Flashcards in Module 3: Thorax Deck (94):
What are the bones of the thoracic wall?
Function of the thoracic wall:
Protect thoracic content
- lungs, heart, blood vessels, esophagus, etc
True v. false. floating ribs. How many of each?
True : 1-7
Floating: 11 and 12
Which ribs are typical and which are atypical? Why?
Ribs 3-9 are typical and have 2 costal facets
Ribs 1-2 and 10-12 are atypical
Atypical ribs only articulate w/ 1 vertebrae
Where on the rib is the most common fracture site?
Where does the tubercle of the rib articulate?
What is the clinical significance of the sternal angle of the sternum?
1. Bifurcation of trachea
2. Beginning and ending of the aortic arch
3. Palpation of sternal angle is location for 2nd rib
What 3 segments make up the sternum?
The part of the sternum that is either ossified or cartilaginous is the ______.
What are the 4 "major" articulations of the thoracic wall?
1. Costovertebral joint
2. Costochondral joint
4. Sternoclavicular ("SC joint")
The costovertebral joint articulates with...
Vertebral and TP's of vertebrae
The sternocostal joint articulates with...
Articulation between costal cartilage and sternum
The sternoclavicular joint is unique from the other major articulations of the thoracic wall because...
It contains a disc and is critical for shoulder girdle function
Describe the movement of the thoracic wall during inspiration. I.e. what do the ribs do?
Rib cage increases in diameter because ribs motion in a "bucket handle" way
Where does the nipple of a male lie? (ribs and intercostal space)
Between ribs 4 and 5 in the 4th intercostal space
Where is the breast positioned on the female?
Between ribs 2-6 from the sternum to the mid-axillary line
When examining the breast of a female, how would you document where you have seen a lump/bump? i.e. how is the breast divided up to the clinician?
Document in quadrants
--> upper inner
--> lower inner
--> lower outer
--> upper outer
In terms of lymph drainage, where does the majority of breast drain into?
Axillary lymph nodes (75% of breast drains here)
What two things compose the female breast?
Glandular and adipose tissue
The superior aperture contains:
3. Nerves & blood vessels that supply the head, neck, and UE
The inferior aperture allows what structures to pass though?
Which intercostal muscles are responsible for inspiration?
Which intercostal muscles are responsible for expiration?
Does the transversus thoracis assist in inspiration or expiration?
Expiration (depresses rib)
Do the subcostal muscles assist in inspiration or expiration?
Inspiration (elevate ribs)
Do the levator costarum muscles assist in inspiration or expiration?
Inspiration (elevate ribs)
Where do the levator cosarum muscles attach?
Ribs and TP's of C7-T11
Do the serratus posterior superior muscles assist in inspiration or expiration?
Do the serratus posterior inferior muscles assist in inspiration or expiration?
What is the major function of the diaphragm?
What nerve innervates the diaphragm?
What are the 3 layers of musculature of intercostal spaces?
3. Innermost intercostal muscles
What is the intercostal VAN?
The neurovascular bundle in the intercostal space that consists of vein, artery, and nerve
Describe what muscles are used during inspiration at:
c. extreme exercise
a. rest: diaphragm
b. exercise: diaphragm + external intercostals
c. extreme exercise: diaphragm + external intercostals + accessory muscles (SCM & scalenes...pecs can assist too)
Describe what muscles are used during expiration at:
a. rest: NONE - elastic recoil of lungs
b. exercise: internal intercostals + abdominal muscles
What are the two major sources of blood supply to the rib cage?
1. Descending aorta
2. Subclavian arteries
The anterior intercostal arteries originate from __________.
Descending internal thoracic artery
The azygos and hemiazygos veins descend near the esophagus. Which side of the body is the azygos on? What side the hemiazygos?
Azygos - right side
Hemiazygos - left side
**(and accessory vein)
What are the 3 compartments of the thoracic cavity?
2 pulmonary cavities
What structures does the mediastinum contain?
- Great vessels
- Lymph nodes
two layers of continuous, thin, serous membranes
Two types of pleurae and what they invest?
Visceral pleura - invests lungs
Parietal pleura - lines thoracic wall and diaphragm
pleural recess that can accumulate fluid w/ various conditions, lateral and posterior removed via thorencentesis
smaller pleural recess located posterior to sternum
What does the hilum of each lung contain?
1. Primary bronchus
2. 2 pulmonary veins (sup. and inf.)
3. 1 pulmonary artery
4. Bronchial vessels
5. Pulmonary nerve plexus
6. Lymph vessels
The right lung has ___ lobes and the left lung has ____ lobes.
Right lung has 3 lobes
Left lung has 2 lobes
Where can you find the base of lungs on the anterior side and posterior side of body
6th or 7th rib - anterior
9th or 10th rib - posterior
The oblique fissure of the lung separates which two lobes?
Superior and inferior
Located on both left and right lungs
The horizontal fissure of the lung separates which two lobes?
Superior and middle lobe
Located only on right lung
Describe the bronchial tree
Trachea --> bifuricate into R/L primary bronchi --> divide into lobar bronchi --> Divide into segmental bronchi --> divde into smaller divisions of bronchioles (20-25 generations) --> end as terminal bronchiole which give rise to respiratory bronchioles
Borders of the mediastinum?
Superior: superior thoracic aperture
Anterior: Sternum and costal cartilages
Posterior: thoracic vertebrae
What is the mediastinum?
The region between the pleural cavities
What does the superior division of the mediastinum contain?
- thymus in children, remnants in adults
- Arch of aorta/great vessels
What does the anterior portion of the inferior division of the mediastinum contain?
internal thoracic vessels
few lymph nodes
What does the middle portion of the inferior division of the mediastinum contain?
roots of great vessels
What does the posterior portion of the inferior division of the mediastinum contain?
What is the heart enclosed in?
What are the two layers of the pericardium?
Fibrous pericardium (outside)
Serous pericardium (inside)
What are the two layers of the serous pericardium?
Visceral layer (outer layer)
What does the pericardiacophrenic ligament connect?
Fibrous pericardium and diaphragm
What does the sternopericardial ligament connect?
Fibrous pericardium and sternum
Where is the pericardium cavity?
The space between the parietal and visceral pericardium where heart can "freely" move
Differentiate between epicardium, myocardium, and endocardium:
Epicardium - visceral serous pericardium
Myocardium - cardiac muscle
Endocardium - thin, smooth endothelial layer that lines the heart and valves
What are 3 functions of the fibrous skeleton of the heart?
1. Provide attachments for myocardium of atria and ventricles
2. Provide attachment for cardiac valves
3. Provide electrical insulation between atria and ventricles
Where is the apex of the heart?
tip of the left ventricle
5th intercostal space just medial to midclavicular line
Where is the base of the heart?
Posterior side of heart as it sits in cavity in vivo
Left atrium (technically some right atrium too)
Right border of the heart:
right atrium, extending between SVC and IVC
Left border of the heart:
Primarily left ventricle and some left atrium
Inferior border of the heart:
Primarily right ventricle and some left ventricle
Superior border of the heart:
junction where great vessels enter and leave heart
Where is the sternocostal surface of the heart?
Mostly right ventricle
Where is the diaphragmatic surface of the heart?
Mostly left ventricle and partially right ventricle
Where is the pulmonary surface of the heart?
Mostly left ventricle
Where is the tricuspid valve found?
In the right atrium connecting to the right ventricle
Where is the bicuspid (mitral) valve found?
In the left atrium connecting to the left ventricle
The branches of the aortic arch are:
Left common carotid artery
Left subclavian artery
In which valve do you find the opening to the coronary sinus
Where is the left sternal border and what is it's importance clinically?
Found at 4th or 5th intercostal spaces
Can ausculate along it
Where is the pulmonary valve located and what is it's other name?
Located between the right ventricle and pulmonary trunk
Also called right semilunar valve
Where is the aortic valve located and what is it's other name?
Located between left ventricle and the aorta
Also called the left semilunar valve
Where would you be able to auscultate the pulmonary valve?
left 2nd intercostal space
Where would you be able to auscultate the aortic valve?
right 2nd intercostal space
Where would you be able to auscultate the bicuspid valve?
Along apex...5th intercostal space
Where do coronary arteries arise from?
The base of aorta --> the "backflow" from aortic pressure creates blood flow through coronary arteries
The right coronary artery supplies _____ and _____.
Right atrium and right ventricle
The marginal branch of the right coronary artery supplies...
The left coronary artery divides into ____ and _____
anterior interventricular artery and circumflex artery
The anterior interventricular artery supplies ____, _____, and _____.
majority of interventricular septum
Circumflex artery supplies the ____ and ____.
Marginal branch of left coronary artery supplies...
The coronary sinus drains into ....
The sympathetic nervous system ____ heart rate
The parasympathetic nervous system ____ HR