Yasmir's Note

DR 1
 Pedicle and lamina are neural arches
 *Pedicle- from body to transverse process
 *Lamina- from transverse process spinous process
 Intercostal muscles origin is superior and insertion is inferior because it pulls
the ribs upward during inspiration
 Umbilicus innervated by T10
 Pectoralis major and minor extend from the the upper limb to the ribs
 Serratus anterior - from the back to ribs

 Skin
 Subcutaneous - adipose tissue, fat, superficial fascia
 White dense connective tissue like membrane - deep fascia

 Anterior Axillary fold - part of the pectoralis major

 Pectoralis major innervated by the lateral pectoralis nerve

 Pectoralis minor innervated by medial pectoralis nerve

 Deep to the skin - platysma muscle which is the muscle of fascial expression

DR 2

 5 planes of the superior mediastinum - Glandular, Venous, Arterio-nervous,

visceral, lymphatic

 Sternopericardial ligament - connect the sternum to the fibrous pericardium

 Fibrous pericardium blends with the central tendon of the diaphragm and
attached to loose CT posteriorly

 Pleura - Parietal pleura

 Internal thoracic artery and vein accompanying each other - lighter/reddish

and darker/ bluish line respectively. They don't have any nerve accompanying
them.

 Parasternal Lymph node - internal thoracic artery ተከትሎ

 Transversus thoracis

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  NB: Vagus nerve is in the carotid sheath along with the carotid artery and
internal jugular vein and located more medially
 Phrenic nerve is located more laterally.

 External intercostal muscle - hands in pockets - pattern towards the sternum

 Internal intercostal muscle - away from the sternum

 There is neurovascular bundles(VAN) between the internal intercostal and

innermost intercostal muscle.

 Costal groove
 VAN- order from up to down

 Vein are dark, firm upon touching

 Artery have lumen, airy, loose upon touching
 Nerves are thinner, no lumen, and are yellowish

 Thymus gland remnant t- next to the thymus, external jugular veins present

 Subclavian vein
 Internal jugular vein
 Brachiocephalic vein formed at venous angle
 Left brachiocephalic vein longer than right brachiocephalic vein

 Pericardiophrenic artery and vein supplying the pericardium

 Pericardiophrenic vein leaves from the internal thoracic vein and enter into the
brachiocephalic vein

 [Subcutaneous nerves along with the pericardiophrenic artery and vein]

DR 3
 Phrenic vein slightly superficial while vagus is deeper
 Pericardiophrenic vein - enters into the left brachiocephalic vein
 Fibrous pericardium - we removed it; continuous with the central tendon of the
diaphragm
 Serous membranes
 SVC and IVC
 Aorta
 Pulmonary trunk

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 The sulci( coronary, anterior interventricular, posterior interventricular )
 Right marginal vessels??

RIGHT VENTRICLE :-
 Infundibulum - smooth part below the semilunar valves and above
supraventricular crest
 Pulmonary SL valves - 3 cusps
 Supraventricular crest - separating the rough(inferior part) and smooth
parts(infundibulum)
 Chordae tendineae connected to the tricuspid valves
 Moderater band/ septomarginalis band - through which the right bundle branch
pass and enters into the anterior papillary muscle; goes from the septum to the
anterior papillary muscle
 Papillary muscles- we saw the largest papillary muscle which is the anterior
papillary muscles. The anterior papillary muscle produces the chordae tendineae
that attaches to the anterior cusp of the tricuspid valve.
 There are also posterior and septal papillary muscles
 Trabeculae carnae - reason for rough surface
 Tricuspid valves - all 3 cusps

Outside the heart

 Fibrous pericardium
 Serous parietal pericardium
 Serous visceral pericardium on the heart/ epicardium
 Arch of aorta - right brachiocephalic artery, common carotid artery, and
Subclavian artery
 Pericardiophrenic veins and artery and phrenic nerve supply the pericardium.
 Phrenic nerve - more taut than vagus and in the fibrous pericardium
 Vagus nerve
 Recurrent nerve - left vagus nerve by the arch of aorta yizoral and the right
vagus nerve by the right Subclavian artery yizoral
 Vagus nerve + common carotid artery + internal jugular vein form the carotid
sheath

LEFT VENTRICLE :-
 Aortic vestibule - smooth part
 Trabculae carniea - rough part; delicate and fine compared to the right ventricle
 Moderator band- may or may not be seen depending the the person
 Anterior and posterior papillary muscles

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  Chordae tendineae
 Mitral valve - both cusps
 Aortic semilunar valve - all 3 cusps

 Left and right coronary arteries arise from the aorta

 Left coronary artery: left descending artery and left circumflex artery
 Left circumflex artery as it goes posteriorly it gives rise to left marginal artery
 Right coronary artery gives rise to the right marginal artery( or just marginal
artery)
 Right coronary artery goes posteriorly to give rise to the posterior
interventricular artery
 Marginal vein and left amrgibal vein merge to form the anterior interventricular
vein

DR 4
 Bronchus is air filled. Has no blood. But it has cartilaginous wall so upon
touching it is sturdy

Left lung - 2 lobes so has 2 [Link] and 2 bronchi

 PA NE and NW of bronchus (only PA) and PV SE and more superior (superior)
and SW (inferior) and more inferior of bronchus
 Impressions of ascending aorta and arch of aorta

Right lung - 3 lobes so 3 bronchi and 3 PA ???

 PA – the 2 most superior, between bronchi and anterior PV
 PV- anterior and inferior
 Bronchi can be felt by touching

Posterior mediastinum
 Order - aortic arch and branches, Trachea, esophagus, azygos vein on right side,
hemiazygos and accessory hemiazygos, thoracic duct
 Azygos vein - thick and sturdy

 Thoracic duct (thin) :

 Posterior to the descending aorta
 Enters the thoracic cavity through the Aortic hiatus of diaphragm.
 Accompanies the azygos vein
 First in the midline(slightly to right) then at level of T5 it crosses to the left as it
enters into the superior mediastinum. Then it enters into the venous angle of
the subclavian vein

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 Vagus nerve on left side over the arch of aorta recurrent and the remaining
forms an anterior esophageal plexus and on the right side over subclavian
artery crosses and the remaining forms the posterior esophageal plexus

Left side
 Drained by hemiazygos vein and accessory hemiazygos veins
 Found posterior to descending aorta
 Up to T8- drained by hemiazygos
 T9 and below - drained by accessory hemiazygos
 They cross over the vertebra and join with the azygos vein at T8 – T9 ???

Right side
 Drained entirely by azygos vein

4 sites of constrictions of the esophagus:

 Pharynx
 Arch of aorta
 Left bronchus
 Esophageal hiatus of the diaphragm
*Constriction may be due to thickening of the smooth muscles or due to external
pressure

 Parietal pleura lying on the vertebra

 Sympathetic chain on the vertebra
 Sympathetic splanchnic trunk has 3 parts:
1. Greater : T5- T9
2. Lesser : T10- T11
3. Least : T12 and contribution of L1

 Thoracic duct - kelay, thin

 Azygous - ketach, thick and sturdy

 Azygos vein, Thoracic Aorta, and Thoracic duct are passing through the
Aortic hiatus of a diaphragm at level of T12

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 DR 5 - Neck

 Skin
Superfically, 3 main structures are expected,
1. Muscle (Platysma)
2. Cutaneous nerves (Great auricular N ,Transverse cervical N, Lesser
occipital N, Supraclavicular N )
3. Vessel ( External jugular vein )
 Platysma muscle
 Greater auricular nerve ascends from platysma, superiorly, parallel to external
jugular vein.
 Transverse cervical nerve towards the midline of the neck
 External jugular vein descending parallel to the greater auricular vein and
superficial to the SCM( unlike internal jugular vein)
 SCM - posterior to platysma
 Lesser occipital nerve - ascends towards the skull; deep to the platysma and and
along/ parallel to/ the posterior border of the SCM.
 Supraclavicular nerve - branches down to the clavicle
Triangle of the neck
1. Anterior triangle - Muscular T, Carotid T, Submandibular T, Submental T
2. Posterior triangle – Occipital T and Supraclavicular T
Muscular T & Carotid triangle
Hyoid ,hyoid – superficial … thyroid, thyroid - deep
 Sternohyoid – anteriorly to sternothyroid
 Sternothyroid
 SH and ST are paired, more medial and originate from the sternum
 Omohyoid - lateral to the sternohyoid and sternothryoid; connects to the clavicle
by tendon
 We also see a nerve branching from the ansa cervicalis that innervates the
omohyoid
 Spinal accessory nerve - only structure located at the level of deep fascia,
between the SCM and trapezius muscle.
 Ansa cervicalis - on the ventral part the carotid sheath
 Carotid sheath - vagus nerve posteriorly, internal jugular vein (wide and big)
laterally, and common carotid medially
 Carotid triangle medial SCM
Thyroid gland- on the ventral surface of trachea, 2 arteries and 3 veins supply
it.
 Inferior thyroid artery- from the thyrocervical trunk ,that branches from
subclavian artery,
 Superior thyroid artery – from external carotid artery

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  Recurrent laryngeal nerve - between the trachea and esophagus; when
damaged, person unable to speak(aphonia)
 Parathyroid glands - dark nodules on the posterior surface of thyroid gland

Submandibular triangle & Submental Triangle

 Digastric muscles
 Submandibular gland : has two parts - deep and superficial parts
 Submandibular lymph nodes
 Facial artery and vein are anterior and facial nerve is posterior
 Facial vein + anterior retromandibular vein = common facial vein ( drain into
internal jugular vein )
 Posterior retromandibular + posterior auricular vein go to external jugular
vein
 Common facial vein
 Superior thyroid vein
Branches that we see finally
 lingual artery and vein and Hypoglossal nerve - hypoglossal nerve superior to
lingual artery and vein
 Ascending pharyngeal artery- inferior to the lingual artery and vein, posterioe
aspect on carotid artery (common or external)
 Superior thyroid artery

NB : External carotid has branches in the neck but internal carotid don't have
branch in the neck

 External carotid artery has 8 branches and 5 of them are found in the carotid
triangle

 *Hyiod- superficial
Some Anatomists Like F M,
Omohyoid and sternohyoid Others Prefer S.
 *Thyro- deep
Sternothyroid, thyrohyoid
1. Superior thyroid artery
2. Ascending pharyngeal
artery
3. Lingual artery
4. Facial artery
5. Maxillary artery
6. Occipital artery
7. Posterior auricular artery
8. Superficial temporal artery

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Senior's Note for DR Exam

[Link] right and left lung

[Link] passing through sternal angle(angle of louis)
[Link] of heart eg,-coronary artery,valves
[Link] of axis
[Link] nerve
[Link] laryngeal nerve
[Link] nerve
[Link] vasculature(VAN)
[Link] cava (tributary)
[Link] descending /ascending branch
[Link] rib /rib 11&12
11. Internal thoracic artery

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