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151 Cards in this Set

  • Front
  • Back
How many thoracic vertebrae are there ? List the typical and atypical ones.
There are 12 thoracic vertebrae.
2-8 Are typical
1 and 9-12 are atypical
List the characteristics of a typical thoracic vertebrae.
1. Heart shaped body
2. Two demi-facets on either side of the vertebrae
3. A small and circular vertebral foramen
What are the differences between the superior and inferior costal facets of the vertebrae ?
Superior-
1. Larger and near the upper border of the vertebrae
2. Articulate with the head of the numerically corresponding rib

Inferior-
1. Smaller near the lower border of the vertebrae
2. Articulate with the next lower rib
What are the differences between typical and atypical thoracic vertebrae.
They bear whole costal facets instead of demi-facets:

T1 - Has a whole costal facet for the first rib but a typical inferior costal demi-facet for the second rib
T9 - Only has a superior demi-facet and no inferior demi-facet
T10-12- Has a sinle pear of whole costal facets
List the structures which form part of the vertebral arch.
1. Pedicles
2. Superior vertebral notch
3. Inferior vertebral notch
4. Superior articular processes
5. Inferior articular processes
6. Transverse processes
7. Spine
Which structure in the vertebral arch articulates with the tubercles of the corresponding rib ?
Articular facets on the anterior surface of the transverse processes.
True or false: All the thoracic vertebrae have articular facets on the transverse processes.
False. The 11th and 12th rib do not have articular facets
How many pairs of ribs are in the human body.
12 pairs.
List the ribs that are classified as true, false and floating ribs.
True- 1-7 because they connect directly to the sternum

False- 8-10 Because they connect indirectly to the sternum

Floating- 11-12 Because they do not connect to the sternum but rather the abdominal muscles
What is the joint called between the anterior part of true rib and the sternum ?
Sternocostal.
What is the joint called between the anterior part of false ribs and the sternum ?
Interchondral.
What is the joint called between the posterior part of the ribs and the vertebrae ?
Costotransverse.
Which ribs are classified as typical and atypical ?
3-9 are typical
1-2 and 11-12 are atypical
What are the characteristics of typical ribs ?
They have the following structures:
1. Head with two facets
2. Neck
3. Tubercle with a smooth articular part
4. Body
List the atypical features of the first rib.
1. It has a single facet on its head
2. It has 2 transversely directed grooves across its anterior surface for the subclavian blood vessels
3. The two grooves are separated by a scalene tubercle
List the atypical features of the second rib.
It has a rough area on its upper surface called the tuberosity for serratus anterior.
List the atypical features of the 10th rib.
It has a single costal facet on its head.
List the atypical features of the 11th and 12th rib.
1. They have a single costal facet on its head
2. They have no neck or tubercle
List the borders of the superior thoracic aperture.
Anterior- Superior border of the sternum

Lateral- 1st Pair of ribs and costal cartilages

Posterior- The first thoracic vertebra
Which structures pass through the superior thoracic aperture ?
1. Trachea
2. Esophagus
3. Apex of lungs
4. Nerves
5. Arteries and veins
List the borders of the inferior thoracic aperture.
Anterior- Xiphisternal joint

Antero-lateral- Joined costal cartilages of the 7-10th pair of ribs, forming the costal margin

Postero-lateral- The 11th and 12th pair of ribs

Posterior- The 12th thoracic vertebra
Which structures pass through the inferior thoracic aperture ?
1. Esophagus
2. IVC
3. Aorta
List the different joints of the thoracic wall.
1. Intervertebral
2. Costovertebral
3. Costochondral
4. Interchondral
5. Sternocostal
6. Sternoclavicular
7. Manubriosternal
8. Xiphisternal
What type of joint is the intervertebral joint ?
Symphisis or secondary cartilaginous joint.
What type of joint are the costovertebral joints ?
Synovial plane joint.
What type of joint is the costochondral joint ?
Synchondrosis or primary cartilaginous joint.
What type of joint is the interchondral joint ?
Synovial plane joint.
What type of joint is the sternocostal joint ?
1st - Synchondrosis or primary cartilaginous joint.

2-7 - Synovial plane joint.
What type of joint is the sternoclavicular joint ?
Saddle type synovial joint.
What type of joint is the manubriosternal joint ?
Symphysis or secondary cartilaginous joint.
What type of joint is the xiphisternal joint ?
Synchondrosis or secondary cartilaginous joint.
Describe the articulation and ligaments of the intervertebral joints.
Adjacent vertebral bodies are bound together by intervertabrel discs. Anterior and posterior longitudinal ligaments are present.
Describe the articulation and ligaments of the costovertebral and costotransverse joints.
Costovertebral:
The head of each rib with the superior demi- or costal facet of the vertebral body of the same number and the inferior demi- or costal facet of the vertebral body superior to it, and an IV disc in between. Radiate and intra-articular ligaments at the head of the rib.

Costotransverse:
Tubercle of the rib articulates with the transverse process of the vertebra with the same number. The costotransverse, superior costotransverse and lateral costotransverse ligaments are present.
Describe the articulation and ligaments of the costochondral joint.
Lateral end of costal cartilage with the sternal end of the rib. They are bound together via the periosteum.
Describe the articulation and ligaments of the interchondral joint.
It is between the costal cartilages of the 6th and 7th, 7th and 8th, and 8th and 9th ribs. The interchondral ligament is present.
Describe the articulation and ligaments of the sternocostal joint.
1st:
Articulation with the 1st costal cartilages with the manubrium of the sternum.

2nd - 7th:
Articulation with the the costal cartilages and the sternum. Anterior and posterior radiate sternocostal ligaments are present and an intra-articular ligament.
Describe the articulation and ligaments of the sternoclavicular joint.
It is between the sternal end of the clavicle with the manubrium of the sternum and the 1st costal cartilage. Anterior and posterior sternoclavicular ligaments are present and a costoclavicular ligament as well.
Describe the articulation of the manubrosternal joint.
Articulation between the manubrium and the body of the sternum.
Describe the articulation of the xiphisternal joint.
Articulation between the xiphoid process and the body of the sternum.
List the main muscles of the thoracic wall.
1. Serratus posterior superior
2. Serratus posterior inferior
3. Levator costarum
4. External intercostal
5. Internal intercostal
6. Innermost intercostal
7. Subcostal
8. Transversus thoracis
List the superior and inferior attachment of the serratus posterior superior muscle.
Superior attachment:
Nuchal ligament and the spinous processes of C7-T3.

Inferior attachment:
Superior borders of the 2nd to 4th ribs.
List the superior and inferior attachemnt of the serratus posterior inferior muscle.
Superior attachment:
Spinous processes of T11 to L2.

Inferior attachment:
Subjacent ribs between tubercle and angle.
List the superior and inferior attachment of the external, internal and innermost intercostal muscles.
Superior attachment:
Inferior border of ribs.

Inferior attachment:
Superior border of ribs below.
List the superior and inferior attachment of the subcostal muscle.
Superior attachment:
Internal surface of the lower ribs, near the angle.

Inferior attachment:
Superior border of 2nd or 3rd ribs below.
List the superior and inferior attachment of the transversus thoracis muscle.
Superior attachment:
Posterior surface of lower sternum.

Inferior attachment:
Internal surface of costal cartilages 2-6.
Describe the innervation of the serratus posterior superior muscle.
2nd to 5th intercostal nerves.
Describe the innervation of the serratus posterior inferior muscle.
Anterior rami to T9 to T12 thoracic spinal nerves.
Describe the innervation of the levator costarum muscle.
Posterior primary rami of C8-T11 nerves.
Describe the innervation of the external intercostal, interna intercostall, innermost intercostal, subcostal and transversus thoracis muscles.
Intercostal nerves.
What is the main action of the serratus posterior superior muscle ?
Proprioception (elevate ribs).
What is the main action of the serratus posterior inferior muscle ?
Proprioception (depress ribs).
What is the main action of the levator costarum muscle ?
Elevate the ribs.
What is the main action of the external intercostal muscles ?
Elevate ribs during forced inspiration.
What is the main action of the internal intercostal, innermost intercostal and subcostal muscles ?
During forced respiration-
Interosseous part: Depress the ribs.

Interchondral part: Elevates the ribs.
What is the main action of the transversus thoracis muscle ?
Weakly depress ribs and proprioception.
True or false: The external intercostal muscles are more active during expiration.
False. They are more active during inspiration.
In which direction do the fibres of the external intercostal muscles run ?
Inferoanteriorly.
In which direction do the fibres of the internal intercostal muscles run ?
Inferoposteriorly.
True or false: The internal intercostal muscles are most active during expiration.
True.
Which structures separate the interneal intercostal muscles from the innermost intercostal muscles ?
Intercostal nerves and vessels.
Describe the course of a typical intercostal nerve.
The anterior rami of the spinal nerve initially runs within the endothoracic facia between the parietal plura and the internal intercostal membrane nearly in the middle of the intercostal space.

At the angle of the rib:
The nerves pass between the internal and innermost intercostal muscles and run into or just inferior to the costal grooves. Here, colateral branches of the nerves originate which run along the superior border of the ribs.

The nerves continue anteriorly between the internal intercostal and innermost intercostal muscles. At the midaxillary line the intercostal nerves give rise to lateral cutaneous branches of nerves. Near the sternum the intercostal nerves turn anteriorly and pass between the costal cartilages to become the anterior cutaneous branch.
True or false: The posterior rami of the spinal nerves is also called the intercostal nerve.
False. The anterior rami of the spinal nerves is also called the intercostal nerve.
Which intercostal nerves can be classified as typical and atypical ?
Typical:
3rd-6th intercostal nerves.

Atypical:
1st-2nd and 7th-11th intercostal nerves.
True or false: There are 12 pairs of intercostal nerves.
False. There is only 11. The 12th pair of nerves originating from the spinal nerves are called subcostal nerves.
List the branches of a typical intercostal nerve.
1. Rami communicantes
2. Collateral branches
3. Lateral cutaneous branches
4. Anterior cutaneous branches
5. Muscular branches
Discuss the rami communicantes branches of the intercostal nerve.
These branches connect the intercostal nerve with the sympathetic trunk. Presynaptic fibres leave the initial portion of the anterior ramus of each thoracic nerve by means of a white communicating ramus and pass to the sympathetic trunk.
Discuss the collateral branches of the intercostal nerve.
These branches arise near the angles of the ribs and descend to course along the superior margin of the lower rib supplying the intercostal muscles and the parietal pleura.
Discuss the lateral cutaneous branches of the intercostal nerve.
These branches arise near the midaxillary line and pierce the intercostal muscles. They then divide into an anterior and posterior branch and these terminal branches supply the skin of the lateral thoracic and abdominal walls.
Discuss the anterior cutaneous branches of the intercostal nerve.
These branches pierce the muscles and membranes of the intercostal space in the parasternal line and divide into medial and lateral branches, supplying the skin on the anterior aspect of the thorax and abdomen.
Discuss the muscular branches of the intercostal nerve.
These branches supply the intercostal, subcostal, transversus thoracis, levatores costarum and serratus posterior muscles.
List the atypical features of the 1st intercostal nerves.
The anterior ramus of the first thoracic spinal nerve first divides into a large superior and a smaller inferior part. The superior part forms part of the brachial plexus and the smaller inferior part becomes the 1st intercostal nerve

The 1st intercostal nerve courses along the internal surface of the 1st.

The 1st intercostal nerve has no anterior cutaneous branch and often no lateral cutaneous branch.
List the atypical features of the 2nd intercostal nerve.
The 2nd intercostal nerve courses along the internal surface of the 2nd rib.

The second intercostal nerve gives rise to a large lateral cutaneous branch called the intercostobrachial nerve. It emerges from the second intercostal space in the midaxillary line, penetrates the serratus anterior muscle and enters the axilla and arm.
List the atypical features of the 7th-11th intercostal nerves.
After these nerves have given rise to the lateral cutaneous branches they cross the costal margin posteriorly and continue to supply abdominal skin and muscles. Since they are now no longer in intercostal spaces, they now become thoracoabdominal nerves.
What is the muscolotendinous part called that separates the thoracic and abdominal cavities ?
The diaphragm.
Which dome of the diaphragm is higher ?
The right dome is higher due to the presence of the liver.
What are the normal limits of the superior margin of the domes of the diaphragm ?
4th or 5th intercostal space for the right dome and 5th intercostal space for the left dome. Also the xiphisternum for the central tendon.
Which vertebra is the posterior inferior margin of the diaphragm ?
12th thoracic vertebra.
List the openings of the diaphragm.
1. Vacal opening
2. Esophageal hiatus
3. Aortic hiatus
True or false: Contraction of the diaphragm causes relaxation of the esophageal hiatus due to the muscle of the right crura.
False. Contraction of the diaphragm causes contraction of the esophagus.
At which vertebral level would you find the esophageal hiatus ?
At T10.
At which vertebral level would you find the caval opening ?
At T8.
Inspiration effects the caval opening. What effects does inspiration have on blood flow ?
During inspiration the caval hiatus wil enlarge, increasing blood flow to the heart.
True or false: The caval opening is found at the central tendon of the diaphragm.
True.
Which structures form the aortic hiatus of the diaphragm ?
It is formed by the right and left crura and the median acruate ligament.
True or false: Just like the caval opening, inspiration enlarges the aortic hiatus thus increasing blood flow.
False. The aorta does not pass through the diaphragm, therefore it is unaffected by contraction of the diaphragm.
Which arteries supply the superior surface of the diaphragm ?
1. Pericardiacophrenic
2. Muscolophrenic
3. Superior phrenic
From which major blood vessel does the superior phrenic artery originate from ?
The thoracic aorta.
Which veins are responsible for the venous drainage of the superior surface of the diaphragm ?
1. Pericardiacophrenic
2. Muscolophrenic
3. Superior phrenic (only the right side of the diaphragm)
True or false: All the veins draining the superior surface of the diaphragm drain into the IVC.
False. Only the superior phrenic vein drains into this major blood vessel. The percardiacophrenic and musclophrenic veins drain into the internal thoracic veins.
List the nerves which supply the motoric and sensory function of the superior and inferior surface of the diaphragm.
Motor: Phrenic nerves C3-C5

Sensory:
Phrenic nerves C3-C5 (central)
Intercostal nerves T5-T11 (peripheral)
Subcostal (peripheral)
Which arteries supply the inferior surface of the diaphragm ?
Inferior phrenic.
From which major blood vessel does the inferior phrenic artery originate from ?
The abdominal aorta.
Which veins are responsible for the venous drainage of the inferior surface of the diaphragm ?
Inferior phrenic.
Into which vessels do the right and left inferior phrenic veins drain into, respectively ?
Right: Drains into IVC.

Left: Drains into IVC and suprarenal vein.
List the muscles used during forced inspiration, and also how they help in increasing the thoracic volume.
1. Serratus posterior superior - Elevates the ribs
2. Internal IC muscle and subcostal - Interchondral part elevates the ribs
3. Levator costarum - Elevates the ribs
4. Sternomastoid - Elevates the sternum
5. Scalene muscles - Elevate and fixate upper ribs
6. Pectoralis - Elevates ribs
7. Upper iliocostalis
8. Serratus anterior
Approximately, at which vertebral level does the trachea start and terminate ?
The trachea starts at C6 and ends in the mediastinum at T5.
What is the loose connective tissue called that the respiratory epithelium overlies inside the trachea ?
Lamina propria.
What are the ligaments that bind neighboring tracheal cartilages ?
Annular ligaments.
What is the shape of a tracheal cartilage described as ?
C-shaped.
What is the trachealis ?
An inelastic ligament and a band of smooth muscle connecting the ends of an individual tracheal cartilage.
What is the structure called that marks the bifurcation of the trachea into the right and left main bronchi ?
The carina.
True or false: The main bronchi of the lung have complete rings of cartilage for support.
False. They contain C shaped cartilage.
What are the differences between the right and left main bronchi ?
The right main bronchi is:
Wider
Shorter
Runs more vertically
What is the region called that separates the right and left pleural cavities ?
The mediastinum.
On which structure does the base of the lung rest ?
The diaphragm.
How many pleural sacs are in the human body ?
Two.
List the two layers of the pleura.
1. The inner layer lining the lungs called the - Visceral pleura
2. The outer layer lining the thoracic cavity called the - Parietal pleura
Define: Pleural cavity.
The potential space enclosed between the two membranes of the pleura.
What are the functions of the pleura ?
1. Reduce friction between lungs and thoracic cage
2. Help create pressure gradient during inspiration
3. Prevent the spread of infections
Name the different parts of the parietal pleura.
1. Costal pleura
2. Mediastinal pleura
3. Diaphragmatic pleura
4. Cervical pleura
Which layer of connective tissue separates the parietal pleura from the internal surface of the thoracic wall ?
The endothoracic facia.
Which surface is lined by the mediastinal pleura ?
The mediastinal pleura lines the lateral part of the mediastinum partion of tissues and organs separating the pulmonary cavities and the pulmonary sacs.
Describe as which structures the mediastinal pleura continues as:
1. Anteriorly and posteriorly
2. Superiorly
3. Inferiorly
1. It continues as the costal pleura
2. It continues as the cervical pleura
3. It continues as the diaphragmatic pleura
What is the part of the parietal pleura called lining the apex of the lung ?
Cervical pleura.
Define: Pulmonary ligament.
Parietal pleura surrounding the root of the lung extending downward beyond the root as a fold.
What is the function of the pulmonary ligament ?
It provides a space into which pulmonary veins can expand during increased venous return, the lung root also descends into it with the descent of the diaphragm.
Describe the course of the right and left sternal lines of pleural reflection, respectively.
Both lines start superiorly from the apeces of the lungs. They then run inferomedially, passing posterior to the sternoclavicular joints to meet at the anterior median line at the sternal angle.

Right sternal line:
It continues to pass inferiorly in the AML to the level of the 6th costal cartilage, where it turns laterally.

Left sternal line:
It passes inferiorly in the AML to the level of the 4th costal cartilage, here it passes to the left margin of the sternum and continues inferiorly to the 6th costal cartilage.
Describe the course of the right and left costal lines of pleural reflection, respectively.
Right costal line:
It continues laterally from the AML at the level of the 6th costal cartilage and becomes continuous with the diaphragmatic pleura.

Left costal line:
The left costal line only begins at the midclavicular line.

From where the left costal line starts, the two lines are symmetrical as they proceed laterally, posteriorly and medially, passing obliquely across the 8th rib at the MCL, the 10th rib at the MAL and becoming continuous with the vertebral lines at the necks of the 12th ribs inferior to them.
True or false: The vertebral lines of pleural reflection parallel the vertebral column from T1 to T12 where they continue as the costal line.
True.
What are the potential pleural spaces called where:
1. The diaphragmatic pleura is in contact with the lowermost parts of the costal pleura
2. Where the costal pleura is in contact with the mediastinal pleura
1. Costodiaphragmatic recesses
2. Costomediastinal recesses
Which nerves innervate the visceral pleura and the different parts of the parietal pleura, respectively ?
Visceral pleura:
Pulmonary plexus

Parietal pleura:
Mediastinal and central part of diaphragmatic - Phrenic nerves
Costal and peripheral part of diaphragmatic - Intercostal nerves
True or false: The visceral pleura is extremely sensitive to pain, especially during inspiration.
False. The visceral pleura is not sensitive to pain, instead the parietal pleura is.
True or false: Irritation of the mediastinal and central parts of the diaphragmatic pleura can be referred pain projected to the neck and over the shoulder.
True.
True or false: Irritation of the costal and peripheral parts of the diaphragmatic pleura can be referred pain projected to the neck and over the shoulder.
False. It can be projected to the thoracic and abdominal walls.
Which fissure separates the superior and middle lobes of the right lung ?
The horizontal fissure.
Describe the course of the horizontal fissure.
It courses horizontally in the level of the 4th costal cartilage and meets the oblique fissure in the MAL.
What is the tongue shaped projection below the cardiac notch on the left lung called ?
The lingula.
True or false: The lingula corresponds with the inferior lobe of the right lung.
False. It corresponds with the middle lobe of the right lung.
List the main differences between the left and the right lung, respectively.
Right:
1. It has 2 fissures dividing it into 3 lobes
2. The anterior border is straight
3. Larger and therefore heavier
4. Shorter and broader

Left:
1. It has one fissure dividing it into 2 lobes
2. The anterior border is interrupted by the cardiac notch
3. It is smaller and therefore lighter
4. It is longer and narrower
List the different surfaces of the lung.
1. Costal
2. Mediastinal
3. Diaphragmatic
List the different borders of the lung and describe the position of each.
1. Anterior - It is where the costal and mediastinal surfaces meet anteriorly and overlap the heart
2. Inferior - Circumscribes the diaphragmatic surface of the lung to separate it from the costal and mediastinal surfaces
3. Posterior - Where the costal and mediastinal surfaces meet posteriorly
Describe the arrangement of the structures that form the root of the lung, when sectioned before the branching of the main bronchus and pulmonary artery.
Pulmonary artery:
Superiormost on the left.

Superior and inferior pulmonary veins:
Anteriormost and inferiormost, respectively.

The main bronchus:
Against and approximately in the middle of the posterior boundary with bronchial vessels coursing on its surface.
What is the hilum of the lung ?
It is the wedge-shaped area on the mediastinal surface of the lung through which the structures entering or exiting the lung pass.
Define: Terminal bronchioles.
They are the smallest conducting bronchioles.
What is the difference between a bronchi and a bronchiole ?
Unlike bronchi, bronchioles lack cartilage in their walls.
Define: Conducting bronchioles.
Bronchioles that transport air, but lack glands or alveoli.
Define: Respiratory bronchioles.
Bronchioles characterized by scattered, thin-walled outpocketings that extend from their lumens. These outpocketings are called alveoli.
What is the basic unit of gas exchange in the lung ?
The pulmonary alveoli.
List the names of the generations of the structures of a lung.
1. Lung
2. Lobe
3. Segment
True or false: The pulmonary veins branch in unison with the bronchi of the lung.
False. The pulmonary arteries branch in unison with the lung.
Which vessels can be described as the nutritive blood vessels supplying the lung tissue ?
The bronchial arteries and veins.
Which structures does the bronchial artery supply arterial blood to ?
1. The supporting tissues of the lung
2. The visceral pleura
From which blood vessel do the inferior and superior left bronchial arteries arise from ?
The thoracic aorta.
From which blood vessel does the right bronchial artery arise from ?
One of the following:
1. One of the upper posterior intercostal arteries
2. From a common trunk with the left superior bronchial artery
3. Directly from the aorta
Discuss which arterial blood is drained by the bronchial veins.
The bronchial veins only drain part of the blood supplied to the lungs by the bronchial artery, primarly that distributed to or near the more proximal part of the roots of the lung .
If only a part of the blood from the bronchial artery is drained by the bronchial veins, which blood vessels drain the remainder of the blood supplied by the bronchial arteries ?
It is drained by the pulmonary veins, specifically the peripheral parts of the lung and the visceral pleura.
Which blood vessel drains blood from the visceral pleura ?
The pulmonary veins.
Into which blood vessels do the left and right bronchial veins drain, respectively ?
Right bronchial vein:
Azygos vein.

Left bronchial vein:
The accessory hemiazygos vein, or
the left superior intercostal vein.
True or false: A single pulmonary vein receives oxygenated blood from adjacent bronchopulmonary segments.
True.
List the different types of pneumocytes.
Type 1 - Squamous epithelial cells

Type 2 - Surfactant cells
Which pneumocytes are responsible for secreting surfactant ?
Type 2 pneumocytes.