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ANAT380 > Module 1: The Thoracic Wall > Flashcards

Module 1: The Thoracic Wall Flashcards

1
Q

Diaphragm

A

Thin musculotendinous septum that separates the thoracic and abdominal cavities

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2
Q

Diaphragm function

A

Respiration
Contracts and its dome flattens to increases volume in thoracic cavity

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3
Q

Features of the diaphragm

A

Right dome
Left dome
Central tendon
Right and left crus

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4
Q

Right dome

A

Rises to upper border of fifth rib

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5
Q

Left dome

A

Rises to lower border of fifth rib

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6
Q

Central tendon

A

Where the peripheral muscle fibres of diaphragm attach to inferior margin of thoracic cage and lumbar vertebrae

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7
Q

Right crus

A

Originates from anterolateral surface of upper 3 lumbar vertebrae

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8
Q

Left crus

A

Originates from anterolateral surface of upper 2 lumbar vertebrae

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9
Q

Apertures of the diaphragm

A

Caval opening
Esophageal hiatus
Aortic hiatus

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10
Q

Caval opening

A

In central tendon at T8
Opening for IVC

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11
Q

Esophageal hiatus

A

In right crus at T10
Opening for esophagus

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12
Q

Aortic hiatus

A

Btwn left and right crus, anterior to T12
Opening for abdominal aorta

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13
Q

External intercostals

A

Fibres run anteroinferiorly from lower border of rib
Elevate ribcage during inspiration

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14
Q

Internal/innermost intercostals

A

Fibres run posteroinferiorly from upper border of rib
Depress rib cage during expiration

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15
Q

Injury to intercostal muscles

A

Results from twisting and reaching upwards causing swelling, pain and muscle tightness

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16
Q

Manubriosterbal joint

A

Sternal angle or angle of Louis
In line w 4th and 5th vertebrae
Easily palpable forming a clinical landmark

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17
Q

Xiphoid process

A

Attaches to sternal body at xiphisternal joint
In line w T9

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18
Q

Intervertebral discs

A

Annulus fibrosus
Nucleus pulposus

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19
Q

Annulus fibrosus

A

Outer ring of disc made of fibrocartilage
Resists shear forces

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20
Q

Nucleus pulposus

A

Gelatinous structure that resists compressive forces

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21
Q

DDx: Herniated (slipped) disc

A

Results from bulging of nucleus pulposus through weak spots of the annulus fibrosus
Symptoms: localized back pain, numbness and weakness along lower thoracic cage

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22
Q

What happens to the intervertebral disc if the annulus fibrosus ruptures completely?

A

The protruding nucleus pulposus can compress contents of the intervertebral foramen (spinal nerves)

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23
Q

Possible injuries to ribs

A

Rib fracture
Bruising
Inflammation of costal cartilage

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24
Q

DDx: Fractured rib

A

Crack or break in ribs caused by a direct blow to the chest
**break in costal cartilage can be considered a rib fracture
Symptoms: injury to internal organs, localized chest and back pain, pain associated with inhalation/exhalation

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25
Q

Thoracic apertures

A

Thoracic inlet (superior)
Thoracic outlet (inferior)

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26
Q

Thoracic inlet

A

Formed by manubrium, rib 1, body of T1
Allow for passage btwn thorax and neck

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27
Q

Thoracic outlet

A

Formed by xiphoid process, costal margin, rib 11 and 12 and body of T12
Allows for passage btwn thorax and abdomen

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28
Q

DDx: Thoracic outlet syndrome

A

A conditon when blood vessels/nerves passing through the thoracic inlet are compressed causing pain in the neck and shoulders and numbness in fingers

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29
Q

Common causes of thoracic outlet syndrome

A

Physical trauma, repetitive injuries, anatomical defects, pregnancy

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30
Q

Internal thoracic arteries

A

Paired (right and left) arteries that run on either side of sternum and supply the anterior thoracic wall

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31
Q

Where do anterior intercostal arteries arise from and travel?

A

Arise from internal thoracic arteries
Travel in costal grooves of ribs and anastomose with posterior intercostal arteries

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32
Q

Posterior intercostal arteries

A

Branch of thoracic aorta
Travel anteriorly to anastomose w anterior intercostal arteries

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33
Q

Subcostal arteries

A

12th pair in intercostal space
Run inferior to costal margin

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34
Q

Veins of thoracic region

A

Anterior and posterior intercostal veins, subcostal veins
Drain deoxygenated blood into heart

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35
Q

Inferior vena cava

A

Principal vessel draining lower body
Travels through caval opening at T8

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36
Q

Hemothorax

A

Accumulation of blood in the pleural cavity due to damage to intercostal artery

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37
Q

Thoracic spinal nerves

A

Rami and branches

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38
Q

Rami of thoracic spinal nerves

A

After exiting the intervertebral foramen each thoracic spinal nerve divides into a dorsal (posterior) ramus and a ventral (anterior) ramus

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39
Q

Ventral rami

A

Intercostal nerves
Run in costal grooves of corresponding ribs

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40
Q

Dorsal rami

A

Supply deep muscles of back and skin

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41
Q

Branches of thoracic spinal nerves

A

Cutaneous branches
Muscular branches to intercostal and anterolateral muscles

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42
Q

Cutaneous (sensory) branches

A

Branch from intercostal nerves
Lateral cutaneous branch and anterior cutaneous branch

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43
Q

Intercostal nerves 1-6

A

Innervate intercostal muscles of the thoracic wall and overlying skin

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44
Q

Intercostal nerves 7-12 (and subcostal nerve T12)

A

Supply abdominal muscles and overlying skin

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45
Q

Phrenic nerves

A

Left and right
Formed by union of C3, C4, C5
Motor innervation to diaphragm, sensory innervation to central tendon

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46
Q

Internal structures of the breast

A
  1. Lobes
  2. Suspensory ligaments
  3. Lactiferous ducts
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47
Q

Lobes of the breast

A

Each breast divided into 15-20 lobes that contain mammary glands

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48
Q

Suspensory ligaments of Cooper

A

Separate lobes and support breast

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49
Q

DDx: Mammary duct ectasia

A

Condition in which lactiferous ducts widens causing duct walls to thicken leading to nipple discharge, breast tenderness and breast lumps
Symptoms: can be asymptomatic
**more common in perimenopausal women

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50
Q

DDx: Torn pectoralis muscle

A

Can occur due to the placement of an implant during breast augmentation surgery
Symptoms: localized swelling at breast, weakness, reduced range of motion of shoulder

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51
Q

Arterial supply of lateral breast

A

Lateral thoracic arteries (branches of axillary artery)

52
Q

Blood supply of medial breast

A

Branches of internal thoracic artery

53
Q

DDx: Paget’s disease of the breast

A

Rare form of breast cancer that can spread via arterial vessels or lymphatic system
Symptoms: nipple changes in shape and crusting of lactiferous products

54
Q

Regions of the thorax concentrated with lymph nodes

A
  1. Axillary nodes (lateral)
  2. Parasternal nodes (medial)
  3. Supraclavicular nodes (superior)
55
Q

DDx: Intraductal papilloma

A

Small benign palpable tumor in lactiferous duct proximal to nipple
Symptoms: swollen axillary and/or parasternal lymph nodes

56
Q

Pericardium

A

Sac surrounding heart and vessels

57
Q

DDx: Pericarditis

A

Inflammation of the pericardium causes abnormal buildup of fluid in pericardial cavity
Symptoms: diaphragmatic spasms, shortness of breath and chest
**idiopathic

58
Q

Innervation of the heart

A

The phrenic nerve provides sensory innervation to the fibrous pericardium and serous parietal pericardium

59
Q

Pericardial layers of the heart

A

**Outer to inner
Fibrous
Parietal layer
Serous fluid in pericardial fluid
Visceral layer

60
Q

DDx: Referred pain in a heart attack

A

Pain associated with the heart is felt in shoulder and neck region due to cervical nerves C3, C4, C5 (phrenic nerves)

61
Q

Left ventricular outflow tract

A

Aortic orfice
Aortic valve: 3 semilunar cusps and 3 aortic sinuses

62
Q

Right ventricular outflow tract

A

Infundibulum or conus arteriosus–> leads to pulmonary trunk
Pulmonary orfice–> pulmonary valve which consists of 3 semilunar cusps

63
Q

DDx: Hypertrophic cardiomyopathy

A

Long excessive endurance exercise leads to enlargement of the muscle in the left ventricular walls
Symptoms: shortness of breath, chest pain during exercise, fainting

64
Q

DDx: Mitral valve prolapse

A

Backflow of blood from left ventricle to left atrium
Associated with heart palpitations

65
Q

Cause of mitral valve prolapse

A

Mitral valve cusps dont close properly due to abnormally long or short chordae tendinae or malfunctioning papillary muscles

66
Q

The interventricular septum

A

Divides left and right ventricles
Separates oxygenated and deoxygenated blood

67
Q

Parts of interventricular septum

A
  1. Thick muscular part
  2. Thin upper membranous part
68
Q

What is a ventricular septal defect?

A

Incomplete formation of interventricular septum, leaving an opening btwn right and left ventricles

69
Q

Most common site for a interventricular defect?

A

Membranous part of interventricular septum

70
Q

Symtoms/causes of interventricular septum defect

A

Thickened ventricular walls and interventriculular septum
Left to right shunting of blood flow

71
Q

Calcified aortic stenosis

A

Fibro-calcific remodelling and thickening of the aortic valve leaflets that evolve over years causing obstruction to cardiac outflow

72
Q

Symptoms of calcified aortic stenosis

A

Shortness of breath, chest pain, feeling faint or dizzy when exercising

73
Q

Three main branches of the aorta

A
  1. Brachiocephalic
  2. Left subclavian
  3. Left common carotid
74
Q

Brachiocephalic trunk

A

Ascends 4-5 cm before it bifurcates into right common carotid and right subclavian arteries

75
Q

DDx: Aortic aneurysm

A

Balloon like buldge in aorta
Interferes w oxygenated blood delivery to body from heart

76
Q

Symptoms of aortic aneurysm

A

*Symptoms only present when dilation is sufficiently large
Chest or back pain
Difficulty breathing
Shortness of breath

77
Q

What is the flow of blood from the left ventricle?

A

Aorta->brachiocephalic artery->left common carotid artery->left subclavian artery

78
Q

Origin of right internal thoracic artery

A

Right subclavian

79
Q

Origin of left internal thoracic artery

A

Left subclavian artery

80
Q

What arteries do the left and right sinuses of the aorta give rise to?

A

Left and right coronary arteries

81
Q

What arteries does the posterior aortic sinus give rise to?

A

None

82
Q

What do the left and right coronary arteries create?

A

An anastomoses to form a circle in the coronary sulcus (atrioventricular sulcus)
Loop in the interventricular sulcus btwn the ventricles

83
Q

Why is a circle/loop arrangement of arteries advantageous?

A

Sets up a backup blood supply
If theres plaque buildup in a vessel, the blood can reroute via an alternate path
Ensures constant blood supply

84
Q

DDx: Coronary artery disease

A

A blockage in the coronary artery circle and loop arrangement of the heart that arises from an aortic sinus

85
Q

Symptoms of coronary heart disease

A

Chest pain and shortness of breath

86
Q

What happens if there is a complete blockage of a coronary artery?

A

Heart attack

87
Q

Coronary bypass surgery

A

Arteries/veins from other areas of body are transplanted to heart to divert blood flow around an occluded section of blocked artery

88
Q

Angioplasty

A

Balloon catheter inserted into blocked artery and inflated to dilate it

89
Q

Pleural recesses

A

Potential spaces of pleural which are not filled with lung tissue during expiration

90
Q

Types of pleural recesses

A
  1. Costomediastinal recess
  2. Costodiphragmatic recess
91
Q

DDx: Pleural effusion

A

Buildup of excess pleural fluid in the pleural cavity btwn the parietal and visceral pleura of the lungs
Impairs ability of lungs to expand

92
Q

Symptoms of pleural effusion

A

Difficulty breathing and pain extending into shoulder/neck region due to phrenic nerve irritation

93
Q

What can pleural effusions be caused by?

A

Underlying heart failure or cirrhosis

94
Q

Costomediastinal recess

A

Right and left
In anterior thorax btwn the costal and mediastinal parietal pleura

95
Q

Left costomediastinal recess

A

Larger and overlies heart

96
Q

Why is it imp to distinguish btwn the right and left costomediastinal recesses?

A

To determine site of pleural effusion

97
Q

Costodiaphragmatic recesses

A

Located btwn costal and diaphragmatic pleura, below inferior part of lungs
Clinically significant landmarks in pleural effusion

98
Q

Innervation of parietal pleura

A

Intercostal nerves and phrenic nerves

99
Q

Innervation of visceral pleura

A

Autonomic innervation
Not sensitive to pain, temp or touch but it is sensitive to stretch

100
Q

Root of the lungs (hilum)

A

Collection of structures that enter and exit the lungs
Connect lungs to trachea and heart

101
Q

DDx: Pulmonary arterial hypertension (PAH)

A

Condition in which patient has high blood pressure in the pulmonary arteries

102
Q

Structural changes resulting from PAH

A

Pulmonary artery walls become stiff, swollen and thick causing scarring, clots and build up of plaque

103
Q

Changes to blood flow caused by PAH

A

Impedes or occludes blood flow to lungs, increasing pressure in pulmonary arteries and veins and compressing adjacent bronchi

104
Q

Consequences of PAH on the heart

A

Heart is required to generate a greater force to direct deoxygenated blood through pulmonary arteries to lungs

105
Q

Cardiac dysfunction resulting from PAH

A

Prolonged exertion weakens the cardiac muscle resulting in tightness in thoracic wall, shortness of breath, fatigue and fainting

106
Q

Where do brachiocephalic veins drain into?

A

Superior vena cava

107
Q

Where does the azygos vein travel and drain into?

A

Enters thorax through aortic hiatus (T12), ascends to right of thoracic vertebral bodies, drains into SVC

108
Q

Where do the posterior intercostal veins drain into?

A

Directly into azygos vein

109
Q

Tributaries of the azygos vein

A

Hemiazygos veins
Acessory hemiazygos veins
Right posterior intercostal veins
Right bronchial veins

110
Q

Hemiazygos veins

A

Lies left to thoracic vertebrae and drains the left posterior intercostal veins

111
Q

Acessory hemiazygos veins

A

Lie left of thoracic vertebrae, superior to hemiazygos vein and drains the left posterior intercostal veins

112
Q

Right posterior intercostal veins

A

Drain directly into the azygos vein

113
Q

Right bronchial veins

A

Remove deoxygenated blood from lungs

114
Q

What area of the body does the thoracic duct drain lymph from?

A

Left side of head, neck, thorax, left upper limb and all structures below diaphragm

115
Q

What area of the body does the right lymphatic duct drain lymph from?

A

Right side of head, neck, thorax and right limb

116
Q

Types of lymph nodes

A
  1. Pulmonary
  2. Bronchopulmonary (hilar)
  3. Tracheobrachial
  4. Paratracheal
  5. Bronchomediastinal trunks
117
Q

DDx: Sarcoidosis

A

Inflammatory disease causing abnormal masses to form in pulmonary, bronchopulmonary and paratracheal lymph nodes
These enlarged lymph nodes compress airways

118
Q

Symptoms of sarcoidosis

A

Persistant dry cough, fatigue, shortness of breath, tightness in chest
Rarely pain

119
Q

Arterial supply of lung

A

Descending aorta provides oxygenated blood to thorax and bronchial arteries supply the lungs

120
Q

DDx: Anxiety and Dyspnea

A

Anxiety (fight or flight) can lead to the constriction of bronchial arteries resulting in decreased blood supply to lungs

121
Q

Symptoms of anxiety and dyspnea

A

Shortness of breath (dyspnea), tightness in chest, hyperventilation, fainting, nausea

122
Q

Compartments of the mediastinum

A

Superior and Inferior
Inferior is divided into anterior, middle and posterior

123
Q

Superior mediastinum

A

Posterior to manubrium and sternum, anterior to first 4 thoracic vertebrae

124
Q

Inferior mediastinum

A

Superior border is the superior mediastinum, inferior border is diaphragm

125
Q

Anterior mediastinum

A

Extends from sternum to anterior border of pericardium

126
Q

Middle mediastinum

A

Btwn anterior and posterior borders of pericardium

127
Q

Posterior mediastinum

A

Extends from posterior pericardium to posterior thoracic wall

ANAT380 (8 decks)

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