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150 Cards in this Set

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what divides the subclavian vein and artery on the 1st rib?
anterior scalene muscle, or the tuberosity between grooves.
Superior angle of scapula is at the level of ~ ____ spinous process
T2
Inferior angle of scapula is at the level of ~ ___ spinous process
T7
Jugular notch is at the level of ___ vertebral body
T2
Sternal angle (manubrosternal joint, aka angle of Louis) is where the 2nd costal cartilages attach. It lies at the level of the IV disc between ___ and ____.
T4 & T5
there are more superior suspensory ligaments than inferior ligaments. True/False
True
What space lies between the pectoral fascia and the breast and allows movement?
The retromammary space
Male nipple is usually at the ___ intercostal space
4th
a breast is Usually situated vertically over the ___ thru ____ ribs
Usually situated vertically over the 2nd – 6th ribs
Innervation of the breast is via anterior and lateral cutaneous branches of the ____ to ____intercostal nerves
2nd to 6th
(text lists 4th-6th, this is wrong!)
The nipple is innervated by the ____ intercostal nerve
4th
Lymph passes from the nipple, areola, and lobules to the subareolar lymphatic plexus

Most lymph (75%), drains laterally and superiorly into ____ ____. Eventually, these drain into the right lymphatic or thoracic ducts
axillary nodes
During radical mastectomy, the ___ ____ nerve may be damaged because of its location on the lateral thoracic wall, resulting in winged scapula
long thoracic nerve
what does the long thoracic nerve innervate?
serratus anterior
winged scapula is caused by what?
serratus anterior denervation, innervated normally by the long thoracic nerve
what two nerves could be damaged during a radical masectomy?
long thoracic nerve, thoracodorsal nerve
External intercostals
are membranous (anteriorly/posteriorly)
anteriorly
External intercostals
are continuous with ____ oblique.
External
the vessels and nerves that innervate the thorax, come from the circumfrence of rib cage. Some say this is the reason why WHAT are membranous?
Three layers of intercostal muscles are membranous,
external, internal, and innermost
Internal intercostals
are membranous (anteriorly/posteriorly).
posteriorly
Internal intercostals
are continuous with the ____ oblique.
internal
Innermost intercostals are membranous (anteriorly/posteriorly).
BOTH anterior and posterior
Posterior intercostal aa.
Originate from the ____ ____.
thoracic aorta
Venous drainage basically parallels arterial supply, except for the _____ system
azygous
the azygous system eventually drains into the ____ ___ ___.
superior vena cava
thoracic wall Innervation is via intercostal nerves (anterior ramus of ___ through ___ spinal nerves) and the Subcostal nerves (anterior ramus of ____ spinal nerve)
T1 – T11
T12
What passes through the central tendon at vertebral level T8?
The inferior vena cava & right phrenic nerve and pericardiacophrenic artery
The esophagus and vagus nerves pass through the muscular part at vertebral level ____
T10
The thoracic aorta and thoracic duct pass posterior through the aortic hiatus at vertebral level ___
T12
the diaphragm Innervated by ____. These penetrate the diaphragm and supply it from underneath
phrenic nerve (C3-C5)
what are the blood supplies to the diaphragm?
Largest blood supply is from branches of the abdominal aorta. Other supply is via pericardiacophrenic, musculophrenic, branches from intercostals, and branches from thoracic aorta
what causes the ribs to increase in size as you breath in?
elastic recoil of the lung!
(not sure where i pulled this question from but may be incorrect, as elastic recoil = transpulmonary pressure = spring unstretching itself back to weightless original length can be the cause of lung collapse when unopposed by pleural negative pressure, ie. pneomothorax).
What occurs when a lung is allowed to use elastic recoil without opposite resistance?
pneumathorax, lung collapses on itself.
what is outside the visceral layer?
the parietal layer (just outside the plueral cavity
The root of the lung passes through the ____ of the lung
hilum
On the left lung, the main bronchus is _____ to the pulmonary artery
inferior
On the right lung, the main bronchus is ____ to the pulmonary arteries
posterior
how many segments of the lung are there?
10
_____ arteries supply the lungs
Bronchial ;
Bronchial veins drain the lung tissue
the thoracic skeleton contains ___ pairs of ribs and costal cartilages, ___ thoracic vertebrae and IV discs, and the sternum.
12
12
what is the costal margin/costal arch?
the joined costal catilages of ribs 7 - 10
the subclavian artery rests anterior or posterior to the subclavian vein on the grooves of the 1st rib?
posteriorly to the vein.
unlike the typical ribs, the 11 and 12th ribs are short and have no ____ or ____.
necks or tubercles.
The 10th thru 12th ribs have ___ facet(s).
1, the others have two facets.
the subcostal nerve is a branch of what?
the subcostal nerve is the anterior ramus of spinal nerve T12.
WHat are three characteristics of thoracic vertebrae that set them apart from the rest?
1. bilateral costal facets (demifacets)on their bodies for articulation with the heads of ribs.
2. costal facets on their transverse processess for articulation with the tubercles of ribs, except for the inferior two or three vertebrae.
3. Long inferiorly slanting spinous processess.
the sternal angle occurs at which rib?
this is also know as the manubriosternal joint and occurs at the 2nd rib
manubriosternal joint occurs at which intervertebral disc?
T4/T5, also known as sternal angle
the xiphisternal joint occurs at which vertebrae?
T9.
the superior part of the sternum is known as the _____.
manubrium
The manubrium is located at which vertebral level?
disc of T2/T3
the angle of louis is also known as what?
sternal angle
and the manubriosternal joint
the jugular notch is aka what?
suprasternal notch
the 1st rib fuses with what part of the sternum?
the manubrium
the superior level of the liver, the central tendon of the diaphragm, and the inferior border of the heart are all at which vertebral level? what does this match up with on the sternum?
T10 - the xiphoid process.
Cupula of lungs (pleural cavity) extend into the ____, above the ____.
neck

clavicles
the liver lies predominantly under the ____ dome of the diaphragm.
right; two lobes, left and right, the bigger one is the right lobe.
The stomach and spleen lie under the ____ dome.
left
The left kidney lies anterior to ____ vertebrae.
T12-L3
The right kidney lies anterior to the ______ vertebrae. This is lower or higher to the left kidney?
L1 – L4.
Left is at T12 - L3. (pg. 176 ECA)
What does the mediastinum contain?
thoracic viscera - except lungs.
what closes the thoracic cavity inferiorly?
the diaphragm
false ribs attach to what?
costal margin
floating ribs do not attach to what?
the sternum
which ribs are typical
3-9
the thoracic cage ___ during forced ____ as the ribs are elevated.
widens; inspiration
the thoracic cage ___ during forced _____ as the ribs are narrowed.
narrows; exhalation
the middle parts of the lower ribs move laterally when they are elevated - causing the _____ diameter to increase and thus a decrease in pressure with inhalation.
anterior-posterior. because of the rib movement, (analgous with the bucket handle), the sternum is pushed antero-superiorly, (analgous to the water pump).
unlike regular sweat glands, the mammary glands form what?
lobules
what are mammary glands composed mainly of?
Composed mainly of subcutaneous fat, glands, and ligaments
Each lobule drains into a ____ that opens on the nipple
lactiferous ducts
The Lateral region of a mammary gland can form an ____ _____.
axillary tail (of Spence).
two thirds of the breast rests on the fascia overlying the pec major, the other one-third rests on fascia overlying what muscle?
serratus anterior
what is the arterial blood supply to the mammary gland?
The blood supply to the breast occurs by multiple routes
The lateral thoracic artery (Lateral Mammary Branches)
The internal thoracic artery (Medial Mammary Branches)
Posterior intercostal arteries (2nd, 3rd, and 4th intercostal spaces)
the posterior intercostal arteries reach the mammary gland through which intercostal spaces?
2nd 3rd and 4th.
in the breast, Venous drainage is to the _____ vein via lateral mammary veins
axillary
in the breast, Medial mammary veins drain into the _____ veins
internal thoracic
in the breast, Venous drainage can reach the azygous system via _____ veins
intercostal
Innervation of the breast is via anterior and lateral cutaneous branches of the 2nd to 6th intercostal nerves.
These nerves conduct sensory fibers to what part of the breast?
the skin over the breasts, and to the smooth muscle of vessels
Lymph passes from the nipple, areola, and lobules to the ____ _____ _____.
subareolar lymphatic plexus
Most of the lymph from the medial quadrant drains into ____ ____ nodes and into the ____ ____ veins. From here, it can travel across to the contralateral breast or drain to the lymphatic or thoracic duct. (this is not the predominant pathway).
parasternal nodes

internal thoracic veins
Some lymph drainage follows the lateral branches of posterior intercostal vessels, which eventually drains into the _____ _____ and into the ____ ____.
azygous system

thoracic duct
a very small portion of lymph from the breast drains liver and ____.
subdiaphragmatic nodes
what muscle does the thoracodorsal nerve innervate?
lat dorsi
what, particularly in the superior part of the breast, supports mammary gland lobules?
suspensory ligaments (of Cooper).
which muscle attaches to the coracoid process?
pectoralis minor
The pectoralis major muscle overlies the pectoralis minor muscle which is enclosed by what?
clavipectoral fascia.

Pectoralis major & minor can help in forceful respiration
all intercostal muscles are innervated by ___ nerves.
intercostal
what are the major contributors to respiration.
external, internal, innermost intercostals
what are minor contributors to respiration?
The scalene muscles, Posterior serratus muscles, Deep back muscles, e.g. levator costorum, and transverse thoracic muscles.
external intercostal muscles are oriented fiber bundles running _____.
inferioanteriorly.
internal and innermost intercostal muscles are fiber bundles oriented ____.
inferoposteriorly
the anterior rami of ___ to ___ form the intercostal nerves.
T1-T11
the anterior rami of the ___ spinal nerve forms the subcostal nerves.
T12
What are the typical intercostal nerves?
3rd thru 6th
What are the branches of intercostal nerves that leave the costal groove at the angle of the ribs, and travel along the superior border of the rib below.
collateral branches
The ____ muscles posteriorly span 2-3 intercostal spaces & can be considered a counterpart of the transversus thoracis
subcostal
which nerves are the atypical intercostal nerves?
1-2 and 7-12
Do typical or atypical nerves give rise to cutaneous branches that supply the abdominal skin and muscles?
atypical (7-12)
the muscles supplied by the MOTOR fibers of the posterior and anterior rami of each pair of thoracic spinal nerves constitute a _____.
myotome (figure 1.14)
rami communicantes connect each intercostal nerve and subcoastal nerve to the ipsilateral ____ ____.
sympathetic trunk
Posterior intercostal aa.
-Originate from the thoracic aorta
-Upper two originate from the superior thoracic artery, a branch from the costocervical trunk

Anterior intercostal aa. (usually paired)
-Originate from internal thoracic aa.
-Internal thoracic aa. terminate in the superior epigastric and musculophrenic aa.
-Musculophrenic aa. supplies the lower spaces
Venous drainage basically parallels arterial supply, except for the azygous system


Ultimately, blood drains back to the venous system via two routes

Internal thoracic veins
Drain into brachiocephalic veins

The azygos system
Drains into the superior vena cava
in the thoracic wall, Collateral branches of nerves are found near the ____ border of ribs
superior
Intercostal branches of nerves in the thorax contain sympathetic motor fibers to what?
smooth muscle in the body wall vasculature, hair follicles, etc.
Vessels & nerves pass from posterior to anterior between the ____ & ____ intercostal muscles
innermost AND internal muscles.
VAN is an acronym for what?
the superior to inferior arrangement of Vein, Artery, and Nerve, traveling from posterior to anterior in the thoracic wall
the heart sits from what vertebral levels?
t5 to t9
the arch of aorta sits just posterior to what two structures of the sternum?
jugular notch; sternal angle
what are the blood supplies to the diaphragm?
Largest blood supply is from branches of the abdominal aorta. Other supply is via pericardiacophrenic, musculophrenic, branches from intercostals, and branches from thoracic aorta
What nerve innervates the diaphragm? how does it get there?
Innervated by phrenic nerve (C3-C5). These penetrate the diaphragm and supply it from underneath
in the balloon-fist anaology, the membraneon the fist is the ____ pleura, and the membrane not adjacent but close by is the ___ pleura.
visceral, parietal

the area between the layers is known as the plueral cavity
the ____ fascia is a thin fibroareolar layer between the internal aspect of the thoracic cage and the lining of the pleural cavities.
endothoracic
The pleural layers are continuous, forming a ____ ____.
pleural sac
where is the hilum located?
where the visceral and parietal layers are continuous near the bronchus (in the balloon-fist model - this is where the wrist would be).
True/False - The visceral pleura is contained within the parietal pleura.
FALSE! in the balloon-fist model - Note that your fist is outside of the balloon, just as the lung is outside of the pleural cavity
The visceral pleura contains what?
it covers the lung and all of its surfaces - it is almost essentially the lung, and cannot be dissected from it.
What fluid acts like "a layer of water between two glass plates" in the plueral cavity?
serous pleural fluid - lubricates plueral cavity, keeps lung surface in contact with thoracic wall through cohesion
What are the four parts of the parietal pleura and where are they situated?
Cervical pleura
---Extends into the root of the neck
Costal pleura
---Adjacent to ribs and intercostal spaces
Mediastinal pleura
---Covers the mediastinum
Diaphragmatic pleura
---Covers the diaphragm
At what vertebral level does the parietal pleura reflects back on itself?
T5-T7
This reflection forms the hilum of the lung. The structures entering through this region make up the root of the lung.
what is the pulmonary ligament?
An extension of the two pleural layers that continues inferiorly as the pulmonary ligament. This allows for movement of the lung.
what is the endothoracic fascia made of?
loost CT
Where is the costodiaphragmatic recess located?
It is located below the 6th rib in the midclavicular line and the 8th rib in the midaxillary line.
The costomediastinal recess is located where?
anteriorly where the costal pleura and mediastinal pleura meet
What is the function of pleural recessess?
These recesses allow for expansion during forced respiration and provides a place for fluid collection
On which lung, the right or left, is the bronchus located posterior to the pulmonary artery?
left lung
Where does the left lung bronchial artery come from?
these arise from the thoracic aorta
where does the right lung brachial artery arise from?
3 locations
1 - a superior posterior intercostal artery
2 - a common trunk from the thoracic aorta with the right third posterior intercostal artery.
3 - a left superior bronchial artery.
The bronchial veins drain into the azygous vein and the hemiazygous system, but they are specific to right and left. which is which?
on the right side the bronchial vein drains into the azygos vein & on the left side the vein drains into the hemiazygos system
What is the reason why blood oxygenation at the heart never reaches 100%?
Bronchial veins unite within the lungs with pulmonary veins. This delivers low oxygenated blood back to the left atrium. For this reason, blood oxygenation cannot reach 100%.
which nerve contains the parasympathetic fibers for constriction?
vagus n.
which nerve contains the sympathetic fibers for dilation?
sympathetic trunks
What does the phrenic nerve supply?
the diaphragm, C3-C5.
A problem with the phrenic might cause what ?
paralysis of half of a diaphragm
the acronym "VAN" in which veins arteries and nerves are arranged in order, applies to intercostal or collateral branches?
Both - see picture.
what is the accumulation of blood in the pleural cavity; usually due to injury of the intercostal vessels?
hemothorax
what is the accumulation of fluid in the pleural cavity that may be due to pleural effusion?
hydrothorax
what is the entry of air into the pleural cavity; may be due to trauma, etc.?
pneumothorax
what is a pulmonary embolism?
Obstruction of a pulmonary artery by a thrombus (blood clot) due to fat globule, air from leg vein
The clot may block blood flow in part or completely – when the embolus is large, patient suffers acute respiratory distress due to a major decrease in the oxygenation of blood & may expire in minutes
what vertebral level does the trachea bifurcate?
T4/T5