What are the 5 vertical lines of the chest wall called?
- Midline (down centre of sternum)
- Mid-clavicular line (taken from middle of clavicle)
- Anterior axillary line (from fold of muscle at anterior of axilla = front of armpit)
- Mid-axillary line (from middle of axilla + usually widest part of thorax)
- Posterior axillary line (from fold of muscle at posterior of axilla)
What is the origin, insertion, innervation and action of the pectoralis major?
- Origin (where muscle starts) = medial third of clavicle, sternum + costal cartilages
- Insertion (where muscle ends) = humerus
- Innervation = medial + lateral pectoral nerves
- Action = adduction + medial rotation of humerus at shoulder
Which vein runs in the groove between the deltoid and pectoralis major?
What is the origin, insertion, innervation and action of pectoralis minor?
- Origin = ribs 3-5
- Insertion = coracoid process of scapula
- Innervation = medial pectoral nerve
- Action = protraction of shoulder
What is the origin, insertion, innervation and action of serratus anterior?
- Origin = upper 8 ribs
- Insertion = costal surface of scapula
- Innervation = long thoracic nerve
- Action = protraction of scapula
What is the function of the lungs?
Oxygenates blood by bringing inspired air into contact with O2 poor blood in the pulmonary capillaries
What are the two intercostal muscles? What is the innervation of the intercostal muscles?
- Gap between adjacent ribs is closed by external and internal intercostal muscles. Deep to anterior intercostal membrane, muscle fibres run at 90 degrees to external intercostal muscles = internal intercostal muscles
- Intercostal nerves
What does the internal thoracic artery branch into?
- Musculophrenic - supplies diaphragm
- Superior epigastric arteries - supplies front of abdomen
Chest cavities containing lungs are lined by pleura. What are the 2 types of pleura?
- Visceral pleura = on surface of lung
- Parietal pleura = chest wall
The central placed mediastinum has pleural cavities either side. What is the pleural cavity?
A potential space between visceral + parietal pleura
Name 2 functions of the serious fluid within the pleural cavity?
- Lubricates the pleurae
- Creates a surface tension helping the lungs to expand on inspiration
The lung is 'connected' to the mediastinum at the hilum of the lung. What are the 4 main structures found at the hilum of the lung?
- Pulmonary artery x1
- Bronchus x1
- Pulmonary vein x2
- How does the contraction of pectoralis major assist in breathing?
- Which bony structures lie subcutaneously in the anterior chest wall?
- What are the articulations of the clavicle?
- What forms the anterior axillary fold?
- What lies deep to the pectoralis minor muscle?
- The majority of the breast tissue is in the upper outer quadrant of the breast. Where does lymph from this part of the breast drain?
- Which costal cartilage connects to the sternum at the sternal angle (angle of Louis)?
- The two pectoralis muscles form part of a ring of muscles which encircle the thoracic cage; the other muscles forming the ring are the scapula muscles. When the ring contracts the thoracic pressure rises to assist exhalation. This only occurs in disease and during exercise; normal exhalation is a passive process.
- The clavicles and sternum (made up of the manubrium, body and xiphi-sternum). The ribs are deep to muscles so are not subcutaneous.
- At the medial end to the manubrium of the sternum; the sternoclavicular joint and at the lateral end to the acromion of the scapula; the acromioclavicular joint.
- The lower edge of the pectoralis major muscle
- The axilla
- To the axillary lymph nodes
- The second costal cartilage
What other smaller vessels are found at the hilum of the lung?
- Bronchial arteries
- Pulmonary plexus of autonomic nerves
- Lymph nodes
What branch does the right main bronchus give off outside of the right lung?
Superior lobar bronchus
Which lung are inhaled foreign antibodies most likely to be found in and why?
Right lung as right main bronchus is shorter + more vertical
How many lobes does the right lung have? What are they called? What are the two fissures?
3. Superior, middle + inferior. Horizontal (extends from mid-axillary line anteriorly along 4th rib) + oblique (along 6th rib)
How many lobes does the left lung have? What are they called? What is the fissure called?
2. Superior + inferior. Oblique (lies along 6th rib)
What are the 3 surfaces of the lungs?
What are the 3 borders of the lungs?
Describe the innervation of the lungs.
- Parasympathetic innervation derived from vagus nerve
- Sympathetic innervation derived from sympathetic trunks
- Visceral afferent fibres - conducts pain impulses to sensory ganglion
What is the action of parasympathetic innervation in the lung?
Bronchonstriction and vasodilation of pulmonary vessels
What is the action of sympathetic innervation in the lung?
Bronchodilation + vasoconstriction of vessels that are poorly ventilated
What is the surface marking for the apex of the lung?
2 finger breadths (3cm) above the medial clavicle in the neck
What are the surface markings for the lower border of the pleural cavity?
8th rib anteriorly, 10th rib in mid-axillary line + 12th rib posteriorly
What are the surface markings for the lower border of the lung?
6th rib anteriorly, 8th rib in mid-axillary line + 10th rib posteriorly
What are the 3 branches of the arch of the aorta?
- Brachiocephalic trunk
- Left common carotid artery
- Left subclavian artery
What are the branches of the brachiocephalic trunk?
Right common carotid (LHS) and right subclavian (RHS)
Where do the phrenic nerves run?
Run just under mediastinal pleura + run downwards anterior to hilum of lung + pierce dome of diaphragm
Describe the anatomical course of the right phrenic nerve.
Runs adjacent to right brachiocephalic vein + superior vena cava and along right side of heart. Crosses in front of root of lung