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205 Cards in this Set
- Front
- Back
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What is the function of the thoracic wall
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1. Movement of gases
2.Protection of thoracic and abdominal viscera 3. Attachment of appendicular muscles (intercostals) |
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What is a distinguishing feature of thoracic typical vertebra
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costal demifacets (full facets on atypical)
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Which part of the rib is in contact with thoracic facets
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Tubercle of the rib
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Which thoracic vertebrae are typical? atypical?
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atypical have 1 in them - 1 and 11, typical - 2-9
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Describe typical ribs
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3d-9th
-Has head, neck, tubercle and body (shaft) -Head articulates with corresponding vertebral bodies, IV discs and vertebral bodies above -BODY is thin flat and turns sharply anteriorly at ANGLE and has COSTAL GROOVE on inferior internal surface of the rib and passes INTERCOSTAL VEIN,ARTERY,NERVE (VAN) -TUBERCLE associates with transverse process (except ribs 11 and 12) |
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What type of joint is costovertebral joint
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Plane synovial
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Which ribs are atypical
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1st, 2nd, 10, 11
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Describe 1st rib
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-It is BROADEST and SHORTEST of true ribs
-Has single articular facet on head, which articulates with first thoracic vertebra -Has SCALENE tubercle for insertion of anterior scalene muscle -Has 2 GROOVES for subclavan artery and vein |
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Describe 2nd rib
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-Has two articular facets which articulate with bodies of 1st and 2nd thoracic vertebrae
-twice as long as 1st rib, attachment for posterior scalene muscle |
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Describe 10th rib
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-Has single facet for articulation with 10th thoracic vertebra
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Describe ribs 11 and 12
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-Have single articular facets on their head
-Have no neck or tubercle |
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What is the main function of ribs
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Increase diameter of thorax from front to back and sideways (for breathing)
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Which ribs are true ribs
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First SEVEN ribs (1-7), attached to sternum by costal cartilages
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Which ribs are false ribs
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Lower FIVE ribs 8-12, ribs 8-10 are attached to costal cartilages immediately above them
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Which are floating ribs
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11 and 12, attach only to vertebrae
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What type of joint is sternoclavicular joint
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Only bony attachment of upper limb to sternum
-SADDLE type synovial joint but has ball and socket movements |
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What type of joint is sternocostal joint
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-Articulation of sternum with first seven ribs
-1st -SYNCHONDROSES -2nd-7- PLANE SYNOVIAL |
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What type of joint is costochondral joint
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Joint between rib and costal cartilage
-SYNCHONDROSES |
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What is the consequence of 1st rib fracture
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Injury to brachial plexus and subclavian vessels
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Distinguish rib dislocation from rib separation
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Dislocation of the rib is disarticulation and sternocostal and intercostal jooints.
Separation of ribs is disarticulation at costochondral joints |
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What type of joint is intercostal joint
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Plane synovial
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Which three lines can be landmarks of thoracic wall
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Midaxillary line - through middle of axilla
Midclavicular line-through middle of clavicle Scapular line-through middle of scapula |
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Describe muscles of thoracic wall
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-Serratus posterior
-Levator costarum -Intercostals -Subcostals -Transversus thoracis -Diaphragm |
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What is the main function of thoracic wall muscles
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Respiration
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What are three layers of intercostal muscles
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External
Internal Inner most |
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Describe external intercostals
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-extend from tubercle of the rib to costochondral junction
-Originate at lower border of the rib in the space, insert at upper border of the rib below -Innervated by internal costal nerve -Blood supply internal costal artery -keep intercostal space from blowing out or sucking in during respiration, elevate ribs in forced inspiration -Orientation- putting hands in pockets |
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Describe internal intercostals
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-originate at upper border of the rib, insert at lower border of the rib above
-from margin of sternum to the angle of the rib -elevate and depress ribs during forceful inspiration |
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Describe inner most intercostals
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originate at upper border of the rib, insert on inferior margin of the rib above
-have same orientation as internal but lie deep to neurovascular bundle |
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Describe subcostal muscles
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-originate at angle of the rib and insert at angle 2-3 vertebrae above
-compress intercostal spaces, elevate ribs |
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Describe transversus thoracis
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-originate at posterior sternum, insert between angle and tubercle
-compress thorax for forced expiration, pulls rib down |
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What innervates diaphragm
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-Motor fibers from phrenic nerve (C3,4,5- keep men alive)
-Sensory from phrenic, intercostal and subcostal nerves |
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How does diaphragm assist inspiration
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Descends when it contracts, causing increase in thoracic volume by increasing vertical diameter and decrease in lung pressure, which becomes negative and sucks air into lungs
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Right crus
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part of diaphragm, longer and larger then left crus
-originates at L1-L3 (left L1-L2) |
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Medial arcuate ligament
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-attaches to body and transverse process of L1
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Lateral arcuate ligament
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extends from transverse process of L1 to rib12
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What passes through diaphragm
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-Vena cava opening- at level of T8, passes IVC, and sometimes right phrenic nerve
-Esophageal opening- T10, esophagus and anterior and posterior trunks of vagus nerve -aortic hiatus - T12, aorta, azygus veins, thoracic duct |
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what is the consequence of lower rib fracture
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tear in diaphragm, can have hernia of abdominal organs to chest
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Name muscles used for quiet inspiration
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Diaphragm + intercostal muscles
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Name muscles used for deep inspiration
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erector spinae (take deep breath, straighten back), diaphragm, rhomboids, serratus anterior, pec minor
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Name muscles used for forced expiration
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serratus posterior
subcostals quadratus lumborum, transversothoracic abdominal wall (oblique rectus) |
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Patient has fracture of 1st and 2nd ribs. What is injured?
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Subclavian artery, lower brachial plexus (C7 C8)
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Define costoclavicular syndrome
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compression of artery nerve between clavicle and 1st rib- numbness, pain of upper limb
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Intercostal nerves
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anterior rami of thoracic nerves
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What is the name of the nerve that runs beneath 12th rib
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subcostal nerve
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Where do intercostal nerves run
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Between inner and innermost layers of muscles with intercostal artery and vein (VAN), lodged in costal grooves of the rib, have lateral and anterior cutaneous branches and muscular branches
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Describe internal thoracic artery
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arises form FIRST PART OF SUBCLAVIAN ARTERY, descends directly behind first six costal cartilages
-gives rise to two anterior intercostal arteries in each of upper six intercostal spaces and terminates at sixth intercostal space by dividing into musculophrenic and superior epigastric arteries |
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Which veins drain body wall
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Azygos
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Which vein drains 1st intercostal space
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1st intercostal vein
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Which veins drain intercostal spaces 2-4
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superior intercostal veins
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What is the level of male nipple
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T4
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What is the level of xyphoid process
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T6
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What is herpes zoster
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Shingles, viral disease of spinal ganglia, distributed according to dermatomes
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Intercostal nerve block
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Need to inject into intercostal nerve, but there is overlap of dermatomes, so to get complete numbness, need to inject into two adjacent nerves, need to insert needle along inferior margin
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What are three divisions of thoracic cavity
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Left pulmonary
right pulmonary mediastinum |
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Define pleura
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Thin serous membrane that consists of parietal and visceral pleura
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Name two types of pleura
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Parietal and visceral
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Where does parietal pleura go
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lines inner surface of thoracic wall and mediastinum
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Name parts of parietal pleura
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Costal
Diaphragmatic Mediastinal |
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What is the name for parietal cervical pleura
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Cupula, dome of pleura, projects into neck above the neck of first rib
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What is Sibsons fascia
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Thickened portion of endothoracic fascia, attached to first rib and transverse process of seventh cervical vertebra
-PROTECTS TOP OF LUNG |
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What separates Sibsons fascia from thoracic wall
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Endothoracic fascia which lines thoracic cavity
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Is parietal pleura sensitive to pain
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YES, very sensitive
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What innervates parietal pleura
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Intercostal and phrenic nerves
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What supplies blood to parietal pleura
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Internal thoracic, phrenic, superior and posterior intercostal arteries
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Visceral pleura envelops..
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surface of lung
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Blood supply of visceral pleura
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Bronchial arteries
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What drains venous blood of visceral pleura
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pulmonary veins
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Is visceral pleura sensitive to pain
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Insensitive to pain but sensitive to stretch. contains vasomotor and sensory vagal fibers involved in respiratory reflexes
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Define pleurisy
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INFLAMMATION OF PLEURA with exudation into cavity causing pleural surfaces to be rough and PLEURAL RUB can be heard with stethoscope. Forms adhesions later. Symptoms - chills followed by dry cough.
Treatment - pain killers or intercostal block with lidocaine |
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What kind of space is pleural cavity
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POTENTIAL between pleural and visceral.Contains film of fluid only
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What are two pleural reflections
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STERNAL and COSTAL - areas where pleura changes direction
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What are two pleural recesses
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1. Costodiaphragmatic - formed by reflection of costal and diaphragmatic pleurae, can accumulate fluid, allows lungs to be pulled in and expanded during inspiration
2. Costomediastinal - part of pleural cavity where costal and mediastinal pleurae meet |
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Which costomediastinal recess is larger - right or left
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left
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Define thoracocentesis, where should you do it, where to insert needle
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surgical puncture of thoracic wall into pleural cavity for aspiration of fluid. Performed at or posterior to MIDAXILLARY LINE one or two intercostal spaces below the accumulation of fluid but not below ninth intercostal space. Ideal space is seventh eigth or ninth intercostal spaces, because avoid accidental puncture of lung, spleen, liver or diaphragm.
Needle should be inserted immediately above superior margin of rib to avoid injury to intercostal neurovascular bundle |
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Which lung is larger and heavier?
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RIGHT
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Which lung is longer?
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LEFT
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How many lobes does right lung have
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3 lobes - upper, middle, lower
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Describe apex of right lung
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projects into root of neck and is smaller then apex of left lung
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What are the levels for root of the lung
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T5-T7
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How many lobes does left lung have
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2 - upper and lower
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What is oblique fissure
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Fissure that divides into uper and lower lobes, follows line of 6th rib, receives two bronchial arteries
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Whats a lingula
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tongue shaped portion of upper lobe of left lungthat corresponds to middle lobe of right lung
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What is on surface of left lung
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Cardiac impression
Cardiac notch (deep indentation on anterior border of superior lobe of left lung), grooves for various structures |
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How many fissures does left lung have
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one- oblique
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How many fissures does right lung hae
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two - oblique and horizontal
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At which level trachea bifurcates into two bronchi
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level of sternal angle(T4-T5)
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Which primary bronchus does foreign bodies go to
Why? |
Right, because its shorter wider and more vertical
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How many secondary and tertiary bronchi does right lung have
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3 secondary and 10 tertiary
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How many secondary and tertiary bronchi does left lung have
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2 secondary and 8 tertiary
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What is the significance of carina
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may be examined with bronchoscope, can be compressed and distorted by bronchogenic carcinoma
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Which surface is irritated during cough reflex
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Mucous membrane of carina, in trachea
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Define atelectasis
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Collapse of lung caused by blockage of the air passages
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What is the main function of alveoli
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Gas exchange
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What blood does pulmonary trunk carry
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Poorly oxygenated to lungs for oxygenation
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Where does pulmonary trunk separates into right and left pulmonary arteries
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at the level of sternal angle
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Describe pulmonary veins
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INTERSEGMENTAL
One coming out of each lobe of the lung - 5 veins |
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What kind of blood do pulmonary veins carry
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OXYGENATED from alveoli
DEOXYGENATED from visceral pleura and part of bronchioles to LEFT ATRIUM |
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Where do bronchial arteries arise from
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THORACIC AORTA
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How mnay bronchial arteries go to right lung
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ONE
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How many bronchial arteries go to left lung
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TWO
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What kind of blood do bronchial arteries carry
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OXYGENATED to conducting non respiratory tissues of lung and visceral pleura
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PUlmonary embolism
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obstruction of pulmonary artery by embolus - air, blood clot, fat, tumor cells or other foreign material.
Arise in deep veins of lower limb (DVT) or pelvic veins |
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Bronchial veins drain into
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AZYGOS and HEMIAZYGOS
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Superior mediastinum boundaries
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1st rib and sternal angle
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Contents of superior mediastinum
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SVC
Brachiocephalic veins ARCH OF AORTA thoracic duct TRACHEA esophagus vagus nerve phrenic nerve left recurrent laryngeal nerve thymus |
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Anterior mediastinum location
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ANTERIOR to pericardium
POSTERIOR to sternum and transverse thoracic muscles |
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Contents of anterior mediastinum
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Thymus
Fat Lymph nodes Connective tissue |
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Middle mediastinum location
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Between right and left pleural cavities
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COntents of middle mediastinum
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HEART
pericardium roots of great vessels(aorta, pulmonary arteries and veins, venae cavae) ARCH OF AZYGOS VEIN MAIN BRONCHI |
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Posterior mediastinum location
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Posterior to pericardium, between mediastinal pleurae
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Contents of posterior mediastinum
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Esophagus
Thoracic aorta Azygos and hemiazygos veins Thoracic duct Vagus nerves Sympathetic trunk Splanchnic nerves |
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What is the mnemonic for remembering contents of posterior mediastinum
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DATES
D- descending aorta A- azygos veins T-thoracic duct E-esophagus S-sympathetic trunk+ganglia |
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Pericardium location
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Middle mediastinum, encloses heart and roots of great vessels
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Two parts of pericardium
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Fibrous and Serous
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Fibrous pericardium
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Strong dense fibrous layer located outside of pericardium
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Serous pericardium
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Composed of PARIETAL - lines inner surface of fibrous pericardium
VISCERAL - forms epicardium of heart wall and roots of great vessels |
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Which primary bronchus does foreign bodies go to
Why? |
Right, because its shorter wider and more vertical
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How many secondary and tertiary bronchi does right lung have
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3 secondary and 10 tertiary
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How many secondary and tertiary bronchi does left lung have
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2 secondary and 8 tertiary
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What is the significance of carina
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may be examined with bronchoscope, can be compressed and distorted by bronchogenic carcinoma
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Which surface is irritated during cough reflex
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Mucous membrane of carina, in trachea
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Define atelectasis
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Collapse of lung caused by blockage of the air passages
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What is the main function of alveoli
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Gas exchange
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What blood does pulmonary trunk carry
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Poorly oxygenated to lungs for oxygenation
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Where does pulmonary trunk separates into right and left pulmonary arteries
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at the level of sternal angle
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Describe pulmonary veins
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INTERSEGMENTAL
One coming out of each lobe of the lung - 5 veins |
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What kind of blood do pulmonary veins carry
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OXYGENATED from alveoli
DEOXYGENATED from visceral pleura and part of bronchioles to LEFT ATRIUM |
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Where do bronchial arteries arise from
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THORACIC AORTA
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How mnay bronchial arteries go to right lung
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ONE
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How many bronchial arteries go to left lung
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TWO
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What kind of blood do bronchial arteries carry
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OXYGENATED to conducting non respiratory tissues of lung and visceral pleura
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Location of pericardium
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Middle mediastinum
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two parts of pericardium
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Fibrous and serous
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Two parts of serous pericardium
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Visceral and parietal
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Define pericarditis
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Inflammation of pericardium, can result in cardiac tamponade,pericardial effusion, epigastric pain
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Pericardial friction rub
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Surfaces of pericardium become rough and result in sounds like rustling of silk which can be heard on auscultation
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Name two sinuses of pericardium
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Transverse and oblique
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Why is transverse sinus important
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It is of great importance to cardiac surgeon because while performing surgery on aorta or pulmonary artery, surgeon can pass finger and make ligature to stop blood circulation
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Cardiac tamponade
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Acute compression of heart caused by rapid accumulation of fluid in pericardial sac caused by wounds to heart or pericardial effusion
Results in DECREASE of cardiac output |
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Pericardial effusion
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Accumulation of fluid in pericardial space resulting from inflammation of acute pericarditis
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Describe pericardiocentesis
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SURGICAL PUNCTURE OF PERICARDIAL CAVITY, done for aspiration of fluid, relieving pressure from heart
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Where is needle inserted in pericardiocentesis
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5th intercostal space, left to sternum, 45 degrees angle ti xyphoid process
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Why does needle in pericardiocentesis miss vital structures
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Cardiac notch allows needle to miss pleura and lungs, but to penetrate pericardium
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What vessel is in danger during pericardiocentesis
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Internal thoracic artery
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Blood supply to pericardium
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Pericardiophrenic, epigastric and esophageal arteries - branches of internal thoracic
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Innervation of pericardium
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Vagus, phrenic and sympathetic chain nerves
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What forms apex of heart
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Left ventricle
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Which atrium is larger
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RIGHT
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What is apex of heart significant for
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Auscultating for mitral valve
Left border of heart |
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Coronary sulcus
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Groove on external surface of heart, separates ventricles and atria
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Rough part of right atrium
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Primitive atrium and auricle with pectinate muscles
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Smooth part of right atrium
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Sinus venarum
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Sinus venarum arises from
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sinus venosus
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Sinus venarum receives
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SVC, IVC, coronary sinus, cardiac veisn
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Fossa ovalis
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Depresion in interatrial septum, former foramen ovalum that shunts blood right to left before birth
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Crista terminalis
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Separates sinus venarum from primitive atrium, origin of pectinate muscles, runs from SVC opening to IVC opening
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Left atrium compared to right atrium
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Smaller, has thicker walls, higher atrial pressure, walls are smooth unlike right atrium that has pectinate muscles
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Where does left atrium receive blood from
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Four pulmonary veins, oxygenated blood
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What is the name of anastomosing muscular ridges in right ventricle
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Trabeculae carnae cordis
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Infundibulum in right ventricle
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smooth part of right ventricle, leads to pulmonary trunk
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Moderator band
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in RIGHT ventricle, forms a bridge between IV SEPTUM and ANTERIOR PAPILARY MUSCLE
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Tricuspid valve is also called
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Right AV valve
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Tricuspid valve is located
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between right atrium and ventricle
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Tricuspid valve can best be heard
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at RIGHT LOWER PART of body of sternum
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How does tricuspid valve work
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Has three septal cusps, which are attached by cordae tendinae to papillary muscles that keep valves closed against pressure created by pumping heart
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where is pulmonary valve most audible
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Left second intercostal space lateral to sternum
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What is the other name for bicuspid valve
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Mitral or left AV valve
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Where is mitral valve most heard
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LEFT FIFTH intercostal space at midclavicular line
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Valves are open in
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DIASTOLE
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Valves are closed in
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SYSTOLE
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Where is aortic valve best heard
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Second intercostal space
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What kind of cells present in conducting system
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modified cardiac cells
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Where is SA node located
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Upper end of crista terminalis near opening of SVC to right atrium
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What is the other name for SA node
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Pacemaker
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AV node is located
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at interatrial septum
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Name functions of cardiac skeleton
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Keeps orifices of valves open
Site for attachment for myocardium site for attachment of valves Electrical isolation |
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Myocardium consists of
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Atrial fibers
Ventricular fibers Conducting fibers |
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Coronary arteries arise from
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ASCENDING AORTA
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Branches of Right coronary artery
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SA nodal
Marginal Posterior descending AV nodal |
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Which artery is responsible for 70% of Coronary Artery occlusions
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LAD - left anterior descending (anterior interventricular)
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Two branches of Left Coronary artery
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LAD
Circumflex |
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Right coronary artery supplies
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most of RV, small part of LV, inferior 1/3 of IV septum, RA, part of LA and almost all of conducting system
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Left coronary system supplies
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most of LV, strip of RV, anterior 2/3 of septum and most of LA
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What determined which coronary artery is dominant
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Whichever gives rise to posterior descending artery, usually its RIGHT
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Where does Great Cardiac vein come from
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Originates from LAD and apex of heart
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What is the largest vein draining heart
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Coronary sinus
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Where does coronary sinus lie
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Coronary sulcus
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What accompanies middle cardiac vein
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Posterior descending artery (branch of Right coronary artery)
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What is main function of thymus
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Maturation of lymphocytes, not present in adults
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Myasthenia Gravis
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Immune disorder where antibodies are made against Ach receptors on muscles, associated with thymoma - take thymus out - get better
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Blood supply to thymus
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Internal thoracic artery
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Coarctation of aorta
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Aorta is abnormally constricted just inferior to ductus arteriosus. Collateral circulation develops - can be through intercostal, epigastric or scapular anastomosis
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What is location of phrenic nerve in relation to vagus nerve
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Phrenic nerve is always ANTERIOR to airway
VAGUS NERVE always POSTERIOR to airway |
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Injury to recurrent laryngeal nerve results in
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respiratory obstruction, hoarseness, and inability to talk because of paralysis of vocal cords
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How do you find thoracic duct
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Its in the middle of the triangle made by ESOPHAGUS, AORTA, and AZYGOS VEIN
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Thoracic aorta begins at
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End of arch, level of T4
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Thoracic aorta descends to
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DIAPHRAGM and abdominal aorta, level of T12
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Thoracic aorta gives rise to
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intercostal arteries, subcostal arteries, bronchial arteries, esophageal arteries, pericardial arteries, mediastinal arteriesm superior phrenic artery
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What compresses esophagus
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DIAPHRAGM
LEFT PRIMARY BRONCHUS AORTA (ARCH) |
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Blood supply to esophagus
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Inferior thyroid
Bronchial Esophageal All branches of aorta Also left gastric and inferior phrenic arteries |
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Innervation of esophagus
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CNX, sympathetic chain branches
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What forms hemiazygus vein
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Left subcostal + ascending lumbar
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Hemiazygos vein drains
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5 lower intercostal spaces
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Beginning of thoracic duct
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Cisterna chyli
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First indicator of bronchiogenic carcinoma
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Enlargement of supraclavicular lymph nodes
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