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100 Cards in this Set

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Sternum - 3 subdivisions:
-Manubrium
-Body
-Xiphoid process
Important features of Manubrium:
-Sternal notch (jugular notch)
-Attachment of 1st Rib
Ribs attached to Body of Sternum:
3-7
Where is the 2nd Rib attached?
Angle of Sternum - articulation between manubrium and body.
Xiphoid process in adults vs. infants?
Freely moveable in children b/c it hasn't yet ossified.
How are ribs attached to sternum?
-Via costal Cartilages
-Synovial joints btwn cartilage & sternum (not ribs/cartilage)
True ribs:
-What makes them true?
1-7
Truly attached to sternum
False ribs
-What makes them false?
8-10
Attached to Rib 7; not attached to sternum independently
Floating ribs
-What makes them floating?
11-12 (sometimes called false)
-Float between layers of muscle
-Have no costal cartilage at all
Are floating ribs completely floating?
No; attached to vertebral column.
What is a function of the floating ribs?
Protection of the kidneys
Way to remember where the STERNAL ANGLE is:
Always the attachment of 2nd Rib costal cartilages to sternum.
Sternal Angle (jugular notch) is the junction between __ & ___:
Sternum Body and Manubrium
Numbering of Intercostal spaces:
1st Space is UNDER rib 1
What lies w/in an intercostal space?
Neurovascular bundle (VAN)
Lean male nipple is located in which intercostal space? Where w/ reference to MCL?
4th IC space/Lateral to MCL
What are the 3 intercostal sets of muscles?
-External
-Internal
-Innermost
Thoracic inlet is sometimes aka:
Superior thoracic outlet
Boundaries of Thoracic inlet:
-Posterior
-Lateral
-Anterior
Posterior: Body of 1st Thoracic vertebra
Lateral: 1st rib
Anterior: manubrium
Structure that sticks out of thoracic inlet:
Dome/apex of lung - above level of 1st rib, just below subclavian artery.
Where is the thoracic outlet located?
Inferior part of the thorax
What are 4 important Lean Male Landmarks in the thorax region?
1. Midclavicular line
2. Male nipple
3. Costal Phrenic Angle
4. Suprasternal notch
Where is the midclavicular line located in the lean male pt?
In the midline of the clavicle; bisects it perpendicularly and descends down the chest.
Where is the male nipple located in the lean male pt?
Lateral to MCL in 4th intercostal space.
Where is the Costal Phrenic angle located in the lean male pt?
Where the diaphragm and inferior costal margin meet.
What important structure is located at the costophrenic angle?
Lowest part of lung - important on an xray
Where is the Suprasternal notch located in the lean male pt?
Above the manubrium between the clavicles
Where is the C1 dermatome?
Nowhere - doesn't exist
Where is the C2 dermatome?
Ant: around ears
Post: back of head to occipital tuberocity
Where are C3/C4 dermatomes?
C3 = adams apple and upper part of the back neck
C4 = under adams apple to clavicles, middle back of neck.
Where is the C5 dermatome?
-Under the clavicles & sternal notch anteriorly
-Along the upper shoulders posteriorly
Where are C6-C8 dermatomes anteriorly?
NOT THERE - dragged into upper limbs during development.
Where is the T4 dermatome?
At nipple level in lean male pt
Where is the umbilicus?
At the T10 dermatome level
What dermatomes are in the upper limbs?
C5-C8, T1
What dermatome is at the groin region level?
T12
What would be required for serious antesthesia in the umbilical region?
Cutting 2 nerves; not just one - bc of considerable overlap.
2 Main groups of respiratory muscles:
-Inspiratory
-Expiratory
3 Principle Inspiratory muscles:
1. External Intercostals
2. Diaphragm
3. Interchondral part of Internal Intercostals
Function of Principle inspiratory muscles:
Quiet state breathing
Action/effect of External and Interchondral Internal Intercostals:
-Elevate ribs
-Increases lung vol and thoracic cavity width
Action/effect of Diaphragm:
-Depression of diaphragm
-Increases intrathoracic volume and creates negative air pressure
When are Accessory muscles of inspiration used?
During forced breathing - strenuous exercise or certain lung diseases
Example of lung disease that needs accessory muscles:
Chronic obstructive pulm disease
What are the Accessory inspir muscles? Actions?
-Scalenes - elevates upper ribs
-Sternocleidomastoid - helps elevate clavicle/upper ribcage
What causes RESTING, quiet expiration?
The elastic recoil of the lungs - no muscles.
In what diseases are the Active expiratory muscles used?
Asthma, emphesyma
What are the Active expiratory muscles?
-Internal intercostals (except the interchondral parts)
-Abdominals
How do the abdominal muscles aid in expiration?
Pull ribs down to decrease ribcage airspace.
What are the 3 divisions of the thoracic cavity?
-2 Pleural cavities
-1 Mediastinum
What dermatome is at the groin region level?
T12
What would be required for serious antesthesia in the umbilical region?
Cutting 2 nerves; not just one - bc of considerable overlap.
2 Main groups of respiratory muscles:
-Inspiratory
-Expiratory
3 Principle Inspiratory muscles:
1. External Intercostals
2. Diaphragm
3. Interchondral part of Internal Intercostals
Function of Principle inspiratory muscles:
Quiet state breathing
Action/effect of External and Interchondral Internal Intercostals:
-Elevate ribs
-Increases lung vol and thoracic cavity width
Action/effect of Diaphragm:
-Depression of diaphragm
-Increases intrathoracic volume and creates negative air pressure
When are Accessory muscles of inspiration used?
During forced breathing - strenuous exercise or certain lung diseases
Example of lung disease that needs accessory muscles:
Chronic obstructive pulm disease
What are the Accessory inspir muscles? Actions?
-Scalenes - elevates upper ribs
-Sternocleidomastoid - helps elevate clavicle/upper ribcage
What causes RESTING, quiet expiration?
The elastic recoil of the lungs - no muscles.
In what diseases are the Active expiratory muscles used?
Asthma, emphesyma
What are the Active expiratory muscles?
-Internal intercostals (except the interchondral parts)
-Abdominals
How do the abdominal muscles aid in expiration?
Pull ribs down to decrease ribcage airspace.
What are the 3 divisions of the thoracic cavity?
-2 Pleural cavities
-1 Mediastinum
What are the Internal Thoracic arteries also called? Branches of?
-Internal mammary aa.
-Branch off Subclavian
Location of Internal thoracic aa:
Parasternal
2 Distal terminal branches of Internal thoracic arteries:
-Superior epigastric
-Musculophrenic
Why is the internal thoracic a. important to surgeons?
Used in bypass surgery
Where are Subclavian A/V located w/ ref to ant scalene muscle?
W/ ref to first rib?
Vein = Anterior
Artery = Posterior
Both = go overtop 1st Rib and leave a groove over time.
What else is located between Ant/Mid scalene w/ Subclavian A?
Brachial plexus
Where is the VAN bundle in each intercostal space situated?
Just beneath the rib
So what do you need to be careful of when injecting around ribs?
To insert needle JUST ABOVE the RIB, in the lower part of the intercostal space.
Why must you be extermely careful when inserting a central line in subclavian artery?
The dome of lungs exists sup thoracic outlet, may cause pneumothorax if not careful.
What is the covering of the lungs called?
Pleura
-Parietal (outer)
-Visceral (inner)
What is important to remember about the R / L lung cavities?
Cannot communicate directly between them.
3 Divisions of parietal pleura:
-Costal
-Diaphragmatic
-Mediastinal
When is the pleural potential space present?
Only in a collapsed lung
What is the visceral pleura?
Folding over of the parietal pleura.
Lobes of Right lung:
-Superior
-Middle
-Inferior
Lobes of Right lung:
Fissure?
-Superior
-Inferior
Separated by Oblique fissure
Hilar region
Root of lung where pulmonary A/V, Bronchial A/V, lymphatics and Bronchus enter lung.
2 Parts of Circulatory System:
-Right sided = pulmonary = low pressure

-Left sided = systemic = hi pressure
Which left lobe is the lingula on?
Superior
What is the major fissure? Minor? On which lung?
Major fissure = Oblique
Minor fissure = horizontal
Right lung b/c thats the only one with 2 to differentiate
What supplies blood to the lung tissue?
Bronchial artery
Important factoid re: carina
Causes cough reflex if entotracheal tube touches it
What IC space = the horizontal fissure?
3rd
What IC space = the oblique fissure?
5th
Value of Bronchopulmonary segmentations:
Can remove a PORTION of the lung (vs the whole thing)
Where do the Right and Left Bronchial arteries come from?
Left: from underside of aorta
Right: from intercostal artery
Where does the systemic blood draining from the lung tissue drain into?
Azygous vein (right side)
Hemiazygous vein (left side)
Why are the lymphatics around the lungs important?
They are the main highway for tumor metastesis
How are the R/L thoracic ducts different?
Right = much smaller, only 25% of lymph passes thru it.
Left = much bigger; 75% of lymph fluid passes thru it to venous systme
Where do the thoracic ducts dump into?
Brachiocephalic veins at the junction w/ internal jugular
Why is the right side subclavian artery the usual site of injections?
B/c the right thoracic duct is so much smaller and easier to avoid.
What type of innervation is supplied to the Cardiac plexus?
Parasympathetic - Vagus
Sympathetic - Symp trunk/ganglia
What does the Vagus nerve do at the Carina and bronchial bifurcation?
Splits into the Vagal trunk
What does the Vagus Parasympathetic innervation do for the lungs?
-Efferent innervation constricts the smooth muscle
-Low amounts of afferent
What is the result of not having much afferent innervation in the lung region?
Won't feel pathology until it contacts the parietal wall and is quite significant.