Anatomy of the Thorax Flashcards
(156 cards)
1
Q
How do ribs articulate posteriorly?
A
With the vertebral column anteriorly, including head neck and tubercle of the rib forming the costovertebral joint
2
Q
Where do the costal cartilages attach to the sternum?
A
1- manubrium
2- munubriosternal join
3-7 - body of the sternum
3
Q
How do ribs articulate anteriorly?
A
With the costal cartilages forming costochondral joints
4
Q
What forms the costal margin?
A
10th rib and costal cartilage
5
Q
What forms the thoracic inlet?
A
1st thoracic vertebra
1st ribs
Manubrium
6
Q
What level is the sternal angle?
A
T4/T5
7
Q
What happens at the sternal angle?
A
Apex of the aortic arch
Bifurcation of the trachea
8
Q
What is the contents of the thoracic inlet?
A
Great vessels heading for the neck and upper limb Oesophagus Trachea Nerves Lymphatics
9
Q
Where is the lung tissue with most capacity for lung expansion located?
A
Lower parts of thorax
10
Q
Which direction do external intercostal muscles travel?
A
Downwards and laterally from the lower border of the rib above to the rib below
11
Q
What type of breathing do external intercostals aid in?
A
Quiet and forced inspiration
12
Q
What type of breathing do internal intercostals aid in?
A
Forced expiration
13
Q
Which layers surround the neurovascular bundle?
A
Internal intercostal muscles and innermost intercostal muscles
14
Q
What is the most superior structure of the neurovascular bundle?
A
Vein
Artery
Nerve
15
Q
Where must a chest drain be places?
A
Inferior part of intercostal space to avoid neurovascular bundle
16
Q
What are the posterior and anterior intercostal arteries branches of?
A
Posterior - aorta
Anterior - internal thoracic artery
17
Q
What is the internal thoracic artery a branch of?
A
Subclavian artery
18
Q
How many pairs of intercostal nerves are there?
A
11
19
Q
Which nerve supplies the 12th rib?
A
Subcostal nerve from T12
20
Q
What runs through the mediastinum?
A
Heart Great vessels Oesophagus Trachea Thymus Thoracic duct Lymph nodes Vagus nerves Phrenic nerves
21
Q
What does the axial skeleton consist of?
A
Skull Vertebra Sacrum Ribs Hyoid bone of throat in the neck Sternum
22
Q
How are the upper limbs attached to the axial skeleton?
A
Bones in upper limb girdle and muscles covering most of chest wall
23
Q
Which are the bones in the upper limb girdle?
A
Clavicle and scapulae
24
Q
Which are the 33 types of vertebrae?
A
7 Cervical 12 Thoracic 5 Lumbar 5 Sacral 4 Coccygeal
25
What forms a synovial joint?
Costal cartilage and sternum
26
What is the most superficial of the pectoral region of muscles?
Pectoralis major
27
What are the two heads of the pectoralis major?
Clavicular
| Sternocostal
28
What is the action of the pectoralis major?
Adduct the arm
29
Where do the muscle fibres of the pectoralis major insert?
Fibres converge to form flat tendon which insert into lateral tip of humerus
Insertion is where muscle exerts the action
30
What underlies the pectoralis major?
Pectoralis minor
| Subclavius
31
Where does the subclavius originate?
Junction between rib I and costal cartilage of inferior surface of the middle third of clavicle
Passes laterally
32
What is the purpose of the subclavius
Pulls clavicle medially to stabilise sternoclavicular joint
33
What is the function of the pectoralis minor?
Depresses the tip of the shoulder, protecting the scapula.
34
What causes notching on the ribs?
Erosion of ribs by dilation of intercostal arteries
35
What is coarction of the artery?
Congenital manifestion where the aorta is constricted, usually ocurring in the left subclavian artery
36
From where does the trachea extend?
C6 to T4/5
37
What is the lowest ring of the trachea?
Carina (has a hook)
38
Where is the main bronchi formed?
T4/5
39
Where are the lobar bronchi formed?
Within lungs
40
What do the lobar bronchi supply?
Lobes of lung
41
What do the segmental bronchi supply?
Bronchopulmonary segments
42
How many lobes does each lung have?
Right- 3 (Superior, inferior, middle)
| Left - 2 (Superior, inferior)
43
Why is anything inhaled more likely to enter the right lung rather than the left?
The right bronchi is wider and more vertical
44
How many bronchopulmonary segments are in each lung?
10
45
How are the lungs attached to the heart?
Pulmonary vessels and trachea through the hilium
46
What are the three borders of the lung?
Costal, mediastinal and diaphragmatic
47
How can a stab wound in the neck cause lung damage?
Lung can extend into supraclavicular fossa
48
What does the diaphragm separate the lungs from?
Right lung- right lobe of liver
| Left lung - left lobe of liver, stomach, spleen
49
Which fissures separate the lobes in the right lung?
Oblique and horizontal
50
What is the lingular lobe?
What would have been the third lobe of the left lobe which becomes vestigial as heart takes up the space
51
What is in the root of the lung?
```
Two pulmonary artery
Two pulmonary veins
Primary bronchus
Bronchial arteries and nerves
Plumonary plexus of nerves
Lymph nodes and vessels
```
52
In the lung root, what are the most anterior, posterior and inferior structures?
Anterior - pulmonary vein
Inferior - another pulmonary vein
Posterior - Primary bronchus
53
What are the hiatuses of the diaphragm?
T8- Vena caval hiatus (and phrenic nerve)
T10 - Oesophageal hiatus
T12- Aortic hiatus (and thoracic duct, lymph vessels and azygous system of veins)
54
What is the margin of the diaphragm attached to?
Costal margin
Xiphoid process
Ribs 10 & 11
Lumbar vertebra
55
Where is the jugular notch?
Above manubrium
Between medial ends of clavicle
Where is the
56
Where is the fourth intercostal space
Usually level with the male nipple
| Female nipple is lower
57
Where is the midaxillary line?
Lateral ends of clavicles
58
What is the first palpable vertebra?
C7
59
Where is the superior edge of the scapula?
T2
60
Where is the medial edge of the scapula?
T3
61
What runs level with the inferior edge of the scapula?
T7
62
What runs level with the iliac crests?
L4
63
What is half way between T7 and L4?
T12
64
What is the cardiac notch?
At 4th costal cartilage, lateral deviation of 4-5cm where heart lies
65
What are the surface markings of the lung?
Rib 6, 8 9 from sternum to midclavicular line to midaxilliary line
66
Where does the oblique fissure meet the horizontal fissue?
Mid-axilliary line
67
Where is the oblique fissure marked?
T3/6th costal cartilage
68
Where is the horizontal fissure marked?
T4, running horizontally to meet oblique fissure
69
Where is the biggest impression in left lung?
Impression of aorta, arches over hilium and enters left atrium of heart
70
What is the anterior impression near the apex of the lungs?
Left and right brachiocephalic vein
71
What is the posterior impression near the apex of the lungs ?
Left and right subclavian artery
72
What is the impression above the hilium of the right lung?
Azygous vein which enters the vena cava
73
From where does the mediastinum extend?
Superior thoracic inlet to diaphragm
| Sternum to vertebrae
74
What are the boundaries of the superior mediastinum?
From the superior thoracic aperture to the sternal angle
75
What are the areas of the inferior mediastinum?
Anterior (anterior to pericardium)
Middle (contains heart and pericardium)
Posterior (posterior to pericardium and extends all the way down
76
What do the posterior intercostal veins drain into?
Azygous veins
77
What does the azygous vein drain into?
Superior vena cava
78
What do the left superior intercostal veins drain into?
Left brachiocephalic vein
79
Which arteries are located in the superior mediastinum?
ascending aorta, Arch of aorta, thoracic aorta
80
From where do the vertebral arteries arise?
Subclavian arteries
81
What are the main arteries of the head and neck?
The external and internal common carotid's which arise from the common carotid artery at the level of the jaw
82
What is the purpose of the ligamentum arteriosus?
Connects the pulmonary trunk to the inferior surface of the aortic arch
83
What arteries supply each lung?
Left and right pulmonary arteries which arise from the pulmonary trunk
84
What is the motor supply of the diaphragm?
C3, C4, C5
85
To reach the diaphragm, which structure does the right phrenic nerve lie on the side of?
Right brachiocephalic vein
Superior vena cava,
Right side of the heart and pericardium
Passes anteriorly to the lung root
86
What is the somatic nerve supply to the heart?
Vagus nerves
87
Where does the left vagus nerve pass?
Lateral to the common carotid
Anterior to the arch of the aorta
Posterior to the pulmonary trunk
88
What is the left recurrent laryngeal nerve a branch off?
Left vagus nerve, underneath the ligamentum arteriosum
89
Where does the right recurrent laryngeal nerve branch off?
Right subclavian artery
90
What are commonly used techniques for imaging of the chest?
CAT scan
MRI
Radiography
91
What is an x ray commonly done in the postero-anterior direction?
Heart is closest to the film and not distorted
92
What is a pulmonary artery angiogram?
Radioplaque material passed through the pulmonary artery and is imaged as it passes through the arterial trunk
93
When a barium meal is given during a radiograph, what three impressions can be seen on the oesophagus?
Aortic arch
Left main bronchus
Left atrium
94
What is lung hilar lymphodenopathy?
The abnormal enlargement of mediastinal lymph nodes
| Caused by sarcoidosis and lymphoma
95
What are dermotomes?
Areas of skin which are innervated by single spinal nerves
96
What are myotomes?
Areas of skeletal muscle that are innervated by a single spinal nerve
97
What are the main somatic nerves of the throax?
```
Intercostal nerves (T1-T11)
Subcostal nerves (T12)
Phrenic nerves (C3 C4 C5)
```
98
What happens if there is damage to the spinal chord above C4?
The skeletal muscle of the diaphragm is disconnected from the respiratory centre of the brainstem leading to death by asphyxia
99
How does the right phrenic nerve reach the diaphragm?
Runs down neck in muscles arising from transverse cervical processes and enters mediastinum
Follow the path of the right internal jugular vein as it joins the right subclavian vein to form the right brachiocephalic vein.
Follows the RBV and the right atrium via the fibrous pericardium
Follows the inferior vena cava and to the diaphragm at the vena caval hiatus and reaches the inferior surface of the diaphragm
100
How does the left phrenic nerve reach the diaphram?
Follows the left common carotid artery until the level of the subclavian artery then passes over the aortic arch and pulmonary trunk to reach the anterolateral surface of the pericardium overlying the left ventricle
101
Where do phrenic nerves pass in respect to the lung root?
Anterior to lung root
102
Where is diaphragmatic pain felt?
Top of shoulder
| Base of neck
103
Where do sympathetic pre-ganglionic trunks lie?
The spinal chord between T1-L2
104
Where do sympathetic nerves to the body wall synapse?
Sympathetic trunk
105
Where do sympathetic nerves to viscera synapse?
Unpaired ganglia
106
How do fibres from lower T5-T12 reach the abdomen?
In bundles called splanchnic nerves
107
Which five sets of nerves contain parasympathetic fibres?
```
Occulomotor (III) cranial
Facial (VII) cranial
Glossopharyngeal (IX) cranial
Vagus (X) cranial
Sacral (L2-L4) spinal nerves
```
108
Where do sympathetic nerves to the lungs and heart originate?
T2-T4
| Passing through cervical and upper thoracic ganglia of the sympathetic trunk
109
What is the affect of sympathetic and parasympathetic nerves on the bronchioles?
Sympathetic- dilate
| Parasympathetic- constrict
110
What do sympathetic and parasympathetic afferents relay from the hear?
Sympathetic- pain sensations
| Parasympathetic - blood pressure and chemistry information
111
What is the course of the vagus nerves?
From cranial nerve X
From medulla, leaves head through jugular foramina.
Passes postero-laterally to the common carotid artery.
Left vagus nerve passes anteriorly to aortic arch and posteriorly to lung root
Right vagus nerve passes posteriorly to lung roots
The two meet and form plexi at oesophagus
Split to form anterior and posterior oesophageal/gastric nerves
112
Which branch of the vagus nerve is not parasympathetic?
Recurrent laryngeal nerve
| Runs back up to supply most skeletal muscles of the larynx
113
How does the right vagal fibre continue through the diaphragm?
As the posterior oesophageal nerve
114
How does the left vagal fibre continue through the diaphragm
As the anterior oesophageal nerve
115
Where is pain from the heart felt?
In armpit
| T2-T4 dermatomes
116
How would an outline of the heart be drawn
On the right:
1st costal cartilage, 1 cm from sternal border
6th costal cartilage, 1 cm from sternal border
On the left:
2nd costal cartilage, 1cm from sternal border
5th costal cartilage, midclavicular line
117
Where would you auscultate the aortic valve?
Right upper sternal border
| 2nd intercostal space
118
Where would you auscultate the pulmonary valve?
Left upper sternal border
| 2nd intercostal space
119
Where would you auscultate the tricuspid valve?
Left 5th costosternal border
120
Where would you auscultate the mitral valve?
Left 5th intercostal space at apex beat
121
In which groove does the right coronary artery lie?
Right atrioventricular groove
122
How many lymph nodes are there in humans?
600-700
123
How long is a lymph node?
2.5 cm
124
Where are lymph nodes most commonly located?
Armpits
Groin
Neck
125
Where does lymph from the deep inguinal nodes drain into?
Into iliac arteries to para aortic arteries
Along with lymph from pre-aorta arteries, lymph collects in cysterna chyli
Then drains into thoracic duct and then the left brachiocephalic vein
126
Where does the cysterna chyli drain lympph from?
Abdomen
Pelvin
Perineum
Lower Limbs
127
At what level does the thoracic duct begin?
L2
128
How does the thoracic duct enter the thorax?
Through the aortic hiatus
| Posterior to the oesophagus
129
At what level does the thoracic duct cross over to the left?
T5
130
Where does lymph from the thoracic wall drain into?
Parasternal nodes
Intercostal nodes
Diaphragmatic nodes
131
Which vessels drain lymph from the lungs?
Tracheobronchial
132
Which vessels drain lymph from the heart?
Tracheobronchial
| Brachiocephalic
133
Which vessels drain lymph from the posterior mediastinum?
Nodes of the aorta recieve lymoh from the oesophagus, liver and pericardium
This drain into the thoracic duct and the posterior mediastinal vessels
134
From which ribs does the female breast extend?
2-6
135
What type of tissue is the mammary gland?
Modified and specialised apocrine tissue
136
When do mammary ridges develop?
In the fourth week after gestation
137
When does the mammary gland develop?
Six week gestation
| From the primary bud
138
Where does the lactiferous bud develop from?
Primary bud develops into secondary bud which develops into lactiferous bud and its branches
139
What happens to the breasts at birth?
Main lactiferous buds are formed
| Secretion from the breasts as a result of maternal hormones
140
What happens to the breasts during puberty in female?
Fat and connective tissue develops
| There is growth of the duct system
141
How many ducto-lobular units are in the breast?
15-20
142
What is the fibrous septae that divides the organ?
Suspensory ligaments of Cooper
143
What causes breasts to sad with age?
Suspensory ligaments lose effectiveness
Fat ratio decreases
There is loss of function with senescence
144
Which muscles does the breast overlie?
Pectoralis major
Serratous interior
External oblique
145
Where is the blood supply of the breast derived from?
```
Branches of:
Lateral thoracic artery
Internal thoracic artery
Thoraco-acromial artery
Thoraco-dorsal artery
Intercostal artery
```
146
How is blood supplied to the skin of the breast?
Subdermal plexus
147
How is blood supplied to the nipple/areola?
Branch of the internal thoracic artery
148
What is the nerve supply of the breast?
Anterior cutaneous branch of the thoracic intercostal nerve from T3-T5
149
What is the nerve supply of the nipple/areola?
Lateral cutaneous branch arising from T4
150
Where does lymph in the superficial and deep parts of the breast drain?
Superficial- subareolar plexus
Deep- submammary plexus
From these plexi, lymph is drained into the axillary nodes
151
What abnormalities can be seen in the breast?
Polythemia- extra nipple
Polymastia- extra breast
Athelia- absence of nipple
Amasta- absence of breast
152
Where are the four constriction locations of the oesophagus?
The junction of the pharynx and the oesophagus
Where the aortic arch presses down on the oesophagus
Where the left main bronchus presses down on the oesophagus
The oesophageal hiatus
153
Describe the arterial supply and venous return of the the oesophagus
Arterial- directly from aorta via oesophageal branches
| Venous- via the oesophageal arteries to azygous and hemiazygous veins
154
Where does the greater splanchnic nerve arise and end?
From T5-T10/11 to coeliac ganglion
155
Where does the lesser splanchnic nerve arise and end
From T9-T10 or T10-T11 to adrenocortical ganglion
156
Where does the least splanchnic nerve arise and end?
From T12 to renal plexus
