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176 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What type of innervation is the Vagus Nerve to the Heart?
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Parasympathetic
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Where does the Vagus Nerve Run?
Right & Left? |
descends through the carotid sheath entering the throax through the superior thoracic aperature.
Right Vagus = Anterior to Subclavian A. & posterior to Superior Vena Cava Left Vagus = Anterior to Aortic Arch |
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What are the effects of the vagus nerve on the heart?
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Decrease the heart rate
Decrease the force of contraction of the heart Increase the volume of displacement of the heart Constrict the Coronary Blood Vessels |
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In General, where do the Sympathetic nerves of the heart run?
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From the upper 5 to 6 spinal nerves via the coronary plexus
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What do the Sympathetic nerves of the heart supply?
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Supply the SA (Sinuatrial) & AV (Atrioventricular) Nodes
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Describe SA & AV Node
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SA node: Pace maker of the heart, signal spreads myogenically through both atria
AV Node: Smaller node that quickly receives the signal form the SA node & transmits to the Ventricles through the AV bundle |
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What are the effects of the Sympathetic Nerves on the heart?
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Increase in Force of Contraction
Increase the Heart Rate Decrease the Displaced Volume Dilation of the Coronary Blood Vessels |
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What is anterior mediastinum & Where is it located?
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Located: Anterior to paricardial sac & posterior to the sternum
Very Small Space, Few Structures |
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What structures does Anterior Mediastinum contain?
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Internal Thoracic Blood Vessels
Transverse thoracic muscles Parasternal lymphatic nodes Thymus gland (gone by age 10) |
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Where is the Superior Mediastinum located?
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Located: Superior to the transverse thoracic plane (Sternal angle to IVD T4/5)
Anterior to the bodies of T1-T4 vertebrae Extends superiorly to the root of the neck |
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What structures does the Superior Mediastinum Contain?
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Thymus Gland
Great Vessels of the heart --- Brachiocephalic vein & Superior Vena Cava (SVC) --- Arch of Aorta & its major branches Phrenic Nerves Vagus Nerves |
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What hormones does the Thymus Gland produce? What does it do?
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Superior Mediastinum/Thymus Gland
Hormones: Thymosin & Thymopoetin (Develop immune system & maturation of T-cells) |
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What type of organ is the Thymus gland considered? Where is it present?
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Primary Lymphoid Organ
Only present in children (becomes fatty mass in adults) |
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What is the arterial supply & venous drainage to Thymus Gland (in Superior mediastinum)
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A: Anterior intercostal & Anterior Mediastinal branches of the Internal Thoracic Arteries
V: Veins of thymus end in Left Brachiocephalic, Internal Thoracic & Inferior Thyroid Veins |
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What are the Brachiocephalic Veins (Right & Left) (from the Great Vessels in Superior Mediastinum) formed by?
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Union of Internal Jugular & Subclavian vein, posterior to Sternoclavicular joint
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Which Brachiocephalic Vein is longer?
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Left Brachiocephalic Vein (Twice as long as Right)
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Where do the Right & Left Brachiocephalic Vein unite?
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Unite posterior to the 1st Costosternal junction to form the Superior Vena Cava (SVC)
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Where is Superior Vena Cava (SVC) located?
Where does SVC end? |
On the Right Side of Sternum & Ends at the 3rd Costal Cartilage before entering the Right atrium.
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What is the origin of the Aortic Arch (from Great vessels in Superior Mediastinum) & Where is it located?
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Origin: Posterior to 2nd Right intercostal Joint (Sternal Angle).
Anterior to the Right Pulmonary Artery & Bifrucation of Trachea & Esophagus |
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Where does the Aortic Arch Begin & End?
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Begins to Descend: (Posterior & Left) at level of T4
Ends: by becoming the Thoracic aorta, posterior to the 2nd left Sternocostal joint |
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What are the Branches of the Aortic Arch?
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Brachiocephalic Trunk
Left Common Carotid Artery Left Subclavian Artery |
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What is the 1st & largest branch of the Aorta?
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Brachiocephalic trunk
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Where is the Brachiocephalic trunk located (br. of Aortic Arch/Great Vessels/Superior Mediastinum)?
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Posterior to the Manubrium & anterior to the Trachea. Also posterior to Left Brachiocephalic vein
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What does the Brachioocephalic trunk divide into?
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As it ascends, it gives off Right Subclavian & Right Common Carotid Arteries
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What is the 2nd branch of the aortic arch & Where is it located?
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Left Common Carotid Artery, located posterior to the manubrium
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Where does the Left Common Carotid Artery (br. Of aortic arch/Great Vessels/Superior Mediastinum) Start & Go to?
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Start: Anterior to Left Sublcavian Artery & Trachea, then moves to Left of Trachea & posterior to Left Sternoclavicular joint as it ascends to the neck
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What is the 3rd branch of the Aortic arch & Where is it located?
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Left Subclavian Artery
Located: slightly posterior on aortic arch, posterior to Left Common Carotid Artery |
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Where does the Left Subclavian Artery (Br. of aortic arch/great vessels/superior mediastinum) enter?
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Enters the neck posterior to the Left Sternoclavicular Joint
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What Nerves are located in the Superior Mediastinum?
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Phrenic Nerve & Vagus Nerve
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What does the Phrenic Nerve supply (superior mediastinum)?
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Supplies the diaphragm with motor & sensory fibers, also supplies sensory fibers to the pericardium & mediastinal pleura
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Where does the Phrenic Nerve (superior mediastinum) enter?
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Enters superior mediastinum between the Aubclavian artery & the origin of the Brachiocephalic vein, just anterior to the Anterior Scalene muscles
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Where does the Right Phrenic Nerve (Superior Mediastinum) enter, pass, and pierce?
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Enters: Superior mediastinum, just posterior & right of Brachiocephalic vein & Superior Vena Cava (SVC)
Passes: Anterior to the root of Right Lung Pierces: Diaphragm (just to right of the IVC) |
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Where does the Left Phrenic Nerve (Superior Mediastinum) enter & pass?
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Enters: Superior thoracic aperture, between Left Common carotid artery & subclavian artery
Passes: Lateral to Aortic Arch & anterior to root of Left Lung |
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Where does the Vagus Nerve (superior mediastinum) enter & what does it provide?
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Enters: Superior mediastinum posterior to Sternoclavicular joint & Brachiocephalic vein
Provides: Parasympathetic innervation to the organs of the thorax down to the abdominopelvic structures |
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Where does the Right Vagus Nerve (superior mediastinum) enter? What does it give rise to?
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Enters: Thorax Anterior to Right Subclavian artery
Gives rise to: Right Recurrent Laryngeal Nerve that ascends into the neck |
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What does the Right Vagus Nerve (superior mediastinum) contribute?
As it enters posterior mediastinum, what does it become? |
Contributes to formation of pulmonary plexus
Posterior Mediastinum: Becomes Posterior Vagus Trunk of the Esophagus |
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Where does the Left Vagus Nerve (superior mediastinum) enter? Where is it found?
Where does it pass? |
Enters: Thorax posterior to Left Common Carotid artery
Found: between the Left subclavian & Left common carotid arteries Passes: Aortic arch then curves medially to give off Left Recurrent laryngeal Nerve. |
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Where does the Left Recurrent Laryngeal Nerve ascend to?
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Ascends posterior to the aortic arch & lateral to the ligamentum arteriosum & back into the neck
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What does the Left Vagus nerve contribute to? In posterior mediastinum, What does it form?
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Contributes to: Pulmonary Plexus
Posterior mediastinum: forms Anterior Vagus Trunk of Esophagus |
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Where is the posterior Mediastinum located?
Where does it Begin & End? |
Located: Posterior aspect of the Thoracic Cage
Begins: Level of 5th Thoracic Vertebrae Ends: 12th Thoracic Vertebrae |
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What are the contents of the Posterior Mediastinum?
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Thoracic Aorta & its branches
Thoracic Duct Esophagus |
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Where does the Thoracic Aorta (posterior mediastinum) originate & where does it stay?
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Origin: Inferior aspects of T4 descends to left of T5-T12
Stays: just to left of Esophagus |
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What vertebral level is the Aortic Hiatus?
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T12
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What does the thoracic Aorta branch into (posterior mediastinum)?
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In General:
Bronchial Arteries Posterior Intercostal Arteries Superior Phrenic Arteries Esophageal Arteries (two) |
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How many Bronchial Arteries (thoracic aorta/posterior mediastinum) are on the Right & Left side?
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1 on the Right
2 on the Left |
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What do the bronchial arteries (thoracic aorta/posterior mediastinum) supply ?
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Supply Bronchi & Lungs
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How many pairs of Posterior Intercostal Arteries (thoracic aorta/posterior mediastinum) are there?
What do they give rise to? |
9 pair
Give rise to 3rd - 11th intercostal arteries |
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What are the Superior Phrenic Arteries (thoracic aorta/posterior mediastinum), What do they Supply? & Form?
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Small Branches
Supply thoracic aspect of diaphragm Form: Anastomoses with the Musculophrenic & Pericardiophrenic arteries which are branches of the Internal Thoracic arteries |
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What are the 3 classifications of the Thoracic Aorta branches?
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Anterior Midline
Lateral Branches Paired, Segmental, Parietal Brancches |
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Describe Anterior Midline (thoracic aorta/posterior mediastinum) arteries?
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Unpaired, Visceral branches --> go to gut structures
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Describe Lateral branches (thoracic aorta/posterior mediastinum)?
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Paired, Visceral Branches --> Go to structures other than gut
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Describe Paired, Segmental, Parietal Branches (thoracic aorta/posterior mediastinum)
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Branches go to body wall (Instercostal branches)
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What is the Right Branchial Artery (thoracic aorta/posterior mediastinum) branch off?
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Branches off 3rd Right Posterior Intercostal Artery
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What are the 2 exceptions to the typcial characteristics of Anterior Midline Artery branches of Thoracic Aorta?
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1. Superior Phrenic Arteries = Paired, Parietal (branch to muscle of body - diaphragm)[NOT TO GUT!]
2. Paricardial Branches - Unpaired, Anterior Midline, goes to Pericardium (Heart) [NOT GUT!!] |
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Where does the esophagus (posterior mediastinum) enter?
Where is it located? |
Enters: posterior mediastinum just posterior to the bifrucation of the trachea (Carina)
Located: to the Right of & Posterior to the Arch of the Aorta |
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Where does the Esophagus (posterior mediastinum) descend & Move to?
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Descends: Posterior to the pericardial sac
Moves to: Left of midline as it approaches the diaphragm then passes through the diaphragm at level of T10 |
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Where does the Esophagus (posterior mediastinum) constrict within the thorax?
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1. As it crosses by the aortic arch
2. Where its crossed by the left main bronchus 3. At the esophageal hiatus as it enters the abdominal cavity |
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Describe Thoracic duct (posterior mediastinum) & What does it drain?
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Describe: Thin walled, beaded (due to valves) duct for lymphatic drainage
Drainage of the following: -Lower Limbs -Pelvic cavity -Abdominal cavity -Left side of the thoracic cavity -Left upper limb -Left side of the Head & Neck |
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Where does the Thoracic duct (posterior mediastinum) Begin & Ascend?
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Begin: in abdominal cavity, originating at the chyli cistern
Ascends: through the aortic hiatus of the diaphragm at level of T12 & enters into posterior mediastinum |
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Through Thoracic Duct's course (thoracic duct/posterior mediastinum), Where is the Aorta & Azygous vein located?
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Aorta is Left & Azygous vein is on the right of the thoracic Duct
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Where is the Thoracic Duct (Posterior Mediastinum located)?
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Located: Posterior to the Esophagus
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At what level is the Thoracic Duct (posterior Mediastinum located) & Where does it empty into?
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At the level of the sternal angle (IVD of T4 & T5)
Thoracic duct crosses to the Left, remaining posterior to the esophagus, continuing into the superior mediastinum Empties: into junction of Left Internal Jugular, Left Subclavian Vein, where they become the Left Brachiocephalic vein |
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What is the venous system of the posterior mediastinum contain?
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Azygous vein, Hemiazygos vein, & Accessory Hemiazygos Vein
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What does the Azygos Vein (Venous System/Posterior Mediastinum) form?
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Forms a collateral pathway between the SVC & IVC
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Where does the Azygos vein (Venous system/posterior mediastinum) receive blood from?
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Right Posterior Intercostal Veins
Vertebral Venous Plexus Vertebral Bones Vertebral Canal Esophageal Veins Bronchial Veins |
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Where does the Azygos Vein (Posterior mediastinum) ascend to?
What happens at T5? |
Ascends to right of midline of T12-T8 bodies.
At level of T5 arches anteriorly over root of right lung to empty into SVC |
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Where does the Hemiazygos vein (posterior mediastinum) drain & receive blood from?
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Drains: Lower left thoracic & lumbar regions
Recieves blood from: Left Lumbar & Left Intercostal Veins & some from Esophagus & Small Intestine |
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Where does the Hemiazygos vein (posterior mediastinum) ascend & What happens at level T8/T9?
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Ascends Left side of vertebral Column, posterior to Aorta
at T8/T9: crosses to the Right to empty into the Azygos vein |
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Where does the Accessory Hemiazygos vein begin & travel to?
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Begins: at the 4th & 5th intercostal space
Travels to: Left of Vertebral Column from T5 - T8 |
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Where does the accessory hemiazygos vein (posterior mediastinum) receives blood from?
What Happens at T7/T8? |
Receives: Blood from 4th-8th intercostal veins (may include upper 3 intercostal veins)
At T7/T8: crosses vertebrae posterior to aorta to empty into the Azygos Vein |
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Where are the Hemiazygos & Accessory Hemiazygos located (in relation to esophagus)?
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Located: Posterior to Esophagus
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Complete the Sentence: Parasympathetic innervation of the posterior mediastinum innervation is via ________________________
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Anterior & Posterior Vagus Nerves of the Esophagus
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Complete the Sentence: Sympathetic trunks & their associated ganglia of the posterior mediastinum form ________________
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A Major Portion of the ANS
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Where are they sympathetic chain ganglia (posterior mediastinum) located?
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Located: Anterior to the costervertebral jonits & lateral to the thoracic vertebral column (Paravertebral Gutter)
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What do the paravertebral ganglia (sympathetic chain ganglia/posterior mediastinum) give rise to & Supply, & Where do they Travel ?
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Give rise to: Lower thoracic Splanchnic nerves
Supply: Abdominopelvic organs Travels: through the aortic hiatus to the prevertebral ganglia of the abdominal cavity |
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Where are the 3 parts of the Sympathetic Chain Ganglia (Posterior Mediastinum)
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Greater Splanchnic Nerve (T5-T9)
Lesser Splanchnic Nerve (T10-T11) Least Splanchnic Nerve (T12) NOTE: go through Diaphragm |
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What 3 structures pass through the Aortic Hiatus?
What is the Aortic Hiatus known as? |
1. Aorta
2. Thoracic Duct 3. Splanchnic Nerves Known as: Most posterior hiatus in Diaphragm |
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What does the thoracic cage consist of?
What's the function? |
12 pairs of ribs (form large portion of walls - flat bones)
12 thoracic vertebral bodies sternum Houses important internal organs such as the heart & lungs, liver, & pancreas The Body Structure & Musculature creates a system of changing pressure necessary for respiration |
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What do the ribs produce?
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Produce RBCs
(Hematopoetic) |
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What are the Classifications of Ribs?
Which ribs are considered True ribs & False Ribs & Floating ribs? |
1. Vertebrosternal RIbs (True Ribs)
1st 7 pairs of ribs that articulate with the vertebral column & directly to the sternum (rib 1-7) 2. Vertebrochondral Ribs (false ribs) Ribs 8-10 that attach to the costal cartilage of 7th rib NOT directly to the sternum! (ribs 8-10) 3. Floating Ribs (Vertebral or Free) 11th & 12th Ribs - taper into diaphragm. DON'T attach to the sternum OR costal cartilage. ONLY attachment is to the VERTEBRAL COLUMN |
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What are the types of ribs?
Which # ribs are considered Typical? |
1. Typical Ribs
2. Atypical Ribs Typical ribs = Rib 3-9 Atypical ribs = Rib 1,2,10,11,12 |
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What are the common characteristics of typical ribs?
Define Each One |
Head - presents 2 facets - articulates w/ Demifacets of vertebra
Neck - connecting head to body at level of tubercle Tubercle - has smooth articulating part & rough non-articulating part Body (Shaft)- thin, flat & curved bone that presents w/ Internal & External surface Costal Groove - on Medial & Inferior surface of rib - Protects Subcostal nerve & Blood Vessels |
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Give full description of a Tubercle of a typical Rib.
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Has a smooth articulating part & rough non-articulating part
Smooth surface - articulates with corresponding TP Rough part - attachment for Costotransverse ligament (More lateral) |
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Describe 1st rib.
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Atypical
Wide, Short & Fat Has superior & Inferior Surfaces Very sharp anterior curve Head has Single facet Groove for Subclavian artery & vein Scalene Tubercle (Ant. Scalene) |
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Describe 2nd rib.
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Atypical
-More like a typical rib Considered Atypical due to tuberosity for the Serratus Anterior ms |
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Describe 10-12
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10-12 Ribs are:
Like 1st rib - only have 1 facet & articulate with one vertebrae 11-12 Ribs: Have no neck Are Short Have NO TUBERCLE for TVP articulation |
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Where are the Costal Cartilages located & What do they do?
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Anchors anterior tips of ribs 1-10 to sternum limiting its overall movement
Elongates the Ribs Anteriorly Contributes to elasticity of Thoracic wall |
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What could happen without costal cartilage?
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Flail chest = too much movement which leads to numerous rib fractures
Note: Middle ribs are most common fractured! 1st Rib Fracture = Brachial Plexus & Subclavian A Involved |
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Where is the Sternum located? What are the parts?
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Located anterior & midline in thoracic cage
Has 3 Parts: Manubrium Body Xiphoid |
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Describe & point out characteristics of Manubrium (notches, landmark - angle)
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Most superior portion of sternum
Present with Jugular Notch (Superior & MIdline) Notches for 1st & 2nd ribs on each side & Notches for Clavicle Articulates w/ body to form important landmark: Sternal Angle (Angle of Louis) - at level of IVD of 4th & 5th thoracic vertebrae Note: Costal Cartilage will calcify with Age |
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Describe & point out characteristics of Body of Sternum (Notches)
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Elongated & thin (4 segments in a young person)
Located at level of 5th-9th Thoracic Vertebrae (T5-T9) Has costal notches for attachment of 3rd-6th ribs |
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Describe & point out characteristics of Xiphoid process (Landmark)
What's the percentage of People with Sternal Fractures that Die? |
At level of 10th Thoracic Vertebrae (T10)
Cartilaginous in the young, usually ossified by 4th decade of life (40s) Important Anatomical Landmark: -Midline marker for the superior limit of the Liver -Midline Marker for the Central Tendon of Diaphragm -Midline Marker for Inferior border of the Heart Note: 25-45% of people with Sternal fractures Die |
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Which ribs have 4 bilateral demifacets (Superior & Inferior) that articulate with the heads of ribs?
Which Vertebra Has Superior facets with inferior demifacets? Which Vertebrae have Bilateral facets? |
T2-T9
T1 T10-T12 |
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A) Which Vertebrae have Costal Facets on the TVPs?
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T1-T10
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A) How Many Facets or Demifacets does T1 Have?
B) How Many Facets or Demifacets does T3 Have? C) How Many Facets or Demifacets does T11 have |
A) 2 full costal facets & 2 demifacets
B) 4 Demifacets C) 2 Full Costal Facets |
B) T2-T9 have same as T3 C) T10-T12 have the same as T11 |
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A) How Many Ribs Articulate with T1?
B) How many ribs articulate with T4? C) How many ribs articulate with T10? |
A) 4 ribs
B) 4 ribs C) 2 ribs |
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A) How Many Pairs of Ribs articulate with T6?
B) How Many Pairs of Ribs Articulate With T1? C) How many pairs of ribs articulate with T12? |
A) 2 Pair
B) 2 Pair C) 1 Pair |
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A) Rib 1 articulates with How Many Vertebrae?
B) Rib 3 articulates with how many vertebrae? C) Rib 11 articulates with how many vertebrae? |
A) 1
B) 2 C) 1 |
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A) Where is the Costovertebral jt located?
B) How many demifacets articulate with the head of the ribs? C)What classification of jt is it? D) What are associated ligaments? |
A) Between heads of ribs & vertebral column
B) 2 demifacets articulate with head of ribs C) Synovial jt D) Ligaments: - Articular Capsule (Radiating Ligament) - Intra-articular ligament -Costotransverse jt & its ligament -Superior Costotranverse Ligament -Lateral Costotransverse ligament -Costotransverse jt & it's Ligament |
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A) What type of joint is Costochondral jt?
B) What type of joint is Interchondral jt? C) Where are the articulations for the interchondral jt present? |
A) Hyaline Cartilage joints
B) Plane Synovial Joints C) 6th-7th ; 7th-8th; 8th-9th costal cartilages |
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What are sternocostal joints?
Where are they located? specify each one. |
Articulations between costal cartilages of the 1st-7th ribs w/ the sternum.
1st rib w/ manubrium 2nd at sternal angle (Angle of Louis) 3rd-5th w/ 2nd & 3rd sternal segment 6th rib with 4th sternal segment 7th w/ Sternoxiphoid Junction |
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What are the 2 major thoracic apertures?
Another name for Superior Thoracic Aperture is___________? |
Superior & Inferior thoracic apertures
Thoracic Inlet |
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A) What is the shape of the Superior thoracic Aperture?
B) What is it continuous with? C) What are the boundaries of the Superior Thoracic Aperture? |
A) Kidney Shaped opening
B) Continuous with the Root of the neck C) Posteriorly: Body of T1 Laterally: 1st ribs & their costal cartilage Anteriorly: Superior border of the manubrium (Anterior Landmark) - Opening Slated anteriorly |
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What are the structures that Pass Through the Superior thoracic aperture?
B) What are the dimensions of the Superior Thoracic Aperture? |
A) Esophagus (posterior to trachea)
Trachea Nerves & Vessels that Supply & Drain the Head, Neck, & Upper Limbs B) Transverse diameter: 12.5 cm Anteroposteriorly: 6.5 cm |
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A) Another Name for Inferior Thoracic Aperture is ___?
B) What are the boundaries? |
A) Anatomical Thoracic Outlet
B) Posteriorly: 12th thoracic Vertebra (T12) (Posterior Landmark) Posterolaterally: 11th & 12th Pairs of Ribs Anterolaterally: The Joined Costal Cartilages of Ribs 7-10 Anteriorly: Xiphisternal joint (Anterior Landmark) |
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Diaphragm Closes off the _______. Separating the ____________ from the __________________.
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Inferior Thoracic aperture
Thoracic Cavity Abdominal Cavity |
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A) The diaphragm is part of the ___________ aperture
B) What is the Origin, Insertion of the Inferior Thoracic Aperture? |
A) Inferior Thoracic
B) Origins: - Costal Part: Internal Surfaces of Inferior 6 ribs (rib 6-12) -Sternal Part: 2 muscular slips from the Posterior Aspect of Xiphoid process -Vertebral part: Crura (Musculotendinous) - RIght Crus: From the bodies of L1-L4 -Left Crus: From the Bodies of L1-L3 Insertions: Into the central tendon of the diaphragm muscle |
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A) What are the hiatuses of the Diaphragm?
B) Innervation & Action of diaphragm? |
A) Hiatuses:
Caval Hiatus - T8/T9 Level - Inferior Vena Cava Esophageal Hiatus - T10 Level Aortic Hiatus - T12 level B) Right & Left Phrenic Nerves (C3,4,5) Movement of Thoracic Cage & Diaphragm |
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Describe the Breast, & its characteristics (Glands, location, function, space)
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The most prominent superficial structure of the anterior thoracic wall in both males & females.
Mammary glands in breast are accessory glands to reproduction in women. Considered functionless in men Located from 2nd to 6th ribs & from midline of the sternum to the mid-axillary line Mammary glands are found in the subcutaneous tissue overlying the fascia of the Pectoralis Major. Retromammary Space - Potential space between the Pectoralis major FASCIA & Breast Tissue |
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How does the axillary process (tail of Spence) relate to the breast?
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Possible extension of mammary gland toward the axillary foasa (armpit)
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What are the internal structures of the Breast?
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Mammary Gland Lobules (Modified sweat glands)
Suspensory Ligaments (Ligaments of Cooper) - Firmly attaches mammary glands to the dermis of the overlying skin Fat lobules - Adipose tissue surrounding glandular tissue Lactiiferous Ducts - ducts from mammary glands to the nipple that conduct milk. Each duct usually opens independently at the nipple. Lactiferous sinus - a dilated portion of the lactiferous duct deep to the areola which collects/holds droplets of milk |
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What are the external structures of the breast?
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Areola - pigmented area surrounding the nipple; Oil Glands (Glands of Montgomery) (Sebaceous gland)
Nipple - Usually located at the 4th INTERCOSTAL space (most consistent in men) Milk line - from axilla to the groin along the embryonic ridge (appears wk 7). May see extra breast or nipples anywhere along this line |
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What are the blood vessels of the breast?
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Internal Thoracic (Mammary Artery) - arises from Subclavian artery; Gives rise to Medial Mammary branches
Posterior Intercostal Arteries - branches of the Thoracic Aorta in the 2nd, 3rd, & 4th intercostal spaces Lateral Thoracic & Thoracoacromial arteries - branches of the axillary artery Axillary Vein - Most venous return from the breast Internal thoracic vein - some drainage |
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A) What is the importance of the lymphatic system of the breast?
B) Where does the lymph from the breast travel? C) More than 75% of lymph drains into __________ D) What happens to most of the remaining lymph (after leaving Axillary lymph nodes)? E) Where may lymph from inferior aspect of breast drain? |
A) metastasis of cancer cells
B) to the Subaereolar lymphatic plexus initially C) Anterior or Pectoral nodes, then on to Axillary lymph nodes D) about 25% of lymph from Medial side of breast drains to the Parasternal nodes or to Opposite breast E) May drain into Abdominal Lymph Nodes - into Azygous & Hemiazygos veins to Posterior Vertebral Venous plexus to Vertebrae & up to the brain |
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A) Where are nerves of the breast derived from?
B) What's the role of Rami Communicantes? |
A) Derived from Anterior & Lateral Cutaneous branches of 4th-6th intercostal nerves (Anterior Rami T4-T6)
B) Connects each anterior ramus to a sympathetic trunk |
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What are the nerves that supply the breast?
What is the function of these nerves? |
Intercostal Nerves
Convey sensory fibers to the skin & sympathetic fibers to the blood vessels & smooth muscle of the breast |
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Where does breast cancer come from?
Symptoms of breast cancer? Can males have breast cancer? What are the risk factors for Both Male & Female? |
A) Adenocarcinoma from Areolar cells
B) Lymph Edema: Orange peel appearance or deviation or inversion of nipple - Axillary tail = usually swelling - Painful lymph node = usually just an infection - Non-painful lymph node = probably carcinoma C) Males can have breast cancer D) Females (have higher risk factor) 1. Family history 2. Hormone therapy 3. Age 4. Elevated estrogen 5. Birth control? Males Kleinfelter's Syndrome = XXY chromosomes = Elevated Estrogen Chronic liver disease Family history |
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What are the Thoracic Cage Muscles?
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Pecctoralis Major
Pectoralis Minor Subclavius Serratus Anterior Intercostal Transverse Thoracis Subcostal Back muscles associated with Thorax |
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What are the Thoracoappendicular muscles?
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Pectoralis Major
Pectoralis Minor Inferior Part of Serratus Anterior Act primarily on the Upper Extremity |
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Pectoralis Major
Origin, Insertion, Action (function), Innervation |
O: 2 Heads:
Costosternal (Sternal) head - Anterior aspect of the sternum, abdominal aponeurosis & upper 6 ribs/costal cartilage (fibers travel laterally) Clavicular Head - Medial half of the Anterior Surface of the Clavicle - Deltopectoral triangle - 1st see the cephalic vein (branch of axillary vein) Insertion: Lateral crest of the intertubercular groove of the humerus Action: Major function is adduction & medial rotation of the humerus when the 2 heads act together - When acting alone: - Clavicular head flexes the humerus - Sternal Head extends humerus from a flexed position Innervation: Medial & Lateral Pectoral Nerves from the Brachial plexus (Cord). Note: Medial pectoral nerve (C8,T1) is Lateral to Lateral pectoral nerve (C5,6,7) |
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A) Medial Or Lateral Pectoral Nerve Travels with the Pectoral Artery?
B) Pectoral Artery is a branch of _____________? C) _____ nerve pierces Pectoralis Minor to innervate Pectoralis major |
A) Lateral Pectoral Nerve
B) Thoracoacromion trunk which branches from Axillary Artery C) Medial Pectoral Nerve |
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A) Pectoralis Minor
Origin, Insertion, Action, Innervation B) What are the Divisions of the Axillary A in relation to Pectoralis Minor? |
Origin: external surfaces of ribs 3-5
Insertion: Coracoid process of the Scapula Action: fixes the scapula against thoracic cage by pulling the Scapula anterior & iinferior Innervation: Medial Pectoral Nerve (C8-T1) B) First: First Rib to Pec Minor --> Subclavian A --> Superior Thoracic A (branch) Second: Posterior to Pec Minor --> Axillary A --> Thoracoacromial A & Lateral Thoracic A Third: Pec minor to Teres Major --> Brachial A --> Subscapular A, Anterior Circumflex Humeral A, Posterior Circumflex Humeral A |
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Subclavius Muscle
O, I, A, N ? |
Origin: Junction of 1st rib & costal cartilage
Insertion: Inferior Surface of middle third (1/3) of clavicle Action: Anchors & Depresses Clavicle Innervation: Nerve to Subclavius (C5,C6) via Superior trunk of Brachial Plexus |
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Serratus Anterior Muscle
Also Known as _____________ ? O, I, A, N? What is it called when there's damage to Long Thoracic Nerve? |
Also known as: Bell's Muscle or Serratus Magnus Muscle
Origin: External Surface of Upper 8 ribs Insertion: Medial (Vertebral) Border of the scapula anteriorly Action: Powerful protractor of the Scapula (moves anteriorly) Innervation: Long Thoracic (Lateral or Bell's Nerve) (C5,6,7) from the root level of the brachial plexus Winged Scapula |
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Intercostal Muscles
O, I, A, N? |
Origin: 11 pairs of muscles from the Inferior Borders of Ribs
Insertion: Superior borders of the First 11 Ribs (Rib 1-11) Action: External & Innermost Intercostals: Elevate Ribs Internal Intercostals: Depress ribs Innervation: Intercoastal Nerves (Ventral Rami of Spinal Nerves) |
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Transversus Thoracic Muscle
O, I, A, N? |
Origin: Posterior inferior Aspect of the Sternum
Insertion: Costal Cartilages of 2nd-6th Ribs (Ribs 2-6) Action: Will Depress ribs during Exhalation Innervation: Intercostal Nerve |
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Subcostal Muscles
O, I, A, N? |
Origin: Costal Angle of the Lower ribs
Insertion: Superior Border of the 2 or 3 ribs below Action: Elevate ribs Innervation: Intercostal nerves |
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Which Intercostal Nerves are Typical?
What are the Characteristics of Typical Intercostal Nerves? |
3rd - 6th Intercostal Nerves
Rami Communicantes (White & Gray) Collateral Branch (At the Costal Angle) Lateral Cutaneous Nerve Fibers Anterior Cutaneous Nerve Fibers Muscular branch |
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Which Intercostal Nerves are Atypical?
What are the Characteristics of Atypical Intercostal Nerves? |
1st-2nd & 8th-12th Intercostal Nerves
1st: No Anterior Cutaneous branch & is part of the branchial plexus 2nd:Give rise to the intercostobrachial nerve which supplies the skin & subcutaneous tissue of the axilla 8th-12th: 8th-11th become thoracoabdominal nerves after leaving the rib spaces 12th is Subcostal nerve. |
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A) First 2 intercostal Arteries are branches of the ___________ from the ____________
B) What are the other arteries that give branches to Intercostal Arteries |
A) Costocervical trunk form the Subclavian Artery
B) Thoracic Aorta (by way of posterior intercostal arteries) Axillary (via lateral thoracic arteries) Internal Thoracic: from the Subclavian Arteries |
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A) What are the compartments of the Thoracic Cavity?
B) What do the compartments contain? |
A) Right Pulmonary Cavity
Mediastinum Left Pulmonary Cavity B) Right & Left Pulmonary Cavities = Lungs & Pleurae / Occupies MOST of the Thoracic cavity Mediastinum (Centrally located) = Contains the Heart, Great Vessels, Trachea, Esophagus, and THYMUS / Separates the 2 pulmonary cavities |
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A) What is Pleurae?
B) What are the 2 parts of Pleurae? (Describe each one) |
A) Houses Pulmonary Organs
B) Visceral Pleura & Parietal Pleura Visceral Pleura - Investing Serous pleural Sac that Incloses the lungs Parietal Pleura - Pulmonary Cavity Lining, Adhering to Thoracic Wall, Mediastinum, & Diaphragm |
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What are the Parts of the Parietal Pleura (4 parts)?
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1. Costal Part = Covers Internal surfaces of the Thoracic Wall
2. Mediastinal Part = Covers LATERAL aspects of Mediastinum 3. Diaphragmatic Part = Covers the THORACIC surface of the DIAPHRAGM on EACH side of Mediastinum 4. Cervical Pleura = Extends through the Superior Aperture into the Root of the Neck, Covers apex of the lungs |
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A) Lungs have 3 parts: _______, Border (____, ______, & ______), & ___________.
B) Roots (______________) is where the _______ reflects to the ______ [Area where structures Enter & Exit the Lungs] |
A) Apex, Border (Posterior, Anterior & Inferior) & Base (aka Diaphragmatic)
B) Hilum, Visceral Pleura -->Parietal Pleura |
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A) How many fissures does the Right & Left Lung have?
B) How Many lobes does the Right & Left Lung Have? |
A) Right has 2 Fissures (Oblique & Horizontal / Transverse)
Left Has 1 Fissure (Oblique) B) Right Lung has 3 Lobes (Superior, Middle, & Inferior) Left Lung Has 2 Lobes (Superior & Inferior) |
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A) What are the 2 surfaces of the Lungs?
B) What are the 2 landmarks that the Left Lung have that the Right Lung does not ? On what Lobe are they found? |
Costal Surfaces
Mediastinal Surfaces B) Cardiac Notch & Lingula (on Superior Lobe) |
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What are the 3 major Roots of the Lungs?
Where are they located in the Right & Left Lungs |
Pulmonary Artery, Pulmonary Vein, Main Bronchus
Left Pulmonary Artery: located Superiorly & Posteriorly - Conveys blood form Right Atrium to the lungs Right Pulmonary Artery: Located Posterior to the Pulmonary Vein Left Pulmonary Vein: located Anterior & Inferior, Returns Oxygenated Blood to the Left atrium from the lungs Right Pulmonary Vein: located Anterior & Inferior Left Main Bronchus:Located Posterior at the Midline of the Root Right Main Bronchus: Located Posterior |
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What are the Mediastinal Landmarks of the Left Lung?
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CCC L SAFE
Cardiac Area Cardiac Impression Cardiac Notch on the Superior Lobe Lingula on the Superior Lobe Groove for Subclavian Artery Aortic Area First Rib Notch Esophageal Area |
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What are the Mediastinal Landmarks of the Right Lung?
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GGGGGG T
Groove for the Superior Vena Cava Groove for the Inferior Vena Cava Groove for Subclavian Artery Groove for Brachiocephalic Vein Groove for Azygos Vein Groove for the Esophagus Tracheal Area |
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A) What are the divisions of the Trachea?
What Level do they Divide? B) Describe the divisions? |
A) Left & Right Bronchi
Divides at Level of Sternal Angle (T4/T5 IVD) Right bronchi: Wide & Vertical in shape into Hilum Left Bronchi: Narrow & Longer in shape, descends inferior and lateral. Located INFERIOR to the aortic arch ANTERIOR to esophagus & descending aorta before entering the hilum |
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What is the name of the area where the the Right & Left Bronchi Initially divide?
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Carina
(sensitive tissue - causes cough reflex) |
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The joining of the Left & Right Brachiocephalic Veins form _________________
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Superior Vena Cava
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A) Where do you usually find lung cancer?
B) What nerves does Lung Cancer impact & What effects does it have on those nerves? |
A) See cancer in Lung Apices (apex)
B) Impact Vagus N & Recurrent Laryngeal Nerve which will impact your vocal folds, Change your voice, "Hoarseness" Note: Usually a site of metastasis but can be source of origin |
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What is the location of the Mediastinum?
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Inferior (Starts) at Superior Thoracic Aperture
Anterior to the Bodies of T1-T12 Posterior to the Sternum Superior to the Diaphragm muscle |
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A) What are the 2 major divisions of the Mediastinum?
B) Locations of those divisions C) What are the subdivisions of those divisions (if any)? |
A) Superior & Inferior Mediastinum
B) Superior Mediastinum: From Superior Thoracic Aperture inferiorly to the Transverse Thoracic plane (a plane from the Sternal angle to the IVD of T4/T5) Inferior Mediastinum: Inferior from the Transverse Thoracic plane to the Diaphragm C) Inferior Mediastinum subdivides into 3 Smaller Parts (Horizontal Divisions): 1. Anterior Mediastinum: small & narrow 2. Middle Mediastinum: Heart & its fibrous capsule & thymus 3. Posterior Mediastinum: Anterior to bodies of T1-T12 |
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What does the Middle Mediastinum include?
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Pericardium
Heart Roots of Great Vessels -- Ascending Aorta -- Pulmonary Trunk -- Superior Vena Cava |
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A) What is the Pericardium?
B) What are the 2 layers? What's the Pericardiial Cavity? |
A) A fibroserous membrane that covers the heart & the beginning of its great vessels
B) Closed Sac Composed of 2 Layers 1. Outer Fibrous Layer - attaches Inferiorly to the diaphragm 2. Inner Serous Layer - reflected onto the surface of the heart C) Space between the 2 layers w/ a small amount of serous fluid for lubrication of heart movement - outer -pericardial cavity -inner |
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What are the pericardial attachments?
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Inferior:
to central tendon of Diaphragm via the PericardioacoPhrenic ligament Anterior: to posterior surface of the sternum by the SternoPericardial Ligaments Superior: Continuous with the Tunica Adventitia of the Great Vessels of the Heart |
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Describe the Heart organ (generally) & what 3 layers is it made of?
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Muscular organ that occupies most of the middle mediastinum.
Epicardium (outer layer) - visceral Pericardium Myocardium (middle layer) - Cardiac muscle Endocardium - (inner layer) - endothelium tissue |
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A) Name the outer layer of the heart.
B) Describe this layer. What is it continuous to & where is that located? C) What lies between 2 groups of vessels? |
A) Epicardium
B) Visceral layer of serous pericardium Continuous w/ Parietal layer of Serous Pericardium - Where the Aorta & Pulmonary Trunk leave the Heart - Where the SVC, IVC & Pulmonary Veins enter the heart C) Transverse Sinus |
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A) The reflection of the Visceral Pericardium onto the parietal pericardium around the SVC, IVC, and the pulmonary veins forms the __________________
B) Where does this "space"lie in relation to the heart? C) What is this "Space" limited by? |
A) Oblique Sinus
Posterior Inferior of aspect C) IVD & Left Pulmonary Veins |
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What's the blood supply to the Pericardial Sac?
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Primary: PericardiacoPhrenic arteries which are branches of the Internal Thoracic Arteries (Pericardiacophrenic accompanied by Phrenic Nerve)
Secondary Blood Supplies: Posteriorly: Bronchial & Esophogeal branches of Descending Aorta Inferiorly: Musculophrenic branches of the Internal Thoracic Artery Internally (Visceral Layer): Coronary Arteries |
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What are the Nerves that supply the Pericardial sac?
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Vagus (CN X) - Parasympathetic
Phrenic (C3,4,5) - Sensory function - carry pain sensation from heart to shoulder region Sympathetic Trunks from upper spinal nerves for vasomotor (vasodilation) |
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Describe the internal framework of the heart.
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Made up of a complex network of dense collagen tissue.
Forms 4 fiberous rings that surrounds the openings of the 4 heart valves |
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A) Describe the Location of the heart.
B) Where is the Base? C) Where is the Apex? Distance from median plane of body? What is it formed by? |
A) roughly Posterior to the Sternum & Costal Cartilages of Ribs 3-5 on the Left side
B) Base POSTERIOR Aspect of Heart Formed mainly by Left Atrium with Some Right Atrium contribution Anterior to bodies of T6-T9, Esophagus & Aorta C) Apex: Left 5th Intercostal space ~9cm left of the median plane of the body Formed by the Left Ventricle |
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What are the borders of the Heart?
Full Description of each |
Right border:
formed by the right atrium where the Superior & Inferior Vena Cava empty into right atrium Left border: formed primarily by Left Ventricle (Almost Horizontal in orientation) Superior border: Formed by the Right & Left Atria Ascending Aorta & Pulmonary Trunk emerge from this border Superior Vena Cava enters on the Right side Posterior to the Aorta & Pulmonary trunk & anterior to the SVC find the Transverse Sinus Inferior Border: Formed by Right Ventricle (is almost Horizontal) Inferior border: |
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Receives Deoxygenated blood from both the _________ & ____________ & the ____________ .
B) What is the incomplete valve found only in the IVC? C) What do you find External to the Right Atrium? D) Right Atrium is in contact with the Right Ventricle via the _____________ |
A) Inferior Vena Cava & Superior Vena Cava, Coronary Sinus
B)Valve of Eustachian C) Right Auricle & Groove of Sulcus Terminalis (External presentation of the internal Crista Terminalis) D) Tricuspid Valve (Right Atrioventricular valve) |
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What is the Rough & Smooth Surface of the right atrium separated by?
Full description of Rough & Smooth portion |
Crista terminalis
Rough portion (Anterior Wall): formed by the pectinate muscles Smooth Portion (Posterior wall) is the Sinus Venarum -Receives the SVC at the level of the 3rd costal cartilage -Receives the IVC at the level of teh 5th costal cartilage -Opening for the coronary sinus |
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A) Where exactly is the Fossa Ovalis?
B) What is the small ridge at the Superior aspect of the fossa ovalis called C) Fossa ovalis is the remnant of the _____________of the ____________________ which is the embryonic shunt from __________ to ____________- |
In the Right atrium, on the sinus venarum just superior to the IVC
B) Limbus Ovalis C) Foramen Ovale R Atrium to L Atrium |
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A. The Right Ventricle's superior medial aspect presents a Thin Walled ____________ which is the beginning of the _________________.
B. What are the Major internal structures of the Right Ventricle? C. True or False: The Right Ventricle forms the Inferior border AND Anterior surface of the Heart. D. What is the moderator band that extends from the septum to the Anterior Papillary muscle |
A) Conus Arteriosus
Pulmonary trunk B) Trabeculae Carnae C) True D) Septomarginal trabeculae |
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A) What is the Right Ventricle Guarded by from the Right Atrium?
B) What is the Tricuspid valve anatomically related & Close to? |
A) Tricuspid valve
B) Mid-line of Sternum & Close to Right 5th costal cartilage |
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What's another name for the Right AV valve?
Name the cusps of the Right Ventircle? Which cusp is the smallest? |
Tricuspid valve
Anterior cusp - anchored to anterior papillar ymuscle via chordae tendinae. Posterior cusp - anchored to posterior papillay muscle via chorade tandinae Septal Cups - Anchored to Septalal papillary muscle via it's Chordae Tendinae Smallest = Septal RAPS (Right-Anterior-Posterior-Septal) |
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A) what are the 3 cusps of the Pulmonary valve?
B) What are the cups/valve considered? C) What level is the Pulmonary valve located? |
Anterior
Right Left (AKA Semilunar cusps!!!) B) Start of the pulmonary trunk which is located at the superormedial wall the right ventricle (conus arteriosus) C) At level of 3rd Costosternal junction |
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What forms the base of the heart?
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Left Atrium
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Describe the Left Atrium.
What guards the Left ventricle from the Left Atrium? |
Forms the base of the heart
Thin, smooth walled chamber that receives oxygen rich blood from the lungs via pulmonary veins Has an auricle Mitral valve (Biscupid Vavle) guards Left Atrium from Left Ventricle |
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A) What does the Left Ventricle form?
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A) The Apex ( left of sternum ~9cm; 5th interccostal space)
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Which Chamber is considered a very Muscular chamber?
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Left Ventricle
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Name the superior aspect of the Left Ventricle that is smooth walled & the beginning of the aorta?
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Aortic Vestibule
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A) Where is the Bicuspid valve located?
B) How many cusps does the Left AV valve have and Describe them? |
A) at level of the 4th costosternal junction
B) Mitral/Bicuspid Valve Has 2 Cusps: Anterior cusp - attached to Left Ventricle via chordae tendinae to the anterior papillary muscle Posterior cusp - anchored to Posteiror Paipillary Muscle via its chordae tendinae |
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A) Where is the Aortic Valve located?
B) How many cusps does the Aortic valve have? Which cusp is coronary cusp? |
A) level of Left 3rd Intercostal space
B) Posterior Cusp, Right Cusp, Left Cusp (Coronary cusp) Right & Left feed coronary arteries?!!!!???!!??? |
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Right Coronary artery - Full description.
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- From Right side of Aorta, located within the coronary sulcus (Atrioventricular sulcus)
- Runs Deep to Right Auricle of Right Atrium - Near its origin the RCA gives off the seniatrial nodal branch which supplies the SA node - RCA then gives rise to the RIght marginal branch which supplies the Right border -Posteriorly the RCA gives rise to the posterior (Descending) = interventricular artery |
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Left Coronary Artery
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From the left side of the aorta, short vessel just deep to the left auricle
- Divides into 2 branches: - Anterior (Descending) Interventricular artery - Circumflex artery |
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80% of People have _______ supplied by R coronary Artery
60% of People have ______________ supplied by coronary Artery |
AV node
SA node |
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All venous return of the heart is to the _______________ which ends in the Right Atrium.
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Coronary Sinus
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What are the 3 Primary Veins of the Heart?
Full description |
Great Cardiac Vein - located in Anterior Interventricular groove, Drains the anterior aspect of heart, travels posteriorly to become the Coronary Sinus
Middle Cardiac Vein - Venous return for Right Margin of the heart Small Cardiac Vein - Major blood return for posterior aspect (in posterior interventricular suclcus) Note: Great Cardiac Vein - Drains all structures supplied from Left Coronary A Middle & Small Cardiac Veins drain Right Coronary Artery Supply |
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Which Artery & Vein are the only paired Artery & Vein in the body that contain blood that travels in the same direction?
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Circumflex Artery & Vein
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