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151 Cards in this Set

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mediastinum-
a major space in the thoracic cavity, houses the conducting structures that make up the thoracic viscera except for the lungs
pulmonary cavity-
occupy two of the three major spaces in the thoracic cavity, house the lungs
benefits of dome shaped thoracic cavity
protect vital thoracic and abdominal internal organs from external forces
resist the negative internal pressures generated by the elastic recoil of the lungs and inspiratory movements
provide attachment for and support the weight of the upper limbs
provide the anchoring attachment of many of the muscles that move and maintain the position of the upper limbs
true ribs-
ribs 1-7, attach directly to the sternum through their own costal cartilages
false ribs-
ribs 8-10, cartilages are connected to the cartilage of the rib above them, indirect connection to sternum
floating ribs-
ribs 11 and 12, the rudimentary cartilages of these ribs do not connect even indirectly with the sternum, end in the posterior abdominal musculature
tubercle of rib-
junction of the neck and hody, has smooth articular part for corresponding transverse process and a rough non-articular part for attachment of the costotransverse ligament
costal groove-
parallels the inferior border of the rib providing for protection of the intercostal nerve and vessels
rib 1-
braodest, shortest, and most sharply curved, only a single facet and two grooves for subclavian vessels, two grooves separated by scalene tubercle where anterior scalene attaches
rib 2-
contains tuberosity for serratus anterior
costal cartilages-
prolong ribs anteriorly and contribute to elasticity
intercostal spaces-
occupied by intercostal muscles and two sets (main and collateral) of intercostal blood vessels and nerves
subscostal space-
space below rib 12, does not lie between ribs, houses the anterior ramus of spinal nerve T12 (subcostal nerve)
sternum-
composed of manubrium, body, and xiphoid process
manubrium-
superior aspect of sternum, houses jugular notch,
jugular notch-
superior aspect of manubrium, deepened by the medial ends of the clavicle
angle of Louis-
projection formed at the junction of the manubrium and body of the sternum, palpate to locate 2nd rib
xiphoid process-
inferior part of sternum, lies at the level of T10, in older people, may become ossified and fuse with the sternal body, landmark for the superior limit of the liver, the central tendon of the diaphragm and the inferior border of the heart
endothoracic fascia-
lines the thoracic cage internally, attaches the adjacent portion of the lining of the lung cavities to the thoracic wall
dermatome-
strip like area of skin innervated by a single spinal nerve
myotome-
group of muscles supplied by a single spinal nerve
rami communicates-
connect each intercostal nerve to the ipsilateral sympathetic trunk, presynaptic fibers connect to the sympathetic trunk through a white communicantes rami while postsynaptic fibers ride a gray communicantes rami to the ventral rami
collateral branches
arise near the angles of the ribs and descend to course along the superior margin of lower rib, help supply intercostal muscles and parietal pleura
lateral cutaneous branches
pierce the internal and external intercostal muscles, divide into anterior and posterior branches that supply the skin of the lateral thoracic and abdominal walls
anterior cutaneous branches
supply the skin on the anterior aspect of the thorax and abdomen
muscular branches
supply the intercostal, subcostal, transverse thoracic, levatores costarum, and serratus posterior muscles
thoracic aorta-
derives the posterior intercostal and subcostal arteries
sublavian artery
derives the internal thoracic and supreme intercostal arteries
axillary artery
derives the superior and lateral thoracic arteries
posterior intercostal artery
give off a posterior branch that accompanies the posterior ramus, gives rise to a small collateral branch, accompany the intercostal nerves, have terminal and collateral branches that anasomose with the anterior intercostal artery
internal thoracic artery
arise in the root of the neck from the subclavian artery, descend into the thorax, crossed by the phrenic nerve, terminates in the 6th ICS by dividing into the superior epigastric and the musculophrenic arteries, give rise to the anterior intercostal arteries
anterior intercostal artery
paired, supply anterior parts of the superior 9 ICS, pass laterally in the intercostal space one superior and one inferior, supply the intercostal muscles as well as pectorals, breasts, and skin, missing in the inferior 2 ICS
veins of the thoracic wall-
similar to the arteries in the thoracic wall, the most superior of the vessels in the costal groove
breasts-
both men and women have them, modified sweat gland (have no capsule or sheath)
mammary glands
present in both men and women, function in women, rudimentary and functionless in men, in the subQ tissue overlying the pec maj. and min., attached to the dermis
pectoral fascia
form 2/3 of the bed of the breast, the other 1/3 by the fascia covering the serratus anterior
retromammary space
between breast and pectoral fascia, small amount of fat, allows breast some degree of movement
Tail of Spence
small part of the mammary gland extended to the axillary fossa, women may be
concerned it is a lump
Suspensory ligaments (of Cooper)
skin ligaments, fibrous connective tissue, help support the mammary gland lobules
lactiferous ducts
give rise to buds that form 15-20 lobules of glandular tissue, each lobule drains to nipple
lactiferous sinus
dilated portion, houses a small droplet of milk
sebaceous glands
enlarge during pregnancy and secrete an oily substance that provides a protective lubricant for the areola and nipple
nipples
have no fat, hair or sweat glands, fissured at the tip with the lactiferous ducts
alveoli
milk secretion, arranged in grapelike clusters
colostrum
creamy white premilk fluid, may secrete from the nipples during the last trimester, rich in protein, immune agents,
breast quadrants
used in describing anatomical location and description of tumors and cysts (superior medial, superior lateral, inferior medial, inferior lateral)
axillary vein
venous drainage of the breast
subareolar lymphatic plexus
lymph from the nipple, areola, and lobules of the gland empty here, lymph drainage is important bec. of its role in the metastasis of cancer cells
lymph drainage from the subareolar lymphatic plexus goes:
-most lymph (esp from lateral breast quads drains to the axillary lymph nodes) goes to axillary lymph nodes, some goes to interpectoral, deltopectoral, supraclavicular, or inferior deep cervical nodes

-from the medial breast quads drains to the parasternal lymph nodes or to opposite breast

-from the inferior quads, may go to abdominal lymph
lymph from the skin
except from nipple and areola drains into the ipsilateral axillary, inferior deep cervical, and infraclavicular lymph nodes
lymph from axillary nodes
drains into clavicular lymph nodes and from them into the sublavian lymphatic trunk, then goes to jugular lymphatic trunk
breast nerves
derive from anterior and lateral cutaneous branches of the 4th-6th intercostal nerves
pleurae
lines pulmonary cavities (parietal, 4 types: costal (ribs/thoracic wall), mediastinal (mediastinum), diaphragmatic (diaphragm) and cervical (neck)) as well as reflecting onto the external surface of the lungs (visceral)
pleural cavity
potential space between the visceral and parietal layers of pleura, contains a capillary layer of serous pleural fluid (lubricates the pleural surfaces and allows the layers of pleura to slide smoothly over each other during respiration, its surface tension also provides the cohesion that keeps the lung surface in contact with the thoracic wall
hilum of the lung
spot where parietal pleura is continuous with the visceral pleura, exit and enter point for the structures that make up the root of the lung (e.g. bronchus and pulmonary vessels)
pulmonary ligament
extends between the lung and the mediastinum, anterior to the esophagus
phrenicopleural fascia
connects the diaphragmatic pleura with the muscular fibers of the diaphragm
sternal line of pleural reflection
sharp and occurs where the costal pleura becomes continuous with the mediastinal pleura anteriorly
costal line of pleural reflection
sharp and occurs where the costal pleura becomes continuous with diaphragmatic pleura inferiorly
vertebral line of pleural reflection
rounder and occurs where the costal pleura becomes continuous with the mediastinal pleura posteriorly
costodiaphragmatic recess
potential pleural spaces, space between lung and diaphragm , where pleural exudate fills, 2 rib space
roots of the lungs
bronchi, pulmonary arteries, superior and inferior pulmonary veins, the pulmonary plexuses of nerves and lymphatic vessels

-pulmonary artery, superior most on left

-superior and inferior pulmonary veins, anteriormost and inferiormost

-bronchus, against and approx. in the middle of the posterior boundary, with the bronchial vessels immediately surrounding
hilum
point at which the structures forming the root enter and leave the lung
horizontal fissue of lung
found on the right lung, separates inferior part into an inferior and meddle lobe
oblique fissue of lung
found on both right and left lung, separates lung into superior and inferior lobe
right vs. left lung
right has three lobes, larger and heavier but shorter and wider, left has two
cardiac notch
found on the left lung housing the heart, an indentation, often creates a thin, tongue-like process (lingual) which extends below the cardiac notch and slides in and out of the costomediastinal recess during inspiration and expiration
3 surfaces of the lung
costal, mediastinal, diaphragmatic
3 borders of the lung
anterior, inferior, posterior
trachobronchial tree
constituted of the sublaryngeal airway
trachea
trunk of the trachobronchial tree, located within the superior mediastinum, bifurcates at the angle of Louis into main (primary) bronchi, one to each lung
primary bronchi
bifurcation of the trachea, two, right and left main bronchus
lobar bronchi
secondary, two on the left and three on the right for each of the lobes
segmental bronchi
tertiary, supply the bronchopulmonary segments
bronchopulmonary segments
-pyramidal segments of the lung, apices facing the lung root and bases at pleural surfaces

-largest subdivisions of lobe

-separated from adjacent segments by connective tissue septa

-supplied independently by a segmental bronchus and a tertiary branch of the pulmonary artery

-named according to the segmental bronchi supplying them

-drained by intersegmental parts of the pulmonary veins

-surgically respectable

-usually 18-20 in number (10 in right, 8-10 in the left)
terminal bronchioles
gives rise to several generations of respiratory bronchioles
respiratory bronchioles
provides 2-11 alveolar ducts
alveolar ducts
provides 5-6 alveolar sacs lined by alveoli
pulmonary alveolus
basic structural unit of gas exchange in the lung
alveoli
develop until 8 years, where there are about 300 million alveoli
pulmonary arteries
supply blood to lung, a left and right, arise from the pulmonary trunk at the level of the sternal angle and carry poorly oxygenated blood to the lungs for oxygenation, when reaches main bronchus (it is actually paired with the bronchus) divides into lobar and segmental arteries
pulmonary veins
two on each side, carry well oxygenated blood from the lungs to the left atrium of the heart, run independent of arteries and bronchi, head towards hilum
bronchial arteries
supply blood for nutrition of the structures making up the root of the lungs, the supporting tissues of the lungs and the visceral pleura
left bronchial arteries
two, usually arise from the thoracic aorta
right bronchial artery
single, may arise directly from the aorta, but more likely arises from the upper posterior intercostal artery or from the left superior bronchial artery, branches to upper esophagus and even the bronchi to the respiratory bronchioles
bronchial veins
drain only part of the blood supplied to the lungs (primarily to the more proximal part of the roots of the lungs), remainder drained by pulmonary veins, may also receive blood from the esophageal veins
right bronchial vein
drains into the azygos vein
left bronchial vein
drains into the accessory hemiazygos vein or the left superior intercostal vein
lymphatic drainage of the lungs
originate in superifical subpleural and deep lymphatic plexuses, leaves along the root of the lung and drains to the inerior or superior trachobronchial lymph nodes, inferior lobe of both lungs drain to the inferior trachobronchial nodes, the other lobes of each lung drain to the ipsilateral superior trachobronchial lymph nodes, the lymph then traverses a variable number of paratracheal nodes and enters the bronchomediastinal trunks
nerves of the lungs and visceral pleura
derive from the pulmonary plexuses anterior and posterior to the lungs, contain parasymp. fibers from the vagus nerve and symp. fibers from the symp. trunk
nerves of the parietal pleura
derive from the intercostal and phrenic nerves
chest pain-
can result from pulmonary disease, most important symptom of cardiac disease, may also occur in intestine, gallbladder, and musculoskeletal disorder
thoracotomy
surgical creation of an opening through the thoracic wall to enter a pleural cavity

-anterior: H-shaped cuts through the perichondrium of costal cartilages

-posterior: at 5th-7th intercostal space

-lateral: preferred,
supernumerary ribs-
an excess or shortage of ribs, either extra from cervical or lumbar ribs or 12th rib not forming, cervical ribs may interfere with neurovascular structures exiting the superior thoracic aperture
sternal fractures-
not common, usually a comminuted fracture (break in several pieces), displacement is rare because it is covered by a deep fascia, concern is more so for heart injury
median sternotomy
allows for access to the thoracic cavity (such as coronary artery bypass grafting), sternum is divided medially and retracted, joined by wires afterwards
sternal biopsy-
sternum usually used for bone marrow needle biopsy, used to obtain specimens of marrow for transplantation, detection of metastatic cancer and blood dyscrasias
thoracic outlet syndrome-
thoracic outlet emphasized bec. the arteries and T1 spinal nerves that emerge from the here, TOS’s exist in which emerging structures are affected by obstructions of the thoracic outlet (which occur in the neck, manifestations of the syndromes involve the upper limb
dislocation of ribs-
displacement of costal cartilage from the sternum, are common in body contact sports, complications include pressure on or damage to nearby nerves, vessels, and muscles
separation of ribs-
refers to dislocation of a costochondral junction between the rib and its costal cartilages, tearing of the periochondrium and periosteum usually occurs, rib may move superiorly, overriding the rib above and causing pain
paralysis of the diaphragm-
occurs in halves because the phrenic nerve does not affect the other half (each dome has its own innervation), can detect radiographically by paradoxical movement, ascends during inspiration and descends during expiration
dyspnea-
-difficult breathing, if occurs one uses accessory respiratory muscles to assist the expansion of their thoracic cavity, lean on their knees fix pectoral girdle so these muscles can act on their rib attachment
extrapleural intrathoracic surgical access
the thin endothoracic fascia provides a natural cleavage plane, allowing surgeons to separate the costal parietal pleura lining the lung cavity from the thoracic wall, allows for access to extrapleural structures (e.g. lymph nodes) and prevents disrupting the pleural cavity
herpes zoster infection of the spinal ganglia
causes a distributed, painful skin lesion (shingles), a viral disease of spinal ganglia caused by the reactivation of the chickenpox virus (varicella-zoster), produces a sharp burning pain in the dermatome supplied by the involved nerve
changes in the breasts
branching of the lactiferous ducts occur in the breast tissue during menstrual periods
carcinoma of the breast
understanding the lymphatic drainage of the breasts is important in determining metastasis, are malignant tumors, usually arise from the epithelial cells of the lactiferous ducts in the mammary gland lobules
lymphedema
caused by intereference with the lymphatic drainage by cancer, excess lymph in the subQ tissue, may result in deviation of the nipple and a thickened, leather-like appearance
subareolar breast cancer
may cause inversion of the nipple by shortening of suspensory ligaments involving lactiferous ducts
breast cancer
typically spreads by means of lymphatic vessels (lymphogenic metastasis), carry cancer cells from the breast to the lymph nodes
metastases
nests of tumor cells in lymph nodes
hemiazygos system of veins and cancer
cancer can also spread from the breast by these venous routes to the vertebrae and from there to the cranium and brain
retromammary space and cancer
cancer can invade here, attach to the deep pectoral fascia or metastasize to the interpectoral nodes
mammography
radiographic examination of the breasts, carcinoma appears as a large, jagged density on the mammogram, used as a guide when removing breast tumors
surgical incisions of the breast
placed in the inferior breast quads, less vascular, also least evident
mastectomy
breast excision down the retromammary space, radial masectomy involves removal of the breast, pectoral muscles, fat, fascia, and as many lymph nodes as possible in the axilla
lumpectomy (or quadrantectomy)
removal of tumor and surrounding tissue, breast conserving surgery, followed usually by radiation therapy
polymastia
supernumerary breasts, may occur superior or inferior, consist of only a rudimentary nipple and areola
polythelia
accessory nipples, may occur superior or inferior
amastia
no breast development, but may be a nipple and/or areola
breast cancer in men
1.5% of breast cancers, cancer usually metastasies to lymph nodes but also to bone, pleura, lung, liver and skin, a visible or palpable subareolar mass or secretion from a nipple may indicate malignant tumor
gynecomastia
breast hypertrophy in men after puberty, may result from age, drugs, or an imbalance between estrogenic and androgenic hormones
pneumothorax
the presence of air in the pleural cavity, may be caused by wounds to the base of the neck, the cervical pleura is especially vulnerable to injury during the first few years after birth
pulmonary collapse
occurs if distension in lung is not maintained, then elasticity will cause collapse, also can occur if a wound opens the thorax, sucking air into the pleural cavity (which becomes a real space), one lung can collapse without the other one doing so, collapsed lung occupies less volume within the pulmonary cavity, in radiograph lung will appear more dense (whiter) surrounded by more radiolucent (blacker) air
secondary atelectasis
collapse of a previously inflated lung
primary atelectasis
failure of a lung to inflate at birth
open chest surgery
respiration and lung inflation must be maintained by intubating the trachea with a cuffed tube and using a positive pressure pump to inflate and deflate the lung
pneumothorax
entry of air into the pleural cavity, causes collapse of the lung
bronchopulmonary fistula
rupture of a pulmonary lesion into the pleural cavity, causes collapse of the lung
hydrothorax
accumulation of a significant amount of fluid in the pleural cavity
pleural effusion
escape of fluid into the pleural cavity
hemothorax
entering of blood into the pleural cavity, results more commonly from injury to a major intercostal
thoracoscopy
a diagnostic and sometimes therapeutic procedure in which the pleural cavity is examined with a thoracoscope, small incisions are made into the pleural cavity via an intercostal space, biopsies can also be taken for analysis
pleuritis (pleurisy)
inflammation of the pleura makes the lung surface rough, can detect friction sound through stethoscope, sounds like clump of hair being rolled between the fingers, inflammation can also cause parietal and visceral pleura to adhere
pleurectomy
obliteration of pleural cavity through surgery, does not cause appreciable functional consequences, pain though, performed to prevent recurring spontaneous secondary atelectasis caused by chronic pneumothorax or malignant effusion from lung disease
pleurodesis
induced adherence of the parietal and visceral pleura by covering the apposing layers of pleura with an irritating powder, performed to prevent recurring spontaneous secondary atelectasis caused by chronic pneumothorax or malignant effusion from lung disease
Variations in the lobes of the lung
can have an extra fissure or missing fissure, azygos lobe appears in the right lung in approx. 1% of people (the azygos vein arches over the apex of the right lung and not over the right hilum, isolating the medial part of the apex as an azygos lobe)
appearance of the lungs and inhalation of carbon particles and irritants
healthy lungs are light pink, dark and mottled if exposed to irritants and carbon particles (smokers)
auscultation of the lungs
listening to their sounds with a stethoscope, assesses airflow through the trachobronchial tree into the lobes of the lung
percussion of the thorax
tapping the thorax over the lungs with the fingers to detect sounds in the lungs, helps establish whether the underlying tissues are air filled (resonant sound), fluid filled (dull sound), or solid (flat sound)
lung cancer and the mediastinal nerves
-if involve phrenic nerve may result in paralysis of hemidiaphragm

-if involve recurrent laryngeal nerve to the apex, may be involved in apical lung cancer, causes hoarseness owing to paralysis of a vocal fold b/c supplies all laryngeal muscles but one
Aspiration of foreign bodies
the right bronchus is wider and shorter and runs more vertical than the left bronchus, this causes the potential for aspirated foreign bodies to enter the right main bronchus, to prevent this, dentists may insert a thin rubber dam into the oral cavity
bronchoscopy
procedure where a bronchoscope is placed down the main bronchus through the trachea, observe the carina (cartilaginous projection of the last trachea) to determine cancer (carina becomes distorted, and widened), carina also sensitive and involved in the cough reflex
lung resections
necessary to know the anatomy of the bronchopulmonary segments, surgical resection of segments where tumors or abscesses (collection of pus) may be found
pneumonectomy
removal of a whole lung
lobectomy
removal of a lung lobe
segmentectomy
removal of a bronchopulmonary segment
segmental atelectasis
blockage of a segmental bronchus will prevent air from reaching a bronchopulmonary segment, air will be absorbed into the blood and the segment will collapse, detect by adjacent segments expanding
Pulmonary embolism
obstruction of a pulmonary artery by a blood clot, can lead to sickness and death, pulmonary arteries carry all of the blood that has been returned to the right heart, embolism causes a partial or complete obstruction of blood flow to the lung, patient suffers acute respiratory distress bec. of major DEC in oxygenation of blood
lymphatic drainage after pleural adhesion
if parietal and visceral layers adhere, lymph vessels drain into the axillary lymph nodes
bronchogenic carcinoma (i.e. lung cancer)
lung cancer, mainly caused by cigarette smoking, arise in the mucosa of the large bronchi and produce a persistent, productive cough or hemoptysis (spitting of blood), malignant cells can be detected in the sputum (saliva-borne matter), the primary tumor metastasizes to the hilar lymph nodes and subsequently to other thoracic lymph nodes, tumor cells probably enter the systemic circulation by invading the wall of a sinusoid or venule which are then transported through the pulmonary veins
pleural pain
visceral pleura insensitive to pain bec. it receives no nerves of general association, parietal pleura is extremely sensitive (richly supplied by intercostal and phrenic nerves), irritation may cause localized or referred pain projected to dermatomes