Module 3: Thorax Flashcards Preview

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Flashcards in Module 3: Thorax Deck (94):
1

What are the bones of the thoracic wall?

Ribs
Thoracic vertebrae
Sternum

2

Function of the thoracic wall:

Protect thoracic content
- lungs, heart, blood vessels, esophagus, etc

3

True v. false. floating ribs. How many of each?

True : 1-7
False: 8-10
Floating: 11 and 12

4

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

5

Where on the rib is the most common fracture site?

Costal angle

6

Where does the tubercle of the rib articulate?

Transverse process

7

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

8

What 3 segments make up the sternum?

Manubrium
Body
Xiphoid Process

9

The part of the sternum that is either ossified or cartilaginous is the ______.

Xiphoid Process

10

What are the 4 "major" articulations of the thoracic wall?

1. Costovertebral joint
2. Costochondral joint
3. Sternocostal
4. Sternoclavicular ("SC joint")

11

The costovertebral joint articulates with...

Vertebral and TP's of vertebrae

12

The sternocostal joint articulates with...

Articulation between costal cartilage and sternum

13

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

14

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

15

Where does the nipple of a male lie? (ribs and intercostal space)

Between ribs 4 and 5 in the 4th intercostal space

16

Where is the breast positioned on the female?

Between ribs 2-6 from the sternum to the mid-axillary line

17

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

18

In terms of lymph drainage, where does the majority of breast drain into?

Axillary lymph nodes (75% of breast drains here)

19

What two things compose the female breast?

Glandular and adipose tissue

20

The superior aperture contains:

1. Esophagus
2. Trachea
3. Nerves & blood vessels that supply the head, neck, and UE

21

The inferior aperture allows what structures to pass though?

1. Esophagus
2. IVC
3. Aorta

22

Which intercostal muscles are responsible for inspiration?

External intercostals

23

Which intercostal muscles are responsible for expiration?

Internal intercostals

24

Does the transversus thoracis assist in inspiration or expiration?

Expiration (depresses rib)

25

Do the subcostal muscles assist in inspiration or expiration?

Inspiration (elevate ribs)

26

Do the levator costarum muscles assist in inspiration or expiration?

Inspiration (elevate ribs)

27

Where do the levator cosarum muscles attach?

Ribs and TP's of C7-T11

28

Do the serratus posterior superior muscles assist in inspiration or expiration?

Inspiration

29

Do the serratus posterior inferior muscles assist in inspiration or expiration?

Expiration

30

What is the major function of the diaphragm?

INSPIRATION

31

What nerve innervates the diaphragm?

Phrenic Nerve

32

What are the 3 layers of musculature of intercostal spaces?

1. External
2. Internal
3. Innermost intercostal muscles

33

What is the intercostal VAN?

The neurovascular bundle in the intercostal space that consists of vein, artery, and nerve

34

Describe what muscles are used during inspiration at:
a. rest
b. exercise
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)

35

Describe what muscles are used during expiration at:
a. rest
b. exercise

a. rest: NONE - elastic recoil of lungs

b. exercise: internal intercostals + abdominal muscles

36

What are the two major sources of blood supply to the rib cage?

1. Descending aorta
2. Subclavian arteries

37

The anterior intercostal arteries originate from __________.

Descending internal thoracic artery

38

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)

39

What are the 3 compartments of the thoracic cavity?

2 pulmonary cavities
Mediastinum

40

What structures does the mediastinum contain?

- Heart
- Great vessels
- Trachea
- Esophagus
- Thymus
- Lymph nodes

41

Define pleurae:

two layers of continuous, thin, serous membranes

42

Two types of pleurae and what they invest?

Visceral pleura - invests lungs

Parietal pleura - lines thoracic wall and diaphragm

43

Costodiaphragmatic recess:

pleural recess that can accumulate fluid w/ various conditions, lateral and posterior removed via thorencentesis

44

Costomediastinal recess:

smaller pleural recess located posterior to sternum

45

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

46

The right lung has ___ lobes and the left lung has ____ lobes.

Right lung has 3 lobes
Left lung has 2 lobes

47

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

48

The oblique fissure of the lung separates which two lobes?

Superior and inferior

Located on both left and right lungs

49

The horizontal fissure of the lung separates which two lobes?

Superior and middle lobe

Located only on right lung

50

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

51

Borders of the mediastinum?
- Superior
- Inferior
- Anterior
- Posterior

Superior: superior thoracic aperture

Inferior: diaphragm

Anterior: Sternum and costal cartilages

Posterior: thoracic vertebrae

52

What is the mediastinum?

The region between the pleural cavities

53

What does the superior division of the mediastinum contain?

- thymus in children, remnants in adults
- Arch of aorta/great vessels
- Trachea
- Esophagus

54

What does the anterior portion of the inferior division of the mediastinum contain?

internal thoracic vessels

fat

few lymph nodes

55

What does the middle portion of the inferior division of the mediastinum contain?

pericardium

heart

roots of great vessels

56

What does the posterior portion of the inferior division of the mediastinum contain?

esophagus

descending aorta

thoracic duct

lymph nodes

57

What is the heart enclosed in?

Pericardium

58

What are the two layers of the pericardium?

Fibrous pericardium (outside)

Serous pericardium (inside)

59

What are the two layers of the serous pericardium?

Parietal layer
Visceral layer (outer layer)

60

What does the pericardiacophrenic ligament connect?

Fibrous pericardium and diaphragm

61

What does the sternopericardial ligament connect?

Fibrous pericardium and sternum

62

Where is the pericardium cavity?

The space between the parietal and visceral pericardium where heart can "freely" move

63

Differentiate between epicardium, myocardium, and endocardium:

Epicardium - visceral serous pericardium

Myocardium - cardiac muscle

Endocardium - thin, smooth endothelial layer that lines the heart and valves

64

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

65

Where is the apex of the heart?

tip of the left ventricle
5th intercostal space just medial to midclavicular line

66

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)

67

Right border of the heart:

right atrium, extending between SVC and IVC

68

Left border of the heart:

Primarily left ventricle and some left atrium

69

Inferior border of the heart:

Primarily right ventricle and some left ventricle

70

Superior border of the heart:

junction where great vessels enter and leave heart

71

Where is the sternocostal surface of the heart?

Mostly right ventricle

72

Where is the diaphragmatic surface of the heart?

Mostly left ventricle and partially right ventricle

73

Where is the pulmonary surface of the heart?

Mostly left ventricle

74

Where is the tricuspid valve found?

In the right atrium connecting to the right ventricle

75

Where is the bicuspid (mitral) valve found?

In the left atrium connecting to the left ventricle

76

The branches of the aortic arch are:

Brachiocephalic trunk
Left common carotid artery
Left subclavian artery

77

In which valve do you find the opening to the coronary sinus

Right atrium

78

Where is the left sternal border and what is it's importance clinically?

Found at 4th or 5th intercostal spaces

Can ausculate along it

79

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

80

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

81

Where would you be able to auscultate the pulmonary valve?

left 2nd intercostal space

82

Where would you be able to auscultate the aortic valve?

right 2nd intercostal space

83

Where would you be able to auscultate the bicuspid valve?

Along apex...5th intercostal space

84

Where do coronary arteries arise from?

The base of aorta --> the "backflow" from aortic pressure creates blood flow through coronary arteries

85

The right coronary artery supplies _____ and _____.

Right atrium and right ventricle

86

The marginal branch of the right coronary artery supplies...

right ventricle

87

The left coronary artery divides into ____ and _____

anterior interventricular artery and circumflex artery

88

The anterior interventricular artery supplies ____, _____, and _____.

right ventricle
left ventricle
majority of interventricular septum

89

Circumflex artery supplies the ____ and ____.

left atrium
left ventricle

90

Marginal branch of left coronary artery supplies...

left ventricle

91

The coronary sinus drains into ....

right atrium

92

The sympathetic nervous system ____ heart rate

increases

93

The parasympathetic nervous system ____ HR

decreases

94

The nodal branch of the right coronary artery supplies the...

SA and AV nodes