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Flashcards in Anatomy part 2 Deck (85)
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1

Superior part of the trunk between the neck and the abdomen.

Thorax

Thoracic cage:
*12 pairs of Ribs
*sternum
*costal cartilages
*12 thoracic vertebra
*skin, fascia and muscles

2

Bones that made up the Thorax

Sternum: common site of marrow biopsy
Ribs
Thoracic vertebra

3

Bones that made up the Sternum.

MANUBRIUM
*superior part
*clinical landmark when counting ribs
*corresponds to T4 vertebra level
*suprasternal notch-palpable superiorly
*clavicular notch-articulate with clavicle
*manubriosternal joint-inferior
BODY
*longer, thinner, narrower
*costal notches-articulates with costal cartilages
*manubriosternal joint above; xiphisternal joint below
XIPHOID PROCESS
*thin, sword shaped, smallest
*cartilaginous at birth; becomes bony at 40
*lies opposite the body of the 9th thoracic vertebra

4

All of the following features occur at the level of sternal angle, except:
a, Trachea bifurcates into R/L bronchi
b. 3rd rib articulates with sternum
c. Aortic arch begins
d. Aortic arch ends

d. Aortic arch ends

STERNAL Triangle
*horizontal plane intersecting sternal angle and disk between T4 and T5
*trachea bifurcates into primary bronchi
*arch or the aorta arises from ascending aorta and continues as the descending aorta
*azygous vein drain into SVC

5

1st to 7th ribs.

True ribs/Vertebrosternal

True ribs: 1st-7th
False ribs proper: 8th, 8th, 10th
Floating ribs: 11th, 12th

Typical ribs: 3-8
Atypical ribs: 1, 2, 10, 11, 12

6

False ribs/Vertebrochondral ribs.

8th to 12th rib

False ribs proper: 8th, 8th, 10th
Floating ribs: 11th, 12th

Typical ribs: 3-8
Atypical ribs: 1, 2, 10, 11, 12

7

Wedge shaped part of rib with 2 articular facets for articulation; Facets separated by crest.

Head of Rib

8

Stout and Flat part of rib between head and tubercle.

Neck of rib

9

Have facets which articulates with transverse process of the numerically corresponding vertebra.

Tubercle

10

Thin, Flat, curved; angle- where rib curves and twists
costal groove- at inferior border to protect IV nerves and BV

Shaft

11

The body of the T4 vertebra articulates with which of the following part of the ribs?
a. Head of the 3rd rib
b. Neck of the 4th rib
c. Tubercle of the 4th rib
d. Head of the 5th rib
e. Tubercle of the 5th rib

d. Head of the 5th rib

Articulations
*HEAD of Rib=BODY of THORACIC vertebra
*TUBERCLE of Rib=TRANSVERSE PROCESS of vertebra

e. g.
5th Rib HEAD=superior articular facet=BODY of T4
=inferior articular facet=BODY of T5
5th Rib TUBERCLE=TRANSVERSE PROCESS of T5

12

Rarely fractured; Broadest and most curved with prominent scalene tubercle for attachment of scalenus anterior muscle.

1st Rib

*close relationship to the lower nerves of brachial plexus and subclavian artery/vein

Anterior: subclavian vein crosses
Posterior: subclavian artery and the lower trunk of the brachial plexus crosses

13

Atypical rib that is thinner, less curved, longer and has tuberosity for serratus anterior muscle.

2nd Rib

rib 10: articulates with T10 vertebra ONLY

14

Atypical ribs, short, have single facet on their heads; No neck or tubercle.

Rib 11-12

rib 10: articulates with T10 vertebra ONLY

15

Common area of fracture on ribs.

Anterior to the ANGLE of the Rib.

*weakest point of the rib
*commonly 7-10 ribs
*may cause Pneumothorax; Diaphragmatic hernia (lower part)

16

This is where the thoracic cavity communicates with the root of the neck; where important vessels and nerves emerge from the thorax to enter the neck and upper limbs.

THORACIC INLET

Boundaries:
🔘Post: T1
🔘 Lat: Medial border or first rib
🔘Ant: Manubrium sterni

17

Symptoms caused by pressure on the lower trunk of plexus producing pain down and medial forearm and hand; wasting hand muscles.

Thoracic OUTLET Syndrome

✔pressure of the blood vessels may compromise the circulation of the upper limb
✔brachial plexus and subclavian artery/vein related to upper surface of the 1st rib and clavicle

18

Relationship of VERTICAL Diameter of thoracic wall on Respiration.

INSpiration: INCreases; diaphragm moves down
Expiration: DECreases; diaphragm moves up

19

TRANSVERSE diameter of thoracic wall as described by "Bucket-handle inspiratory movement".

TRANSVERSE diameter

"Bucket-handle inspiratory movement"
🔘IC muscle contract
🔘ribs moves laterally (covex)
🔘INCrease in diameter

20

TRANSVERSE diameter of thoracic wall as described by "Pump-handle inspiratory movement".

ANTEROPOSTERIOR diameter

"Pump-handle inspiratory movement"
INSpiration: Sternum moves UP; INCreases
Expiration: Sternum moves DOWN; DECreases

21

Muscles use in inspiration.

Muscles that ELEVATE the ribs:
✔Serratus posterior SUPerior muscle
✔Levators
✔External and Innermost IC
✔Subcostal

22

Muscles use in expiration.

Muscles that DEPRESS the ribs:
✔Serratus posterior INFerior muscle
✔Internal IC
✔Transverse thoracis

23

The mediastinum is divisible into superior and inferior divisions by an imaginary plane passing from the angle of Louie anteriorly and ____ posteriorly.
a. Lower border of T4
b. Upper border of T4
c. Lower border of T6
d. Upper border of T4

a. Lower border of T4

anterior: angle of Louie
posterior: lower border of T4 (T4-T5)

24

A patient has a small but solid tumor in the mediastinum which is confined at the level of sternal angle. which of the following structures are most likely to be found at this level?
a, Bifurcation of Trachea
b. Beginning of Ascending aorta
c. Articulation of the 3rd rib with the sternum
d. Superior border of the superior mediastinum

c. Articulation of the 3rd rib with the sternum (?)

25

Imaging of the thorax in an 18 month old female reveals a diffuse structure in the superior mediastinum representing the Thymus as gland. All of the following would be found in the superior mediastinum, except:
a. Ascending aorta
b. Brachiocephalic artery
c. Left Brachiocephalic vein
d. Phrenic nerve
e. Vagus nerve

a. Ascending aorta

Superior mediastinum
*thymus gland
*SVC
*brachiocephalic artery/vein
*L common carotid artery
*L subclavian artery
*arch of aorta
*phrenic and vagus nerve
*trachea
*esophagus
*thoracic duct
*L recurrent laryngeal nerve
*lymph nodes
*sympathetic trunk

26

A cross sectional image of the thorax reveals an absence of an anterior mediastinum shadow in a patient diagnosed with Di George syndrome. What else will be missing in this patient?
a. thyroid gland
b. palatine tonsil
c. malleus and incus
d. parathyroid gland
e. adrenal medulla

d. parathyroid gland

Di George Syndrome
*improper development of 3rd and 4th pharyngeal pouches
*THYMUS and Prathyroid gland are absent.

27

A patient was admitted to the hospital because of stab wound on he chest just left to the sternum. He is slightly cyanotic, with distention of veins of neck during inspiration. You suspect that the patient has a cardiac tamponade and order a pericardiocentesis. What is the last tissue layer that the needle must traverse in order to reach the accumulating blood?
a. Epicardium
b. Fibrous pericardium
c. Mediastinal pleura
d. Visceral pericardium
e. Serous layer of Parietal pericardium

e. Serous layer of Parietal pericardium

Pericardiocentesis
*site: Left Xiphocostal angle
*enters the skin - fascia - rectus sheath - rectus abdominis - fibrous layer - serous layer of the parietal pericardium

28

Patient presents with Kussmaul sign due to pericardial effusion and cyanosis.

Cardiac tamponade
*Kussmaul sign --- distention of veins of neck during inspiration
*accumulation of fluid in the pericardial cavity that compresses the chambers of the heart --- decreased venous return and reduced cardiac output

29

Normal amount of pericardial fluid.

30 ml
*serous / visceral layer

30

Double walled fibro-serous sac located anteriorly to T5-T8, and posteriorly to body of sternum and 2nd-6th costal cartilages.

Pericardium
Fibrous Layer
Serous: Parietal and Visceral