Lecture 6 Thoracic Wall and lungs

Question 1

Thoracic Cavity boundaries

Answer 1

Superior Boundary: thoracic outlet; root of neck
Inferior Boundary: the 3 openings

Question 2

Inferior Boundary 3 openings

Answer 2

Caval: inferior vena cava crossing right dome T8 vertebral level

Esophageal Hiatus: T10 level, in right crus folding

Aortic hiatus: T12 level, by right and left crus of the diaphragm; median arcuate ligament

Question 3

Thoracic vertebrae landmarks that articulate with ribs

Answer 3

-Demifacet articulates with ribs
- transverse process costal articulation with neck of rib

Question 4

T1 has what for the first rib

Answer 4

1 full facet

Question 5

T9-10 have no…

Answer 5

superior demifacet

Question 6

T11/12 have no…

Answer 6

no facets on trans processes

Question 7

What forms intervertebral foramen and what are its contents

Answer 7

The vertebral bodies and the sup/inf articulating processes form it, and It includes spinal nerves and arteries

Question 8

The head of every rib except for (blank) have demifacets

Answer 8

1,10,11,12

Question 9

How many full facets on the head of 1,10,11,12th rib

Answer 9

One on each

Question 10

Which ribs have no tubercle on the neck?

Answer 10

11 and 12

Question 11

Which rib articulates at the sternal angle (manubriosternal joint)

Answer 11

Rib 2

Question 12

Which rib articulates with the facet on the xiphosternal joint

Answer 12

the 7th rib

Question 13

The head of ribs and the demi/full facet on vertebrae form a

Answer 13

Costovertebral joint

Question 14

The rib neck and the facet on the transverse process form a

Answer 14

Costotransverse joint

Question 15

The inferior rib neck and superior transverse process are connected by

Answer 15

the Superior costotransverse ligament

Question 16

This ligament is on the same level as the transverse process and the rib neck

Answer 16

Lateral/costotransverse ligament

Question 17

Name the true ribs and where they articulate

Answer 17

1: manubrium
2: sternal angle
3-6: sternal body
7: xiphosternal junction

Question 18

Name the false ribs and where they articulate

Answer 18

8-10: cartilage fused with 7th ribs cartilage (the costal margin)
11-12: floating

Question 19

How many intercostal spaces are there?

Answer 19

11 (between every rib)

Question 20

Planes of motion of true and false ribs

Answer 20

True ribs 1-7: coronal (pump handle)
False ribs 8-10: sagittal (bucket handle)

Question 21

(blank) has only somatic motor; there is no (blank) dermatome

Answer 21

C1; C1

Question 22

Palpateable dermatome T levels and where they are

Answer 22

T4: at/above nipple line or at root of breast
T6: xiphoid process level
T10: umbilical level
T12: along iliac crest to pubic tubercle

Question 23

Sympathetic innervation:
Parasympathetic innervation:

Answer 23

-T1-T4 level; no direct innervation; descending from cervical ganglia; following ventral rami to support thoracic wall
- Vagus nerve (CN 11)

Question 24

Intrinsic blood supply: superior, posterior, and anterior

Answer 24

Superior: Supreme intercostal artery (branch from costocervical trunk)

Posterior: posterior intercostal artery (branch from aorta)

Anterior: internal thoracic artery, branch from subclavian
- anterior intercostal
- musculophrenic along costal margin
- superior epigastricc

Question 25

The subclavian artery is the midpoint of

Answer 25

the clavicle/ lateral border of the first rib

Question 26

The axillary artery is the inferior border of the

Answer 26

teres major

Question 27

Three parts of the axillary artery

Answer 27

Screw The Lawyer, Save A Patient 1) Superior thoracic artery 2) Thoracoacromial + Lateral thoracic 3) Subscapular + Anterior + Posterior circumflex

Question 28

What nerves innervate organs in the thoracic cavity

Answer 28

T1-T4 visceral nerves and Vagus nerve (CN 10)

Question 29

External intercostal fiber orientation vs Internal/innermost

Answer 29

External: Top left to bottom right In: Top right to bottom left

Question 30

neuromuscular bundles in intercostal space =

Answer 30

Major bundle: VAN, cutaneous branch; located on the inferior border of superior rib and runs between the inner and innermost intercostals Muscular/collateral bundle: NAV; located on superior border of inferior rib; also runs between inner/innermost intercostals

Question 31

The diaphragm is an

Answer 31

extrinsic thoracic muscle

Question 32

Which diaphragm dome is higher and why

Answer 32

Right dome because of liver space

Question 33

Intercostal nerve innervates:

Answer 33

transverse thoracis and subcostals

Question 34

Internal intercostal muscles help with

Answer 34

Expiration

Question 35

Break down the pleural cavity

Answer 35

- 2 lungs - parietal pleura = innervated by somatic cutaneous nerves; is along the mediastinum (phrenic nerve) - Visceral pleura - outer layer of lungs innervated by visceral sensory nerves or none at all - intrapleural pressure is always at or below -4mmHg

Question 36

Break down the mediastinum

Answer 36

- holds the heart in the pericardial cavity - esophagus, trachea, bronchi, giant cardiac vessels - 2 serous membrane layers wrap all internal organs from endoderm/mesoderm with some exceptions

Question 37

Expansion vs compression of pleural cavity

Answer 37

Expansion = elevation of rib cage, less than -4mmHg, inspiration Compression = depression of rib cage, back to -4mmHg, expiration

Question 38

the accumulation of fluid in pleural cavity is called

Answer 38

Costodiaphragmatic recess

Question 39

Atmospheric pressure vs pleural pressure

Answer 39

Atm: 760 mmHg P: 756 mmHg

Question 40

What is a pneumothorax and how is it treated

Answer 40

A collapsed lung when pleural cavity is above -4mmHg; tube is inserted above superior border of 5th or 6th rib to avoid cutaneous branch

Question 41

right vs left lung pulmonary artery to bronchi relashionship

Answer 41

RALS = Right anterior Left superior (right lung has pulm artery anterior to bronchi and left lung has pulm artery superior to bronchi)

Question 42

Which bronchi is more vertical?

Answer 42

RIght bronchi

Question 43

What supplys the lungs for normal functions

Answer 43

Bronchial arteries and veins

Question 43

Compare the lobes and fissures on each lung

Answer 43

Right: 3 lobes; 2 fissures (oblique and horizontal) Left: 2 lobes with a lingula (degenerated middle lobe) and 1 oblique fissure

Question 43

Main site for O2 exchange is ..

Answer 43

Alveoli (single layer of specialized epithelia)

Question 44

Difference between pulmonary trunk and veins

Answer 44

Trunk= R+L pulm artery, low O2, BLUE R+L Veins = high O2, RED