Thorax Notecards For Clinical Gross Anatomy

Front 1

mediastinum-

Back 1

a major space in the thoracic cavity, houses the conducting structures that make up the thoracic viscera except for the lungs

Front 2

pulmonary cavity-

Back 2

occupy two of the three major spaces in the thoracic cavity, house the lungs

Front 3

benefits of dome shaped thoracic cavity

Back 3

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

Front 4

true ribs-

Back 4

ribs 1-7, attach directly to the sternum through their own costal cartilages

Front 5

false ribs-

Back 5

ribs 8-10, cartilages are connected to the cartilage of the rib above them, indirect connection to sternum

Front 6

floating ribs-

Back 6

ribs 11 and 12, the rudimentary cartilages of these ribs do not connect even indirectly with the sternum, end in the posterior abdominal musculature

Front 7

tubercle of rib-

Back 7

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

Front 8

costal groove-

Back 8

parallels the inferior border of the rib providing for protection of the intercostal nerve and vessels

Front 9

rib 1-

Back 9

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

Front 10

rib 2-

Back 10

contains tuberosity for serratus anterior

Front 11

costal cartilages-

Back 11

prolong ribs anteriorly and contribute to elasticity

Front 12

intercostal spaces-

Back 12

occupied by intercostal muscles and two sets (main and collateral) of intercostal blood vessels and nerves

Front 13

subscostal space-

Back 13

space below rib 12, does not lie between ribs, houses the anterior ramus of spinal nerve T12 (subcostal nerve)

Front 14

sternum-

Back 14

composed of manubrium, body, and xiphoid process

Front 15

manubrium-

Back 15

superior aspect of sternum, houses jugular notch,

Front 16

jugular notch-

Back 16

superior aspect of manubrium, deepened by the medial ends of the clavicle

Front 17

angle of Louis-

Back 17

projection formed at the junction of the manubrium and body of the sternum, palpate to locate 2nd rib

Front 18

xiphoid process-

Back 18

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

Front 19

endothoracic fascia-

Back 19

lines the thoracic cage internally, attaches the adjacent portion of the lining of the lung cavities to the thoracic wall

Front 20

dermatome-

Back 20

strip like area of skin innervated by a single spinal nerve

Front 21

myotome-

Back 21

group of muscles supplied by a single spinal nerve

Front 22

rami communicates-

Back 22

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

Front 23

collateral branches

Back 23

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

Front 24

lateral cutaneous branches

Back 24

pierce the internal and external intercostal muscles, divide into anterior and posterior branches that supply the skin of the lateral thoracic and abdominal walls

Front 25

anterior cutaneous branches

Back 25

supply the skin on the anterior aspect of the thorax and abdomen

Front 26

muscular branches

Back 26

supply the intercostal, subcostal, transverse thoracic, levatores costarum, and serratus posterior muscles

Front 27

thoracic aorta-

Back 27

derives the posterior intercostal and subcostal arteries

Front 28

sublavian artery

Back 28

derives the internal thoracic and supreme intercostal arteries

Front 29

axillary artery

Back 29

derives the superior and lateral thoracic arteries

Front 30

posterior intercostal artery

Back 30

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

Front 31

internal thoracic artery

Back 31

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

Front 32

anterior intercostal artery

Back 32

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

Front 33

veins of the thoracic wall-

Back 33

similar to the arteries in the thoracic wall, the most superior of the vessels in the costal groove

Front 34

breasts-

Back 34

both men and women have them, modified sweat gland (have no capsule or sheath)

Front 35

mammary glands

Back 35

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

Front 36

pectoral fascia

Back 36

form 2/3 of the bed of the breast, the other 1/3 by the fascia covering the serratus anterior

Front 37

retromammary space

Back 37

between breast and pectoral fascia, small amount of fat, allows breast some degree of movement

Front 38

Tail of Spence

Back 38

small part of the mammary gland extended to the axillary fossa, women may be
concerned it is a lump

Front 39

Suspensory ligaments (of Cooper)

Back 39

skin ligaments, fibrous connective tissue, help support the mammary gland lobules

Front 40

lactiferous ducts

Back 40

give rise to buds that form 15-20 lobules of glandular tissue, each lobule drains to nipple

Front 41

lactiferous sinus

Back 41

dilated portion, houses a small droplet of milk

Front 42

sebaceous glands

Back 42

enlarge during pregnancy and secrete an oily substance that provides a protective lubricant for the areola and nipple

Front 43

nipples

Back 43

have no fat, hair or sweat glands, fissured at the tip with the lactiferous ducts

Front 44

alveoli

Back 44

milk secretion, arranged in grapelike clusters

Front 45

colostrum

Back 45

creamy white premilk fluid, may secrete from the nipples during the last trimester, rich in protein, immune agents,

Front 46

breast quadrants

Back 46

used in describing anatomical location and description of tumors and cysts (superior medial, superior lateral, inferior medial, inferior lateral)

Front 47

axillary vein

Back 47

venous drainage of the breast

Front 48

subareolar lymphatic plexus

Back 48

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

Front 49

lymph drainage from the subareolar lymphatic plexus goes:

Back 49

-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

Front 50

lymph from the skin

Back 50

except from nipple and areola drains into the ipsilateral axillary, inferior deep cervical, and infraclavicular lymph nodes

Front 51

lymph from axillary nodes

Back 51

drains into clavicular lymph nodes and from them into the sublavian lymphatic trunk, then goes to jugular lymphatic trunk

Front 52

breast nerves

Back 52

derive from anterior and lateral cutaneous branches of the 4th-6th intercostal nerves

Front 53

pleurae

Back 53

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)

Front 54

pleural cavity

Back 54

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

Front 55

hilum of the lung

Back 55

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)

Front 56

pulmonary ligament

Back 56

extends between the lung and the mediastinum, anterior to the esophagus

Front 57

phrenicopleural fascia

Back 57

connects the diaphragmatic pleura with the muscular fibers of the diaphragm

Front 58

sternal line of pleural reflection

Back 58

sharp and occurs where the costal pleura becomes continuous with the mediastinal pleura anteriorly

Front 59

costal line of pleural reflection

Back 59

sharp and occurs where the costal pleura becomes continuous with diaphragmatic pleura inferiorly

Front 60

vertebral line of pleural reflection

Back 60

rounder and occurs where the costal pleura becomes continuous with the mediastinal pleura posteriorly

Front 61

costodiaphragmatic recess

Back 61

potential pleural spaces, space between lung and diaphragm , where pleural exudate fills, 2 rib space

Front 62

roots of the lungs

Back 62

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

Front 63

hilum

Back 63

point at which the structures forming the root enter and leave the lung

Front 64

horizontal fissue of lung

Back 64

found on the right lung, separates inferior part into an inferior and meddle lobe

Front 65

oblique fissue of lung

Back 65

found on both right and left lung, separates lung into superior and inferior lobe

Front 66

right vs. left lung

Back 66

right has three lobes, larger and heavier but shorter and wider, left has two

Front 67

cardiac notch

Back 67

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

Front 68

3 surfaces of the lung

Back 68

costal, mediastinal, diaphragmatic

Front 69

3 borders of the lung

Back 69

anterior, inferior, posterior

Front 70

trachobronchial tree

Back 70

constituted of the sublaryngeal airway

Front 71

trachea

Back 71

trunk of the trachobronchial tree, located within the superior mediastinum, bifurcates at the angle of Louis into main (primary) bronchi, one to each lung

Front 72

primary bronchi

Back 72

bifurcation of the trachea, two, right and left main bronchus

Front 73

lobar bronchi

Back 73

secondary, two on the left and three on the right for each of the lobes

Front 74

segmental bronchi

Back 74

tertiary, supply the bronchopulmonary segments

Front 75

bronchopulmonary segments

Back 75

-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)

Front 76

terminal bronchioles

Back 76

gives rise to several generations of respiratory bronchioles

Front 77

respiratory bronchioles

Back 77

provides 2-11 alveolar ducts

Front 78

alveolar ducts

Back 78

provides 5-6 alveolar sacs lined by alveoli

Front 79

pulmonary alveolus

Back 79

basic structural unit of gas exchange in the lung

Front 80

alveoli

Back 80

develop until 8 years, where there are about 300 million alveoli

Front 81

pulmonary arteries

Back 81

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

Front 82

pulmonary veins

Back 82

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

Front 83

bronchial arteries

Back 83

supply blood for nutrition of the structures making up the root of the lungs, the supporting tissues of the lungs and the visceral pleura

Front 84

left bronchial arteries

Back 84

two, usually arise from the thoracic aorta

Front 85

right bronchial artery

Back 85

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

Front 86

bronchial veins

Back 86

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

Front 87

right bronchial vein

Back 87

drains into the azygos vein

Front 88

left bronchial vein

Back 88

drains into the accessory hemiazygos vein or the left superior intercostal vein

Front 89

lymphatic drainage of the lungs

Back 89

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

Front 90

nerves of the lungs and visceral pleura

Back 90

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

Front 91

nerves of the parietal pleura

Back 91

derive from the intercostal and phrenic nerves

Front 92

chest pain-

Back 92

can result from pulmonary disease, most important symptom of cardiac disease, may also occur in intestine, gallbladder, and musculoskeletal disorder

Front 93

thoracotomy

Back 93

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,

Front 94

supernumerary ribs-

Back 94

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

Front 95

sternal fractures-

Back 95

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

Front 96

median sternotomy

Back 96

allows for access to the thoracic cavity (such as coronary artery bypass grafting), sternum is divided medially and retracted, joined by wires afterwards

Front 97

sternal biopsy-

Back 97

sternum usually used for bone marrow needle biopsy, used to obtain specimens of marrow for transplantation, detection of metastatic cancer and blood dyscrasias

Front 98

thoracic outlet syndrome-

Back 98

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

Front 99

dislocation of ribs-

Back 99

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

Front 100

separation of ribs-

Back 100

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

Front 101

paralysis of the diaphragm-

Back 101

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

Front 102

dyspnea-

Back 102

-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

Front 103

extrapleural intrathoracic surgical access

Back 103

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

Front 104

herpes zoster infection of the spinal ganglia

Back 104

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

Front 105

changes in the breasts

Back 105

branching of the lactiferous ducts occur in the breast tissue during menstrual periods

Front 106

carcinoma of the breast

Back 106

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

Front 107

lymphedema

Back 107

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

Front 108

subareolar breast cancer

Back 108

may cause inversion of the nipple by shortening of suspensory ligaments involving lactiferous ducts

Front 109

breast cancer

Back 109

typically spreads by means of lymphatic vessels (lymphogenic metastasis), carry cancer cells from the breast to the lymph nodes

Front 110

metastases

Back 110

nests of tumor cells in lymph nodes

Front 111

hemiazygos system of veins and cancer

Back 111

cancer can also spread from the breast by these venous routes to the vertebrae and from there to the cranium and brain

Front 112

retromammary space and cancer

Back 112

cancer can invade here, attach to the deep pectoral fascia or metastasize to the interpectoral nodes

Front 113

mammography

Back 113

radiographic examination of the breasts, carcinoma appears as a large, jagged density on the mammogram, used as a guide when removing breast tumors

Front 114

surgical incisions of the breast

Back 114

placed in the inferior breast quads, less vascular, also least evident

Front 115

mastectomy

Back 115

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

Front 116

lumpectomy (or quadrantectomy)

Back 116

removal of tumor and surrounding tissue, breast conserving surgery, followed usually by radiation therapy

Front 117

polymastia

Back 117

supernumerary breasts, may occur superior or inferior, consist of only a rudimentary nipple and areola

Front 118

polythelia

Back 118

accessory nipples, may occur superior or inferior

Front 119

amastia

Back 119

no breast development, but may be a nipple and/or areola

Front 120

breast cancer in men

Back 120

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

Front 121

gynecomastia

Back 121

breast hypertrophy in men after puberty, may result from age, drugs, or an imbalance between estrogenic and androgenic hormones

Front 122

pneumothorax

Back 122

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

Front 123

pulmonary collapse

Back 123

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

Front 124

secondary atelectasis

Back 124

collapse of a previously inflated lung

Front 125

primary atelectasis

Back 125

failure of a lung to inflate at birth

Front 126

open chest surgery

Back 126

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

Front 127

pneumothorax

Back 127

entry of air into the pleural cavity, causes collapse of the lung

Front 128

bronchopulmonary fistula

Back 128

rupture of a pulmonary lesion into the pleural cavity, causes collapse of the lung

Front 129

hydrothorax

Back 129

accumulation of a significant amount of fluid in the pleural cavity

Front 130

pleural effusion

Back 130

escape of fluid into the pleural cavity

Front 131

hemothorax

Back 131

entering of blood into the pleural cavity, results more commonly from injury to a major intercostal

Front 132

thoracoscopy

Back 132

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

Front 133

pleuritis (pleurisy)

Back 133

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

Front 134

pleurectomy

Back 134

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

Front 135

pleurodesis

Back 135

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

Front 136

Variations in the lobes of the lung

Back 136

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)

Front 137

appearance of the lungs and inhalation of carbon particles and irritants

Back 137

healthy lungs are light pink, dark and mottled if exposed to irritants and carbon particles (smokers)

Front 138

auscultation of the lungs

Back 138

listening to their sounds with a stethoscope, assesses airflow through the trachobronchial tree into the lobes of the lung

Front 139

percussion of the thorax

Back 139

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)

Front 140

lung cancer and the mediastinal nerves

Back 140

-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

Front 141

Aspiration of foreign bodies

Back 141

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

Front 142

bronchoscopy

Back 142

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

Front 143

lung resections

Back 143

necessary to know the anatomy of the bronchopulmonary segments, surgical resection of segments where tumors or abscesses (collection of pus) may be found

Front 144

pneumonectomy

Back 144

removal of a whole lung

Front 145

lobectomy

Back 145

removal of a lung lobe

Front 146

segmentectomy

Back 146

removal of a bronchopulmonary segment

Front 147

segmental atelectasis

Back 147

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

Front 148

Pulmonary embolism

Back 148

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

Front 149

lymphatic drainage after pleural adhesion

Back 149

if parietal and visceral layers adhere, lymph vessels drain into the axillary lymph nodes

Front 150

bronchogenic carcinoma (i.e. lung cancer)

Back 150

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

Front 151

pleural pain

Back 151

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