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128 Cards in this Set
- Front
- Back
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Name the planes of the thorax and describe where they run.
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-ANTERIOR MEDIAN (MIDSTERNAL):
>thru sternum in mid saggital plane -MIDCLAVICULAR (MCL) >vertical thru midpoints of clavicles, parallen to median line -ANTERIOR AXILLARY >vert. along anterior axillary fold, formed by pectoralis major -MID AXILLARY >vert. thru apex of axilla -POSTERIOR AXILLARY >vert. thru post. axillary fold, formed by latissiumus dorsi and teres major -POSTERIOR MEDIAN (MIDSPINAL/MIDVERTEBRAL) >vert. thru spinous processes of each vert. in mid saggital plane -SCAPULAR >vert passing thru inferior angles of scapular, parallel to post. median |
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What are the bones of the thoracic wall?
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ribs, thoracic vertebrae, and sternum
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What is the function of the thoracic wall?
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to protect the thoracic content, such as heart, lunghs, blood vessels, esophagus, etc...
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Define the three classifications of ribs. Which ribs fall into each?
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TRUE ribs: attach directly to sternum
FALSE ribs: attach indirectly to sternum (cartilage to cartilage connection) FLOATING ribs: do not attach to sternum, aka short ribs TRUE = 1-7 FALSE = 8-10 FLOATING = 11, 12 |
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Which ribs are typical / atypical?
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Typical = 3-9
Atypical = 1, 2, 10-12 |
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Landmarks of typical ribs
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1. Head- two costal facets, articulate with TWO vertebrae
2. Neck 3. Tubercle - articulates with transverse process 4. Shaft - thin, flat, "curves" making the COSTAL ANGLE |
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What is the most common site of rib fracture?
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The costal angle - weakest point of the rib
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Features of Atypical ribs 1 and 2
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- roughened areas for scalene and serratus attachment
- one facet |
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Unique features of thoracic vertebrae
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- There are 2 costal facets on each vertebral body (except lower 3 thoracic)
- Costal facet on each transverse process (except lower 2-3 thoracic) |
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What are the 3 segments of the sternum?
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Manubrium, body, and xyphoid process
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Landmarks of manubrium
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1. jugular / suprasternal notch
2. articulations with clavicle and first rib |
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Landmarks of body of sternum
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1. sternal angle (articulation of body and manubrium)
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Why is the sternal angle a helpful clinical landmark?
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1. location of CARINA (bifurcation of trachea into R/L primary bronchi)
2. beginning and ending of AORTIC ARCH 3. palpation of sternal angle is location of 2nd rib |
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Features of xiphoid process
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1. may be cartilaginous or ossified
2. site of subcostal / infrasternal angle |
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Name the articulations of the the thoracic wall
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1. Costovertebral joints - articulations of ribs with vertebrae (and transverse processes where appropriate)
2. Costonchondral - articulation of rib and costal cartilage 3. Sternocostal - costal cartilage (of true ribs) & sternum 4. Sternoclavicular aka "SC joint" - sternum & clavicle (contains disc, critical for shoulder girdle fxn) 5. Interchondral joints - "articulation" bw costal cartilages of lower ribs 6. Manubriosternal joint - aka sternal angle, manubrium & sternum 7. Xiphosternal - xiphoid & sternum 8. Intervertebral (IV) joints of thoracic spine |
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Movement of thoracic wall
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Inspiration - increase in anterioposterior (AP) and transverse diameter of rib cage due to "bucket handle" motion of ribs
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Male breast clinical landmark
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nipple lies at ~4th intercostal space
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Female breast features
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1. circular base extends from
A) sternum to MAL (midaxillary line) B) Ribs 2-6 2. Adipose tissue and glands (15-20 lobes that drain into ducts) 3. Axillary tail of breast - extends along inferior border of pec twds axilla 4. understanding anat. critical for clinical exam/asst of potential CA > documentation in quadrants - UI, LI, LO, UO 5. Lymph drainage |
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Lymph drainage of breast
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~75% of breast drains later into axillary lymph nodes
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What does lymphadema of upper extremity mean
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potential secondary complication following surgery for breast CA
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Name the thoracic apertures
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superior aferture and inferior aperture
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What does the superior aperture contain
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esophagus, trachea, nerves, and blood vessels that supply the head, neck, and upper extremities
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What is the function of the inferior aperture
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allows the esophagus, inferior vena cava, and aorta to pass inferior
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Name the muscles involved and breathed and their function
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External intercostals - elevate ribs for inspiration
Internal intercostals - depress ribs for expiration |
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How many levels of intercostals are there? Name them.
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3 - external intercostals, interal intercostals, and innermost intercostals
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What is the location and function of the transversus thoracis muscle?
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-located on the internal anterior thoracic cage (along the internal ribs)
-depresses ribs for expiration |
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What is the location and function of the subcostal muscles?
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-located on internal posterior thoracic cage (along the internal ribs)
-elevates ribs for inspiration |
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What is the location and function of the levator costarum?
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-located on external posterior thoracic cage, attaches to ribs and transverse processes of C7-T11
-elevates ribs for inspiration |
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What does the serratus posterior superior do?
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elevates ribs for inspiration
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What does the serratus posterior inferior do?
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depresses ribs for expiration
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Name all the muscles involved in inspiration.
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-External intercostals
-Subcostal muscles -Levator costarum -Serratus posterior superior -DIAPHRAGM |
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Name the muscles involved in expiration
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-Internal intercostals
-Transversus thoracis -Serratus posterior inferior |
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What is the major muscle of inspiration
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diaphragm!
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What nerve innervates the diaphragm?
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Innervated by phrenic nerve (C3-5), which provides motor and sensory components of diaphragm
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explain how the diaphragm is involved in the process of inspiration
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contraction "flattens" the diaphragm (normally it is convex up), which increases thoracic volume. this causes a pressure change which causes an increase of air into the lungs
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Name the tendon of the diaphragm
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central tendon
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names the regions of the diaphragm
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sternal
costal lumbar |
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How many layers of musculature are in the intercostal spaces?
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three - external, internal, and innermost intercostal muscles
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what are the components of the neurovascular bundle of the intercostal spaces
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intercostal VAN (vein, artery, nerve)
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What are the branches of the intercostal nerve?
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lateral and anterior
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Herpes zoster
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-very common in thoracic region
-dormant virus in single segmental nerve will become active -painful, red, vesicular lesion in dermatome pattern -shingles is not limited to tharic region |
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What are the mechanics of inspiration?
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- rest = diaphragm
- exercise = diaphragm + external intercostals - extreme excercise = diaphram, exterternal intercostal, and accessory muscles (SCM and scalenes). pecs may assist also. Clinical: Patients with COPD and other pulmonary disease may display the "extreme" type of breathing pattern |
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what are the mechanics of expiration?
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rest = recoil of the lungs
exercise = recruit the internal intercostals and abdominal muscles (rectus abdominus, int/ext obliques) |
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what are the mechanics of breathing at rest?
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Ins: diaphragm
Exp: elastic recoil of lungs |
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What are the mechanics of breathing during exercise?
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Ins: diaphragm and external intercostals
Exp: recruit internal intercostals and abdominal muscles (rectus abdominus and int/ext obliques) |
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Name the two major blood sources to the rib cage
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descending aorta and R/L subclavian arteries
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What is the function of the descending aorta?
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provides blood to segmental branches known as posterior intercostal arteries
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What is the location of the posterior intercostal arteries?
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Branch off of the aorta and travel anteriorly between ribs (along with intercostal vein and intercostal nerve)
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What is the function of the subclavian arteries?
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provide blood to right and laeft internal thoracic arteries
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What is the location of the internal thoracic arteries?
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descend along anterior wall of internal rib cage
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What is the location of the anterior intercostal arteries?
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they originate from the descening internal thoracic artery and travel between ribs and anastomose with posterior intercostal arteries
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What is the location of the azygos vein?
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located on the RIGHT posterior internal rib cage, drains into superior vena cava.
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What is the location of the hemiazygos and accessory hemiazygos veins?
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located on the LEFT posterior internal rib cage. drain segmental portions of thorax.
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What are the 2 compartments of thoracic cavity and viscera
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2 pulmonary cavities that contain lungs and pleura, and mediastium, which contains heart, great vessels, trachea, esphagus, thymus and lymph nodes.
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Define pleura
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2 layers of CONTINUOUS, thin, serous membranes. the layers are "enfolded" on each other duirng embryionic development
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which pleura invests the lungs?
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visceral pleura (pulmonary pleura)
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which pleura lines the thoracic wall and diaphragm?
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parietal pleura
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what is the potential spaces between to pleural layers called?
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parietal cavity
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what is serous pleural fluid?
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lubrication for the parietal cavity, allowing 2 layers to glide smoothly
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what is thorencentesis
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hypodermic needle inserted through intercostal space
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what is the costodiaphragmatic recess?
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pleural recess that can accumulate fluid with various conditions, later and posterior removed via thorencentesis
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what is the constomediastinal recess?
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small pleural recess located posterior to sternum
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define pneumothorax
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air enters pleural cavity, partial or complete collapse of lung
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define pleural effusion
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abnormal accumulation of fluid from pathology within pleural cavity, potential compression of lung
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define hemothorax
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blood accumulates in the pleural cavity, potential compression of lung
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pleuritis
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inflammation of pulmonary pleura, lung sounds "friction rub"
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what is the difference between ventilation and respiration?
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ventilation is the MECHANICAL MOVEMENT of air in and out of the lungs. respiration is GAS EXCHANGE that occurs in lungs and throughout the body
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where does respiration occur in the lungs and in the body?
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lungs - at alveolar/cappilaries
body target tissue/cappilaries |
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explain inspiration
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increase in volume of thorax creates negative pressure in lungs/pleural cavity, causing air to be "sucked in"
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what is spirometry
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clinical measure of ventilation
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static lung volumes
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total lung capacity, tidal volume, inspiratory reserve capacity
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dynamic lung measures
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- FEV1 (forced expiratory volume) = amount of air expired in 1st second of expiration
- minute ventilation = amount of air expired in one minute |
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pulse oximeter
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measures arterial saturation of oxygen, idea 96-100%
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landmarks of lung
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apex (top)
base (bottom) |
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where do lungs sit?
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on the diaphragm
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what is another name for hilum of lung?
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root
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what is the hilum?
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site where the lung becomes covered by visceral pleura
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what does the hilum contain?
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1. primary brunchus
2. two pulmonary veins (superior and inferior) 3. one pulmonary artery - eventually supplies pulmonary capillaries for gas exchange 4. bonchial vessels - supply the lung tissue and pleurae 5. pulmonary nerve plexus - autonomic nerves and sensory nerves 6. lymph vessels |
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Features of right lung
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- 3 lobes (superior, inferior, middle)
- lobes separated by oblique fissure and horzontal fissure - right lung eventually divides into TEN bronchopulmonary segments |
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how many lobes in right lung
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3 (superior, inferior, middle)
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how many bronchopulmonary segments in right lung
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10 total
2 in superior lobe 3 in middle lobe 5 in inferior lobe |
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how many lobes in left lung?
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2 - superior and inferior, separated by oblique fissure
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what is the lingula and where is it found?
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in left lung, "similar" to middle lobe of right lung
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what are the bronchopulmonary segments of left lung
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10 total
5 superior 5 inferior |
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what is the bronchial tree
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-trachea bifurcates (carina)
-R/L primary bronchi (enter hilum) -primary bronchi diving into lobar bronchi (secondary bronchi) -further divide into segmental bronchi (supply the 10 bronchopulmonary segments) -continue to divide into 20-25 generations of smaller divisions of bronchioles -eventually end as terminal bronchiole -terminal bronchioles give rise to respiratory bronchioles which supply the alveolis (gas exchange) |
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where does gas exchange occur in lungs
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alveoli
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what is the mediastinum
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region between pleural cavities
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what are the borders of medastinum?
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superior - superior thoracic aperture
inferior - diaphragm anterior - sternum and costal cartilages posterior - thoracic vertebrae |
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what are the divisions of mediastinum
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super and inferior, divided by horizontal line through sternal angle to T4-5 disc space
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contents of superior division of mediastinum
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thymus in children (remnants in adults)
arch of aorta/great vessels trachea esophagus |
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what are the portions of inferior division of mediastinum and their contents?
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anterior, middle, posterior
anterior - internal thoracic vessels, fat, few lymph nodes middle - pericardium, heart, roots of great vessels posterior - esophagus, descending (thoracic) aorta, thoracic duct, lymph nodes |
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where is the heart located?
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middle mediastinum
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what is the heart enclosed in
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pericardium, a double walled, fibroserous sac
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pericardium
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outside sac = fibroud pericardium
inside sac = serous pericardium |
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fibrous pericardium
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outside sac containing heart
attaches to diaphragm via pericardiacophrenic ligament also attaches to sternum via sternopericardial |
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serous pericardium
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similar to pleura of lungs - heart invests in on the serous pericardium forming 2 layers:
-parietal layer -visceral layer - "becomes" the outer layer of heart known as epicardium |
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pericardial cavity
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potential space between parietal and visceral layers, smooth fluid allows heart to "move" freely with pericardial sac
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Name layers of wall of the heart
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epicardium - visceral serous pericardium
myocardium - cardiac muscle endocardium - thin, smooth endothelial layer that lines the heart and valves |
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What is the fibrous skeleton of the heart?
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four fibrous rings that surround orifices of valves (mitral, tricuspid, aortic, pulmonic)
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What is the function of the fibrous skeleton of the heart?
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-provides attachments for myocardium of atria and ventricles
-provides attachment for cardiac valves -provides electrical insulation between atria and ventricles |
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The apex of heart is formed by tip of which chamber?
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Left ventricle
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Where is the apex of the heart located in relation to the ribs
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located approximately in the left 5th intercostal space (between ribs 5 and 6), just medial to midclavicular line
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What is apical impulse?
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The pulse that may or may not be palpated and/or visualized in some patients. Having pt lay on left side my help. Obesity, preg, excess musc development etc may limit ability to located it. if located lateral to midclavicular line, may suggest displacement or cardiac enlargement
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what is the location of base of heart
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posterior side (in vivo). mostly left atrium (with some right atrium included)
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describe borders of heart
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right border - right atrium, extending between SVC and IVC
left border - primarily left ventricle and some left atrium inferior border - primarily right ventricle and some left ventricle superior border - junction where great vessels enter and leave heart |
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name and describe surfaces of heart
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sternocostal (anterior) surface - mostly right ventricle
diaphragmatic (inferior) surface - mostly left ventricle and partially right ventricle pulmonary (left) surface - mostly left ventricle |
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Name chambers of heart
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right atrium
right ventricle left atrium left ventricle |
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Landmarks of right atrium
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SVC/IVC openings
opening coronary sinus fossa ovalis tricuspid valve |
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Landmarks of right ventricle
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tricuspid valve
papillary muscle / chordae tendinae pulmonary valve |
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Landmarks of left atrium
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foramen ovale
4 openings of pulmonary veins |
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Landmarks for left ventricle
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bicuspid valve
papillary muscle / chordae tendinae aortic valve |
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function of superior vena cava
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returns blood back to right atrium from areas superior to diaphragm (except from heart and lungs)
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function of inferior vena cava
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returns blood back to right atrium from areas inferior of the diaphragm
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function of pulmonary trunk
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sends oxygenated blood from right ventricle to lungs
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function of right/left pulmonary veins
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return oxygenated blood back to the left atrium from the lungs
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functions of aorta
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sends blood to body from left ventricle
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branches of aorta
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brachiocephalic trunk - gives rise to right common carotid artery and right subclavian artery
left common carotid artery left subclavian artery |
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name the valves of the heart
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Tricuspid (right AV valve)
Pulmonary (right semilunar valve) Bicuspid (left AV valve) Aortic (left semilunar valve) |
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Tricuspid (right AV valve)
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-located between right atrium and right ventricle
-chordae tendinae and papillary muscles anchor cusps of the valve -auscultate along left sternal border and 5th (or 4th) intercostal spaces |
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Pulmonary (right semilunar valve)
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-located between the right ventricle and pulmonary trunk
-auscultate along left 2nd intercostal spaces |
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Bicuspid (left AV valve)
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-located between left atrium and left ventricle
-chordae tendinae and papillary muscles anchor cusps of the valve -ausculate along apex (left 5th intercostal space, just medial to midclavicular line) |
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Aortic (left semilunar valve)
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-located between left ventricle and aorta
-auscultate along right 2nd intercostal space |
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coronary arteries
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arise from base of aorta and are pressure driven; "backflow" form aortic pressure creates blood flow through coronary arteries
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Right Coronary Artery (RCA)
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-supplies right atrium and ventricle
-nodal branches supply SA and AV nodes -marginal branch of RCA is portion that supplies the right ventricle -posterior interventricular artery (right posterior descending) |
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Left Coronary Artery (LCA)
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-divides into anterior interventricular arter and circumflex artery
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Anterior interventricular artery
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-aka left anterior descending (LAD)
-supplies R/L ventricles and majority of interventricular septum |
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Circumflex artery
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-supplies left atrium and ventricle
-marginal branch is portion that supplies left ventricle |
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Cardiac veins (coronary sinus)
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most of the cardiac veins drain into the coronary sinus
-coronary drains directly into the right atrium -great, middle, small cardiac veins and oblique vein of the left atrium all empty into coronary sinus -anterior cardiac vein and smallest cardiac veins empty directly into right atrium |
