Part 2 respiratory book Flashcards
(86 cards)
1
Q
why do the external intercostal muscle fibers and the internal intercostal muscle fibers run at right angles to each
other
A
provide strength to muscle layers
2
Q
what type of joint is the costotranverse
A
synovial plane
between tubercle of rib and transverse process
3
Q
what type of joint is the costovertebral
A
synovial plane
between head of rib and inferior/superior demi facet on vertebral body
4
Q
what type of joints are facet joints
A
synovial
5
Q
what type of joints are intervertebral disc joints
A
secondary cartilaginous
symphysis
6
Q
what is the inside and outside of intervertebral disc called
A
inside - nucleus pulposus
outside - annulus fibrosus
7
Q
the intercostal vein, artery and nerve run in the?
lie between what muscles?
number according to what rib?
A
- subcostal groove (VAN)
- lie between internal and innermost intercostal muscle
- they are numbered by the superior rib
- supplies much of the innervation and vascular supply to the thoracic wall.
8
Q
supplies much of the innervation and vascular supply to the thoracic wall.
A
neurovascular bundle
- located in the undersurface of rib - costal groove
- between inner and innermost intercostal muscles
9
Q
Which structures comprise the neurovascular bundle?
A
intercostal vein, artery , nerve (superior to inferior)
10
Q
which structure in the intercostal space is more liable to damage if a chest drain is inserted into the pleural space to close to the inferior boarder of a rib!!!
A
intercostal nerve - lowest lying structure
11
Q
role of intercostal muscles during respiration
A
- assist with movements of chest wall
- Prevent the lungs and pleura from ballooning out between the ribs during movements
12
Q
small collateral branch of neurovascular bundle
A
- runs above the top of each rib
- NAV (superior to inferior)
- supplies the pleurae AND periosteum of the ribs
13
Q
what dermatome overlies the sternal angle, nipple area and umblicus
A
T2 - sternal angle
T4 - nipples
T10 - belly button
14
Q
what dermatome overlies the inguinal area (pubis area around genitals)
A
L1
15
Q
throacic dermatomes
A
T4: Nipples
T6: Xiphoid Process
T10: Umbilicus
L1: lnguinal region
16
Q
ipsilateral
A
same side
17
Q
contralateral
A
opposite side
18
Q
what is in the superior mediastinum
A
Organs:
- Oesophagus
- Trachea
Arteries
- Aortic arch
- branches of aortic arch (brachiocephalic trunk, Left common carotid/left subclavian.
Veins and lymphatics
- thoracic duct
- superior vena cava
Nerves
- phrenic
- vagus nerve
19
Q
What is in the anterior mediastinum
A
Lymph nodes
Inferior part of thymus
Fat
20
Q
What is in the middle mediastinum
A
- Heart
- Pericardial sac
Origins of great vessels
- Ascending aorta (roots of aorta)
- Pulmonary trunk
21
Q
What is in the posterior mediastinum?
A
DATE V
- Descending aorta
- Azygous and hemiazygo veins
- Thoracic duct
- Eesophagus
- Vagus nerves
22
Q
What comprises the thoracic wall?
A
Anteriorly : sterunum
Posteriorly : T1-T12
Laterally : Ribs 1-12
23
Q
label 1?
A
jugular notch
T2-3
24
Q
label 2
A
Clavicular notch
Sternoclavicular joint
Synovial Saddle joint
25
Label 3
Manubrium
26
Label 4 and state what other landmarks are here
Sternal angle
Sternomanubrial joint (secondary cartilaginous - symphysis - two types of cartilage - hyaline sandwiced between fibrocartilage)
T4-T5 vertebrae posteriorly / 2nd rib (2nd sternocostal joint - synovial plane)
Trachea bifurcates
Carina (A ridge at the base of the trachea (windpipe) that separates the openings of the right and left main bronchi)
27
5.
body of sternum
28
label 6 and state the vertebrae level
what type of joint connects it to the sternum?
xiphoid process
T9
Xiphisternal joint (primary cartilaginous - synchondrosis)
29
Label 7
Fact for the 1st sternocostal joint
Primary cartilaginous joint (hyaline cartilage only)
30
What type of joints are the costochondral joints?
Primary cartilaginous - synchondrosis - bones joined by hyaline cartilage
Attach the sternal ends of ribs to their costal cartilages
31
What is a notch?
A depression in a bone
which often, but not always, provides stabilization to an adjacent articulating bone
32
What are the True ribs
(1-7)
- attach directly to sternum via their costal cartilage
- the first sternocostal joint is primary cartilaginous but the rest are synovial plane joints
33
What are false ribs
8-10
Attach to the sternum indirectly - their costal cartilages are attached to cartilages of the rib above
34
Floating ribs
11-12
have no anterior attached
35
What is the name given to the median notch formed by the superior border of the manubrium?
jugular notch
36
At what vertebral level is the xiphoid process usually located?
T9-T10
37
At what vertebral level is the sternomanubrial joint located?
is at the sternal angle (2nd rib) and at the vertebral level: between T4 and T5
38
Facets for 2nd costal cartilage. With which parts (manubrium/ body/ xiphisternum) of the sternum do these articulate?
Sternal angle - where manubrium joins body of sternum
39
Sternocostal joints
between sternum and costal cartilage
(1st = primary cartilaginous/2-7 synovial plane)
40
Costochondral joints
between sternal end of rib and its costal cartilage
(primary cartilaginous – synchondrosis – connected by hyaline cartilage)
41
Describe primary cartilaginous joints
- bones are joined by hyaline cartilage (1 type)
- immovable
- Ribs (costochondral joints)
- Xiphisternal joint
- 1st Sternocostal joint
- Epiphyseal growth plate (between epiphysis and diaphysis)
42
Describe secondary cartilaginous joints
hyaline cartilage is inbetween two layers of fibrocartilage (2 types of cartilage)
slightly movable
midline of body
- pubis symphysis
- intervertebral discs
- sternomanubrial joint
43
Typical ribs? numbers and key features
3-9
* HEAD with 2 articular surfaces - seperated by a CREST
* NECK - shorter/flatter region - seperating the head from the turbcle
* TUBERCLE - with articular facet/non-articular part
* ANGLE - region that is most strongly bent
* COSTAL GROOVE (neurovascular bundle VAN)
*
44
atypical ribs - what numbers?
1-2 and
10-12
45
why is rib 1 atypical
wide/short/flat
1 articular facet with T1 (head/transverse process)
has two costal grooves (sub-clavian vein and artery)
tubercle for attached of anterior scalene muscle of neck (accessory muscle in forced expiration)
forms the boundary of superior thoracic inlet
46
Posterior articular articulations of typical ribs (3)
1. superior artcular demi- facet at same vertebrae level
2. inferior demi facet of the vertebrae above
3. Tranverse process of same vertebrae level
e.g rib 5
articulars with body and transverse process of rib 5
the body of rib 4
47
the region where the rib is most strongly bent- proximal part of body is called?
Angle
48
What part of a vertebra articulates with the rib tubercle?
The transverse process
49
* Which neurovascular structures lie within the costal groove?
Intercostal veins
Intercostal arteries
Intercostal nerves
(run just under groove) underneath rib above
REVERSE on small collateral branches (RIB BELOW) (VAN-NAV)
50
# typical rib
label 1
Head
- two articular facets, which are separated by a wedge of bone, known as the crest of the head.
- The larger of the two facets is for articulation with the superior costal facet of its corresponding vertebral body,
- while the smaller of the two articulates with the inferior costal facet on the body of the superior vertebra.
51
label 2
Neck
- simply a flat piece of bone that connects the head of the rib with the body.
52
label 3
tubercle
- has a smooth articular part - with transverse process of the associated vertebrae
- rough - non-articular part
53
label 4 to 7 on typical rib
4. Angle - most bent part
5. Internal surface
6. Costal groove
7. External surface
54
what does rib 5 articulate with posterialy
- transvere process of T5
- vertebrae body of T5 (head-> superior)
- vertebrae body of T4 (head-> inferior dem-facet)
55
which facet on the head of a typical rib is larger?
The larger of the two facets is for articulation with the superior costal facet of its corresponding vertebral body,
while the smaller of the two articulates with the inferior costal facet on the body of the superior vertebra.
56
what type of joint is costotransverse joints
synovial plane
57
what type of joint is costovertebral joints
synovial plane joints
58
label
1. Angle
2. Costal groove
3. Tubercle (rough - non-articular)
4. Tubercle (smooth - articulates with Transverse process)
5. Neck
6. Superior articular facet )body of veretbrae above/intervertebral disc)
7. Head
8. Inferior articular facet (body of corresponding vertebrae)
59
Describe 1st rib and why it is atypical
Short, wide, and flat from top to bottom,
and it articulates with only a single vertebra – T1
60
label 7
groove for subclavian artery
61
label 6
groove for subclavian vein
62
label 4
tubercle for anterior scalene muscle attachment
63
label 1, 2, 3, 5
1. tubercle for T1 transverse process
2. neck
3. head
4. 5. Costal cartilage
64
label 1-4
1. phrenic nerve (C3-C5)
2. anterior scalene muscle
3. subclavian artery
4. subclavian vein
65
label 5? what vertebrae level
T1
* remember jugular notch - T2/T3
66
In approximately 0.5% of the population, an additional, cervical rib develops, usually from the
transverse process of C7
can compress lower trunk of brachial plexus (C5- T1 roots)
67
Where does the brachial plexus originate (roots) and what do they innervate/type of innervation
C5-T1 spinal nerves
motor/sensory innveration of the upper extremities (should, arm, hand)
68
Which part of a rib articulates with these demi-facets on vertebral bodies?
head/crest
COSTOVERTEBRAL JOINTS - synovial plane
69
A single typical rib articulates with two vertebral bodies and one vertebral transverse process. These are?
1. the vertebral body of the same number as the rib (superior demi-fact)
2. the vertebral body immediately above (inferior demi-facet)
3. the vertebral transverse process of the same number as the rib
Therefore, rib 5 articulates with the body of vertebra T5 as well as the body of vertebra T4.
And rib 5 articulates with the facet on the tip of the transverse process of vertebra T5
70
Most commonly fractured ribs
and what is the risk of fracturing rib to the pleura?
* Ribs 5-10 are most fractured as they are relatively more exposed and fixed.
The ends of a fractured rib may then perforate the pleura resulting in a pneumothorax.
is accompanied by severe/sudden onset of localised pain
mediated through the intercostal nerves located above and below and concomitant
71
label
1. Body
2. Pedicle
3. Lamina
4. Vertebral foramen
5. Superior articular process
6. Transverse process
7. Spinous process
72
LABEL
1. interferior articular process
2. Facet joint - synovial
3. Superior articular process
4. Intervertebral disc joint - secondary cartilaginous
5. Facet joint - synovial
73
Movement allowed at Lumbar spine
(mainly) - flexion/extension
lateral flexion extension
rotation
74
Features of lumbar vertebrae
* superior articular facet/process faces inwardly (medially)
* inferior articular facet/process faces outwardly (laterally)
* thick/bulky spinous process
* massive vertebral bodies
75
Superior boundaries of the thorax (superior thoracic aperture or inlet)
* T1 vertebral body
* Left and right 1st rib
* Manubrium
76
Inferior boundaries of the thorax (inferior throacic aperture/outlet)
* Diaphragm
* T12 vertebrae
* Costal margins of 7-10th ribs
* 11/12th ribs
* Xiphoid process/xiphoidsternal joint
77
anterior boundary of thorax
* Sternum
* Costal cartilages
78
posterior boundary of thorax
T1-T12
79
Lateral boundary of thorax
ribs 1-12
80
what forms the costal margin/subcostal angle
cartilages of ribs 7-10
forms cartilaginous arch (costal margin)
and subcostal angle (angle between the xiphoid process and right/left costal margin
81
which muscle is primarily used for breathing in the newborn?
Babies and young children will use their abdominal muscles much more to pull the diaphragm down for breathing.
The intercostal muscles are not fully developed at the time of birth/ribs are less in anteroinferior plane \
82
The posterior intercostal veins drain into the?
azygos vein (right side),
and hemiazygos and accessory hemiazygos veins (left side) -> ayzogs vein
superior vena cava
83
type of joint
interchondral joints
synovial
84
why is the suprerior thoracic aperture
bound by?
superior thoracic aperture
T1 veretebrae body
1st pair of ribs
Manubrium of sternum
85
?
superior thoracic aperture
86
What happens at the sternal angle
bifurcation of the trachea
2nd sternocostal joint
arch of aorta begins and ends
separates inferior and superior mediastinum
