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Oh yeah Anatomy! > Thorax > Flashcards

Thorax Flashcards

1
Q

The sternal angle of Louis is aka?

A

Manubriosternal joint

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2
Q

Which part of the sternum possesses articulation for the ribs?

A

Body. It has the costal notches!

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3
Q

The manubriosternal joint corresponds to what vertebral level?

a. C7
b. T2
c. T3
d. T4

A

d. T4

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4
Q

The Sternal angle of Louis is an important landmark because of the following reasons except:

a. It is where the arch of the aorta starts and ends to become the descending aorta
b. The trachea bifurcates here
c. The third rib articulates with the sternum here
d. The recurrent laryngeal nerve on the left hooks around the arch of the aorta here

A

C. the SAOL or manubriosternal joint corresponds to T4-T5, thus the third rib is NOT expected to articulate at the sternum at this level. the rest are correct, along with the fact that the AZYGOUS vein drains to the IVC at this level.

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5
Q

How many pairs of ribs does a human being have?

A

12!

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6
Q

True ribs

A

1-7, aka vetebrosternal

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7
Q

False ribs

A

8-12, aka vertebrochondral

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8
Q

Floating ribs

A

11 and 12

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9
Q

Which part of a typical rib contains two facets for articulation?

a. Head
b. Neck
c. Tubercle
d. Shaft

A

a. Head. Two facets: one facet for the numerically corresponding vertebra and the vertebra above it. The TUBERCLE has only one facet for the transverse process of the vertebra.

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10
Q

Which part of a typical rib contains the costal groove?

a. Head
b. Neck
c. Tubercle
d. Shaft

A

d. Shaft. The costal groove is found at the inferior border containing the VAN.

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11
Q

When performing an intercostal nerve block, which part of the target rib should you perform the said procedure?

A

Inferior to the target rib because that’s where the costal groove, where the VAN are.

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12
Q

Typical ribs

A

3-9

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13
Q

Atypical ribs

A

1, 2, 10, 11, 12

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14
Q 
Which atypical rib has a tubercle for the attachment of the scaleneus anterior?
a. Rib 1
b. Rib 2
c. Rib 3
D. Rib 10
A

a. rib 1. Eliminate rib 3 because it is typical. remember? :)

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15
Q 
Which atypical rib has a tubercle for the attachment of the ?serratus anterior?
a. Rib 1
b. Rib 2
c. Rib 3
D. Rib 10
A

b. Rib 2

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16
Q 
Which atypical rib has only one vertebral articulating facet?
a. Rib 1
b. Rib 2
c. Rib 3
D. Rib 10
A

D. Rib 10 only articulates with T10 and not to the vertebra above it. Again, eliminate rib 3 because it is typical. 3-9 ang typical. :)

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17
Q

Which atypical ribs has NO neck or tubercle?

a. Ribs 10 and 11
b. Ribs 11 and 12
c. Ribs 8 and 9
d. Ribs 9 and 10

A

b. 11 and 12 do not have necks nor tubercles. Eliminate c and d because 8 and 9 are both typical ribs!

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18
Q

A man involved in a vehicular accident was brought in with respiratory distress. On physical exam, you see flail chest on the right with decreased breath sounds on the same area. An abdominal ultrasound done also shows a potentially lacerated liver. A needle thoracostomy done alleviates his DOB. Which of the following ribs are most commonly involved in such accidents?

a. 1-3
b. 1-4
c. 7-10
d. 11-12

A

C. 7-10. The patient has pneumothorax, the most frequent complication of rib fractures. Flail chest is also a common PE finding. The first sets of ribs, (as mentioned in choice A) are not commonly involved unless the injury is very severe. Organ damage to the liver or spleen can also occur if the lower ribs are involved. Tx: Intercostal nerve block and pain relief after the patient has been stabilized (bleeding managed, respi distress addressed)

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19
Q

What part of the rib is most commonly fractured?

A

Angle of the rib. it’s the weakest area.

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20
Q

The costal margins are formed by?

a. medial ends of the 5-10th costal cartilages
b. medial ends of the 7-10th costal cartilages
c. medial ends of the 10-12th costal cartilages
d. medial ends of the 11-12th costal cartilages

A

b. 7-10

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21
Q

Sternocostal joints are can get osteoarthritis, and this is because they are what type of joint?

A

Synovial joints (ribs 2-7)

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22
Q

A 45 y/o female with no claimed comorbidities and who works as a telephone operator for 20 years comes to the clinic complaining of shock-like pain that travels down her right forearm with associated tingling and weakness. Examination of her right upper extremity reveals 3/5 motor strength in gripping objects and slight atrophy of her hypothenar muscles. Her ulnar and radial pulses in the said extremity were also weaker compared to her left. When she raises her arms above her head, her face becomes very flushed. You posit that her condition might be a result of:

a. hypertrophy of her latissimus dorsi on the right causing impingement of the nerves and blood vessels
b. Hypertrophy of her scalenius medius which impinges the nerves and blood vessels
c. She could have an autoimmune neural and muscular disease which causes the wasting and the paresthesia
d. Idiopathic

A

B. Classic thoracic outlet syndrome! The thoracic outlet (or superior thoracic aperture) is bound by rib 1, which is closely associated to the scalenius medius, subclavian artery and vein and the lower trunk of the brachial plexus. hypertrophy of the said muscle through prolonged and repeated head tilting towards the shoulder (as in her case as a telephone operator for 20 years) could cause impingement of the blood vessels and nerves, hence her symptoms.

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23
Q

All diameters of the chest ____ during inspiration.

A

Increase

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24
Q

Muscle that controls the measurement of the VERTICAL diameter of the chest.

A

Diaphragm. Increased as it moves DOWN during inspiration, opposite during expiration

25
Q

Muscles that control the measurement of the TRANSVERSE diameter

A

Intercostals. Contracts during inspiration to move ribs laterally to increase transv diameter. opposite during expiration

26
Q

When the sternum moves up during inspiration, the AP diameter _____.

A

increases. opposite during expiration

27
Q

Which of the following muscles act to elevate the ribs?

a. Inferior part of Serratus posterior
b. Internal Intercostal
c. Transverse thoracis
d. Levator costarum

A

D. the rest mentioned are DEPRESSORS. Other elevators: EXTERNAL IC, INNERMOST IC, SUBCOSTAL

28
Q

The transthoracic plane is an imaginary line dividing the mediastinum to superior and inferior. the TTP corresponds to which vertebral level?

A

T4

29
Q

Contents of the posterior mediastinum include:

A

Goose, goose, duck, goose, goose!

esophagus, azygous, thoracic duct, hemiazygous, vagus

30
Q

Normal amount of pericardial fluid

A

30-50 ml

31
Q

A patient was stabbed in the chest and was brought to the ER. On PE, he was hypotensive, cyanotic and his neck veins were distended especially evident during inspiration. Auscultation of the heart revealed distant heart sounds. ECG done revealed electrical alternans on all leads and 2D echo done showed the swinging heart sign. You decided to perform xiphosternal pericardiocentesis on the patient. What is the last layer pierced by the needle?

a. Fibrous pericardium
b. Mediastinal pleura
c. Parietal layer of the Visceral pericardium
d. Serous layer of the visceral pericardium

A

D. Layers pierced in a xiphosternal peicardiocent: skin, fascia, rectus sheath, rectus abdominis, fibrous pericardium, serous pericardium (parietal) then blood!!!

32
Q

The following veins drain into the Right Atrium except:

a. Coronary sinus
b. SVC
c. Anterior cardiac
d. Great cardiac

A

D. Drains to the RA: IVC SVC, Coronary sinus, anterior cardiac, branches of the middle cardiac vein (Anterior cardiac and venae cordis minimae)

33
Q

An angiogram of a patient revealed bleeding from a vein beside a vessel identified to be the posterior interventricular artery. The source of bleeding is most probably the:

a. Great cardiac vein
b. Middle cardiac vein
c. Anterior cardiac vein
d. Small cardiac

A

B

34
Q

A patient was brought in for MI. ECG shows an infarct in the left ventricle. Which of the following coronary vessels is occluded?

a. circumflex branch of the left coronary
b. Marginal branch of the right coronary
c. Right coronary
d. anterior interventricular branch of the left coronary

A

A. Circumflex and anterior interventricular: from left; supplies LA and LV and IV septum, RV and apex, respectively. Marginal and post interventricular: from right; supplies Right ventricle

35
Q

Referred pain of angina pectoris, what dermatomal level?

A

t1-5

36
Q

Disruption of of the branches of the vagus nerve to the heart would cause the heart to:

a. beat faster and have a stronger force of contraction and could predispose to arrhythmias eventually
b. beat slower and have a reduced force of contraction and could predispose to arrhythmias eventually
c. No effect
d. none of the above

A

A. Sympathetic overdrive without anything to counteract it (vagus is the parasympathetic nerve supply to the heart; slower HR and reduced force of contraction), then arrhythmias!!

37
Q

The moderator band is a modified trabeculae carnae of which chamber of the heart?

A

Right ventricle. Remember, only ventricles have trab carnae. this is where the papillary muscles originate.

38
Q

The primitive heart undergoes which set of movements as it develops?

a. dorsal bending to the right
b. ventral bending to the right
c. dorsal bending to the left
d. ventral bending to the left

A

B. ventral bending to the right. aka DEXTROrotation.

39
Q

Examination of a 4 month old infant brought into your clinic for cyanosis revealed a machine-like murmur upon auscultation. The heart defect is ____ and it is a _____ shunt.

A

PDA, right to left

40
Q

Your friend’s son, a 10 year-old boy, was brought to you for second opinion. Your friend reports that the patient has been complaining of easy fatiguability and being out of breath for more than a month now. He was given anti-asthma medications by his old doctor which did not seem to work. You ordered several tests. Upon examining his chest XR, you see that his right ventricle is enlarged. 2D echo revealed a large ASD, a patent foramen ovale. Which of the following primitive structures of the heart involved in this defect?

a. Right horn of the Sinus venosus
b. Left horn of the Sinus venosus
c. Bulbus cordis
d. Truncus arteriosus

A

a. Right horn of the Sinus venosus. It forms the RIGHT ventricle, which contains the foramen ovale.
Recall the derivatives:
Left horn of the Sinus venosus: coronary sinus
Primitive atrium: left atrium
Primitive ventricle: Left ventricle
Bulbus cordis: Right ventricle
Truncus arteriosus: aorta and pulmonary trunk

41
Q

Components of TOF

A

Pulmo stenosis
Large VSD
Overriding aorta
Right ventricular hypertrophy

42
Q

Vascular structures in the fetal circulation and their corresponding adult structures

A

Ductus arteriosus - Ligamentum arteriosum
Foramen ovale - fossa ovalis
Ductus venosus - Ligamentum venosum
Umbilical vein - Ligamentum teres
Umbilical arteries - medial umbilical ligaments

43
Q

The ductus arteriosus is the derivative of which aortic arch?

a. 1st
b. 4th
c. 5th
d. 6th

A

d. 6th. divides to right and left. LEFT: DA is from the Distal part; Proximal: left pulmo artery. RIGHT: Right pulmo artery.
Remember, 1-6 aortic arches; numerical order of arches follows that the earlier arches form more proximal branches, later arches are more distal ones. The 5th degenerates. (1st: maxillary, 2nd stapedial. 3rd prox common carotid, 3rd distal internal carotid. 4th left aortic arch, 4th right proximal right subclavian.)

44
Q

The omphalomesenteric veins form the _____ and the cardinal veins form the ______.

A

Portal system; caval system

45
Q

A thoracentesis was performed. Which area in between two ribs in the MAL should the needle be inserted to avoid the lungs?

a. Ribs 2 and 4
b. Ribs 4 and 6
c. Ribs 6 and 8
d. Ribs 8 and 10

A

D. Remember that the lower margins of the lungs are in the 6th rib MCL, 8th rib MCL and 10th rib, sides of the vertebral column. Make the patient exhales as well to expand the pleural cavity. The costal line of pleural reflection at the end of expiration: 8th MCL, 10th MAL, 12th rib vertebral border

46
Q

How many ml of pleural fluid is normally in the pleura?

A

15 ml

47
Q

Which of the two layers of lung pleura is insensitive to pain?

A

visceral

48
Q

The left lung has __ lobes, has ___ fissure/s, has a cardiac notch and a lobe specially called the _____.

A

2; 1 (oblique) fissure; lingula

49
Q

What is the only eparterial bronchus and where is it found?

A

2nd superior bronchus of the right lung

50
Q

Level of the trachea?

A

Between c6 and T4; trachea is 5 inches long

51
Q

A patient with lung cancer in his left superior bronchus will also have segments of his lungs excised. Which of the following bronchopulmonary segments should be removed?

a. Apical, superior, anterior
b. Lateral and medial lingular
c. Apicoposterior, anterior, superior and inferior lingular
d. Superior and anterior basal

A

C. Remember: Right lung: APA LM PALMS. Left lung: APASI PALMS

52
Q

An aspirated foreign body would lodge where in a patient that is supine?

A

Whether standing or sitting, aspirated foreign bodies would go to the right lower lobe. If standing, it will go down lower, so it can reach the posterior basal BPS of the right lobe.

53
Q

An aspirated foreign body would lodge where in a patient that is lying on his left side?

A

Inferior lingular BPS of the LEFT UPPER lobe. If lying to his right, posterior BPS of his left upper lobe!

54
Q

Which of the following muscles is not a muscle of inspiration?

a. diaphragm
b. internal intercostal
c. innermost intercostal
d. SCM

A

B. The EXTERNAL intercostal is the other muscle of inspiration other than the choices mentioned.

55
Q

The bronchial arteries comes from?

A

Thoracic aorta

56
Q

In performing a thoracentesis, you should insert the needle where?

A

Superior to the rib of the target area to avoid damaging the intercostal VAN.

57
Q

A patient with coarctation of the aorta displayed rib notchings in his chest XR. A thoracic aortography revealed tortuous collaterals in several intercostal arteries. Which of the following arteries are the ones that formed collaterals because of decreased blood flow due to the coarctation?

a. Posterior intercostals 1-2
b. Posterior intercostals 3-12
c. Anterior intercostals 1-6
d. Anterior intercostals 7-12

A

B. Remember that the posterior ic generally come from the thoracic aorta except the first two (they come from the costocervical trunk). The anterior ic come from the internal thoracic artery (1-6) and musculophrenic (7-12).

58
Q

Where will you insert the needle in thoracentesis?

A

9th IC, MAL

Oh yeah Anatomy! (3 decks)

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