Which ribs are true, false and floating, and what does it mean?
True: 1-7 (directly attached to sternum)
False: 8-10 (indirectly attached to sternum)
NB: intercostal spaces and neurovascular structures are named after the rib above
What are A,B and C?
A: jugular notch
B: costal cartilages
C: costal margin
What are the 2 points of articulation of the rib with the vertebrae?
Ribs tilt inferiorly. What level is the 2nd rib at anteriorly?
Label the parts of the sternum
A: Sternal angle
B: xiphoid process
What is unusual about this patient?
May cause problems e.g. impinge on brachial plexus
What happens in inspiration?
Ribs and sternum raises, increase in thorax volume and decrease in pressure, air moves in
Label the 3 layers of chest wall muscles that help move the ribs, and describe their properties.
A: Innermost intercostal - deficient posteriorly - same as internal
B: Internal intercostal - go in opposite direction to external
A & B act as unit.
C: External intercostal - ends anteriorly at mid-clavicular line, forwards and downwards orientation, contract = pull ribs up
What are the intercostal muscles innervated by?
Anterior rami of thoracic spinal nerves
What are A & B?
A: Internal intercostal muscle
B: External intercostal muscle
What order does the neurovascular bundle following the ribs go in?
Label A - D
A: thoracic aorta
B: posterior intercostal artery and vein
C: interior intercostal artery and vein
D: internal thoracic artery and vein
E: azygos vein
Label A and B
A: internal thoracic artery
B: R. subclavian artery
A: Superior vena cava
B: azygos vein
C: hemiazygos vein
Label the major and accessory muscles involved in inspiration, A-F
B: Pectoralis major
C: Rectus abdominis
D: Pec minor
E: Serratus anterior
F: External intercostal muscles
What is the diaphragm innervated by?
Phrenic nerve C3-5
What spinal levels are:
B: Inferior vena cava
What muscles are invovled in quiet inspiration and expiration?
Inspiration: diaphragm, external intercostals
Expiration: passive (muscle recoil)
What muscles are invovled in deep inspiration and forced expiration?
Inspiration: accessory muscles: scalene muscles, SCM, pectoralis minor
Expiration: interosseous part of internal intercostal, adominal muscles, serratus posterior inferior
Label A and B, and what they're innervated by. What is C?
What is between A and B, and what is its function?
A: Visceral pleura, innervated by sympathetic nerves, covers external lung surface
B: parietal pleura, innervated by intercostal nerves T2-12
C: Phrenic nerves C3-5
Pleural fluid, reduces friction so tissue doesn't wear, and creates surface tension. PF produced by parietal pleura.
Where is the lung apex?
Where is the cardiac notch?
What are the pleural boundries?
What is the potential space during quiet respiration, inferiorly, called?
2cm above clavicle
8, 10, 12 post.
Describe and give reasons for the differences in the size and shape of the R and L lungs.
R lung - shorter and wider due to liver
L lung - taller and narrower due to heart
A: horizontal fissure
B and C: oblique fissure
D: lobar bronchus
E: segmental bronchi
F: carina (sternal angle)
Desrcibe the post. and ant. trachea.
Describe how the trachea bifurcates.
C-shaped cartilage ant., smooth muscle post.
R.bronchus - continuum, L.bronchus - goes off horizontally
Describe the flow of air from nose to alveoli.
Trachea -> main bronchus -> lobar bronchus (3 in R, 2 in L) -> segmental bronchi -> conducting bronchioles -> terminal bronchioles -> respiratory brochioles -> alveolar ducts -> alveolar sacs
What is a bronchopulmonary segment?
Subdivision of lobe
Surrounded by CT
Segmental bronchus, artery, lymph vessels and autonomic nerves
Segmental vein lies in CT between segments
A diseased segment can be removed surgically
Describe the route of blood through the pulmonary circuit
R ventricle pumps blood to pulmonary trunk -> pulmonary arteries -> PA carry blood to lungs for gas echange -> oxygenated blood returns to heart in pulmonary veins
B: Cardiophrenic angle
C: costophrenic angle
D: hila of lungs
What anterior rib postion is the diaphragm?