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38 Cards in this Set
- Front
- Back
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what level is the sternal angle at? what happens here?
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- sternal angle: T4/5
- level where trachea divides into right & left bronchii - pulmonary trunk divides into R & L PAs |
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how many true ribs are there? false? floating? where do these articulate?
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- true ribs: 1-7 --> with sternum
- false ribs: 8-10 --> with costal cartilages above - floating ribs: 11-12 --> end in musculature |
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what level does the inferior angle of the scapula go to?
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- b/w 7th & 8th rib
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what is the angle of the rib?
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- on posterior side - place where ribs often fracture
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the neurovascular bundle of the rib runs in the ___________. what does the superior facet articulate with? inferior? what does the crest articulate with? what is the articular facet for?
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- costal groove
- superior articulates with the thoracic vertebrae above rib # & inferior facet articulates with thoracic vertebrae of same number - crest articulates with IV disk - for articulation with transverse process of vertebrae |
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why is the 1st rib atypical? what muscles attach to the 1st & 2nd ribs?
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- has grooves for subclavian vein & artery separated by scalene tubercle (where scalene anterior attaches)
- anterior & middle attach to 1st rib, posterior attaches to 2nd rib |
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what is costochondritis?
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- common cause of chest pain - chostochondral synovial joints become inflammed
- viral & bacterial infections cause this |
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rib dislocation vs rib separation?
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- rib dislocation: sternocostal joints
- rib separation: costochondral joints |
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what are the ligaments connection the ribs & vertebrae?
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- costovertebral ligament & costotransverse ligaments
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what is a cervical vertebrae? complications?
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- usually arises from C7
- causes thoracic outlet syndrome: compression of brachial plexus or subclavian artery - either weakness in hand or loss of pulse when arm is abducted |
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pectus excavatum vs carinatum?
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- pectus excavatum "funnel chest" vs pectus carinatum "pigeon chest"
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which ribs form the interchondral joints?
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- 7/8/9/10
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how do the external intercostal fibers run? internal? what membrane allows you to see the internal intercostal fibers?
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- external attach anterior and inferior - most active in inspiration
- internal ru superior & posterior --> most active in expiration - external intercostal membrane |
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what levels is the diaphragm pierced at?
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- IVC T8
- esophagus T10 - aorta T12 |
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the ______ is a muscle of the innermost intercostals. Where does it run?
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- transversus thoracis
- back of sternum & xiphoid process --> costal cartilages - depresses ribs possibly |
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what are the main muscles of respiration?
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- flattened diaphragm increases height of thoracic cavity
- external intercostal muscles contract to raise ribs - interchondral part of internal intercostals help to elevate ribs & expand thoracic cage |
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what are the accessory muscles of respiration?
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- scalenes, SCM, pec major/minor & serratus anterior
- obliques, transversus abdominus & rectus abdonimus |
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what does the bucket-handle movement move? pump-handle?
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- bucket-handle: ribs - lateral dimension
- pump-handle: sternum - anteroposterior dimension |
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what is flail chest?
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- during inspiration the lung is sucked inward
- during expiration the tissue is pushed outward - multiple rib fractures cause this, mediastinum shifts to affected side |
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what is the artery & nerve supply of intercostal? which muscles do they run inbetween? what order?
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- posterior intercostal artery is from thoracic aorta, anastamosis with anterior intercostal from the internal thoracic
- intercostals come from ventral primary rami - about midaxillary line send off sensory branches - lie between internal intercostals & innermost - order: VAN just below upper rib |
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herpes zoster/shingles
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- viral disease caused by painful skin rash
- affects DRGs & travels down axons to cause infection in region of skin |
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internal thoracic artery branches into what?
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- superior epigastric & musculophrenic
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what happens in coarctation of the aorta?
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- collateral circulation involving internal thoracic --> ant --> post intercostal arteries --> thoracic aorta
- may result in enlargement of intercostals & "rib notching" |
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what is the venous drainage of the wall?
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- on right side you have azygos vein draining into SVC
- hemiazygos vein drains on left into the azygos vein - posterior intercostals drain into the azygos system & anterior intercostals drain into the internal thoracic |
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where does the oblique fissure of the right lung run? horizontal? what about left lung? where should you listen to lungs during quiet respiration?
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- oblique w/ 6th rib (starts @ T3)
- horizontal w/ 4th - left lung oblique fissue starts @ T3 & runs w/ 6th rib - listen to lungs at 6, 8 , 10 from front to back |
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what are the different portions of the parietal pleura of the lung?
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- cervical, mediastinal, costal & diaphragmatic
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what is pleurisy/pleuritis?
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- inflammation of pleura
- sharp pain during breathing/coughing/sneezing - can be due to infections, PE, pneumothorax, etc |
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pleura effusion?
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- build up of fluid in costodiaphragmatic recess
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bare area & clinical significance?
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- area where there is no parietal pleura from the lungs so it is favorable for pericardiocentesis
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what is hydrothorax? hemothorax? cylothorax? pyothorax or empyema? pneumothorax? how do you drain these?
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- hydrothorax: serous fluid
- hemothorax: blood - chylothorax: lymph - pyothorax/empyema: pus - pneumothorax: air - thoracentesis - insert chest tube into pleural space |
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what is a common cause of penumothorax? what happens in tension penumothorax?
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- common cause is pulmonary blebs - weakened out-pouchings in the lung which can rupture causing pneumothorax
- in tension pneumothorax pressure builds up & you end up with mediastinal shift - very dangerous b/c great vessels can get kinked - need to stick needle into pleural space to get air out |
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the lung root is surrounded by what pleura?
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- mediastinal
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how does the trachea divide? which main-stem bronchus is more susceptible to injury? the trachea divides at the __________
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- trachea --> R & L main-stem bronchus --> Lobar bronchus --> segmental bronchus
- right main stem bronchus is more vertically oriented so more likely to choke down it - carina |
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what arteries travel with the bronchii & carry oxygenated blood?
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- bronchial arteries
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pulmonary embolism
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- blockage of one of pulmonary arteries
- pain on inspiration, low blood oxygen levels, rapid breathing, tachycardia |
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what is RALS law?
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- right PA is anterior to bronchus
- left PA is superior to bronchus |
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what is the vagus & phrenic nerve in relationship to the root of the lung?
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- vagus goes behind the root of the lung, phrenic goes in front
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what are the lymph nodes at the root of the lung? what is interesting about the lung lymphatic drainage (ie which lobes do you worry about)?
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- bronchomediastinal (hilar) nodes
- worry about left lower lobe b/c may have connections to the right side |
