14

35. Tributaries of the SVC

Answer 14

• right brachiocephalic vein
• left brachiocephalic vein
• azygous vein
  
  • → hemiazygous vein

Question 15

36. Unpaired visceral branches of the abdominal aorta

Answer 15

1. Celiac trunk
2. Sup. + inf. mesenteric artery

Question 16

37. Paired visceral branches of the abdominal aorta

Answer 16

• middle suprarenal art.
• renal art.
• gonadal art.
• testicular/ovarian art.

Question 17

38. Parietal branches of abdominal aorta

Answer 17

• inf. phrenic art.
• lumbar art.
• median sacral art.

Question 18

39. Main lymphatic vessels of the body

Answer 18

• Intestinal trunk
• Lumbar trunk
• Thoracic duct (receives 75% of all lymph)
  
  • also called left lymphatic duct
• right lymphatic duct
• Bronchomediastinal trunk
• Subclavian trunk
• Jugular trunk

Question 19

40. Paranasal sinuses + Openings

Answer 19

1. Ethmoidal sinus (w/ air cells!)
   
   • ​​posterior-: → superior nasal meatus
   • middle-: → middle nasal meatus
   • anterior-: → middle nasal meatus
2. Frontal sinus
   
   • → middle nasal meatus
3. Maxillary sinus
   
   • → middle nasal meatus
4. Sphenoid sinus
   
   • → sphenoethmoid recess
5. Nasolacrimal duct
   
   • → inferior nasal meatus

Question 20

41. Frontal section of larynx

Answer 20

Question 21

42. Hilar structures of the lung

Answer 21

Right hilum

• Bronchus → Pulmonary vein → Pulmonary art.

Left hilum

• Bronchus → Pulmonary art. → Pulmonary vein

Question 22

43. Isthmus faucium

Answer 22

• connection between oral cavity and oropharynx
• Structures:
  
  • palato•glossal arch
  • palato•pharyngeal arch
  • palatine tonsils

Question 23

44. Large salivary glands: names, type of secretion, opening sides

Answer 23

1. Parotid gland (+ -duct)
   
   • on side, posterior to masseter muscle
   • typical serous gland
   • duct opens into vestibule
2. Submandibular gland (+ -duct)
   
   • ​​in submandibular triangle
   • serous + mucous
   • ducts opens into sublingual papilla besides frenulum of tongue
3. Sublingual gland (+ -duct)
   
   • ​​beneath mucous membrane of the floor of mouth
   • mainly mucous
   • small gland w/ several small ducts

Question 24

44.1 Large salivary glands: Innervation

Answer 24

1. Parotid gland
   
   • CN IX - glossopharyngeal nerve
   • Nucleus:
     
     • inf. salivatory nucleus
   • Preganglionic fiber:
     
     • lesser petrosal n.
   • Ganglion:
     
     • otic ganglion
   • Postganglionic fiber:
     
     • Auriculotemporal n. (CN V₃)
2. Submandibular + Sublingual gland
   
   • CN VII - facial nerve
   • Nucleus:
     
     • sup. salivatory nucleus
   • Preganglionic fiber:
     
     • Chorda tympani n.
   • Ganglion:
     
     • submandibular ganglion
   • Postganglionic fiber:
     
     • Lingual n. (CN V₃)

Question 25

45. Tonsils of the pharynx

Answer 25

* Pharyngeal tonsil * Palatine tonsil * Tubal tonsil * Lingual tonsil → make up Waldeyer's ring: annular arrangement of lymph vessels

Question 26

46. Openings of the diaphragm

Answer 26

**Openings:** 1. **​Aortic hiatus** - Aorta 2. **Vena caval foramen** - IVC 3. **Esophageal hiatus** * ​​Esophagus * ant. + post. vagal trunks

Question 27

47. Layers of the abdominal wall

Answer 27

1. Skin 2. Superficial fascia 3. Deep fascia 4. Muscles * Rectus abdominis m. * External + internal oblique m. * Transverse abdominis m. 5. Transversal fascia 6. Parietal peritonium

Question 28

48. Inguinal canal

Answer 28

**Male:** * **spermatic cord** * ilioinguinal nerve * genital branch of genitofemoral nerve **Female:** * **round lig. of uterus** * ilioinguinal nerve * genital branch of the genitofemoral nerve

Question 29

49. Topographical regions of the abdominal cavity

Answer 29

* 9 different regions * each region includes an underlying organ

Question 30

50. Peritoneal relations of the abdominal and pelvis organs

Answer 30

**Intraperitoneal**: * stomach, duodenum, small intestine * appendix, transverse colon, sigmoid colon, upper 1/3 of rectum * liver, spleen * in women: * uterus * fallopian tubes * ovaries * gonadal blood vessels **Extraperitoneal:** * ascending colon descending colon, middle 2/3 of rectum * kidneys, adrenal glands * proximal ureters

Question 31

51. Hilar structures of the liver (porta hepatis)

Answer 31

→ on posterior surface * Porta hepatis * common hepatic duct * hepatic portal vein * hepatic art. * venous lig. * round lig. * IVC * gallbladder

Question 32

52. Extrahepatic bile ducts

Answer 32

1. **Gallbladder** * 4 parts: * ​fundus * body * neck * **cystic duct** 1. receives + stores bile from liver 2. concentrates it (collecting salt and water)​​​​ 2. **Liver** * ​​right + left hepatic duct 3. **Pancreas****​** * pancreatic duct * all drain into the major duodenal papilla (p. of Vater)

Question 33

53. Layers of the scrotum

Answer 33

1. Skin 2. Dartos fascia 3. External spermatic fascia * Cremasteric fascia 4. Internal spermatic fascia 5. Tunica vaginalis

Question 34

54. Structures of the spermatic cord

Answer 34

* deferens duct w/ art. * testicular artery (from abdominal aorta) * pampiniform plexus of veins (to testicular veins) * cremasteric art. + vein * genital branch of genitofemoral nerve * lymph vessels

Question 35

55. Structures of the vulva

Answer 35

* mons pubis * clitoris * vestibule of vagina * vaginal orifice * urethral orifice * labia minora + majora * vestibular glands * Bartholin gland

Question 36

56. Fossa ischiorectalis

Answer 36

* ​​bordered by Urogenital diaphragm: * deep transverse perineal m. * perineal membrane * Pudendal canal * formed by the obturator fascia * Internal pudendal art. + vein * Pudendal nerve

Question 37

57. Position, anatomy, fixure of the uterus

Answer 37

* **3 main parts** * Fundus - superior and anterior * Body * Isthmus - constricted part between body + Cervix * anteverted and anteflexed (90° vagina vs. longitudinal axis of uterine body) * lies between urinary bladder and rectum: * vesico•uterine pouch * recto•uterine pouch (Douglas p.) * **enclosed by peritoneum = broad lig.** * pubo•vesical lig * cardinal lig. * recto•uterine lig. * round lig. * **supported by:** * pelvic diaphragm * urogenital diaphragm

Question 38

58. Anatomical parts of the male urethra

Answer 38

1. **Prostatic portion** * widest part of urethra * Seminal colliculus * opening of ejaculatory ducts * Urethral crest * opening of submucosal ducts and prostatic glands 2. **Membranous portion** * ​passage through urogenital diaphragm * controlled by ext. urethral sphincter 3. **Spongy portion** * ​longest of the 2 portions * in spongy body of penis * opens at penile head, forms navicular fossa

Question 39

59. Tributaries of the portal hepatic vein

Answer 39

* collects blood from unpaired abdominal viscera * splenic vein * sup. + inf. mesenteric vein * right + left gastric vein

Question 40

60. Crossings of the ureter

Answer 40

Crosses at 3 sites: 1. Gonodal vessels (posterior to them) 2. Common iliac vessels (anterior to them) 3. Deferent duct/Uterine artery (posterior to them)

Question 41

61. Hilar structure of the kidney

Answer 41

* renal art. + vein * ureter * nerve of renal plexus * lymphatic vessels