Part I. Thorax Flashcards
1
Q
Types of Ribs
A
True, false, floating
2
Q
True ribs:
A
Vertebrosternal ribs 1-7
3
Q
False ribs:
A
Vertebrochondral ribs 8-10
4
Q
Floating ribs:
A
Vertebral ribs 11-12
5
Q
Typical ribs:
A
Ribs 3-9
6
Q
Atypical ribs
A
1, 2, 10-12
7
Q
What are features of typical ribs?
A
- head with 2 facets + a crest
- neck
- tubercle
- body (angle and groove)
8
Q
Why do typical facets have 2 facets?
A
Because demifacets
9
Q
What does the rough part of a typical rib’s tubercle attach to?
A
Lateral coststransverse ligament
10
Q
What are features of atypical ribs?
A
Only 1 facet (Rib 1, 10-12)
Note: Rib 2 has 2 facets
11
Q
Which atypical rib has 2 facets?
A
Rib 2
12
Q
Describe atypical rib 1:
A
- broadest
- shortest
- most curved
- synarthrosis (like sutures of skull)
13
Q
Where are the grooves on rib 1 and what are they for?
A
- superior grooves for subclavian a + v
- scalene tubercle for ant. Scalene m.
- ridge posterior to groove for subclavian a. for middle scalene muscle attachment
14
Q
What kind of joint is Rib 1 NOT?
A
Synovial
15
Q
Describe atypical rib 2:
A
- more typical body
- 2 facet heads
- tuberosity for m
16
Q
What does rib 2 articulate with?
A
T1 and T2
17
Q
What is rib 2’s tuberosity for?
A
Serratus anterior Muscle attachment
18
Q
Describe Ribs 10-12
A
Only 1 facet (so it articulates with only 1 vertebra)
19
Q
Describe ribs 11-12
A
Short, no necks or tubercles because they do not articulate with TPs
20
Q
What level is the manubrium?
A
T3-T4
21
Q
What landmarks are on the manubrium?
A
Jugular notch
Sternoclavicular joints at clavicular notch
Sternocostal ‘synchondrosis’ of rib 1
Manubriosternal joint (rib 2 articulation)
22
Q
What vertebral level is the sternal body?
A
T5-T9
23
Q
Describe the features of sternal body
A
Costal notches = rib 3-7 articulations (and 1/2 of rib 2)
24
Q
What contains hematopoietic bone marrow throughout life?
A
Sternal body
25
The sternal body is made up of ___ sternebrae bones and they fuse by ages _____
4; 14-25 yo
26
What vertebral level is the xiphoid process?
T10
27
Describe the xiphoid process
Cartilaginous (ossified over age 40)
| Xiphisternal joint
28
What is the superior thoracic aperature?
The opening at the top of the thorax
29
Boundaries of thoracic apertures:
T1 vertebra
1st ribs
1st costal cartilages
Manubrium
30
What passes through superior thoracic aperture?
Trachea
Esophagus
Major nerves and blood vessels pass through
31
Another name for superior thoracic aperture?
Anatomical thoracic inlet
32
Another name for inferior thoracic aperture?
Anatomical thoracic outlet
33
Boundaries of inferior thoracic aperture?
T12 vertebra
11th and 12th ribs
Costal arch 7-10
Xiphisternal joint
34
What passes through the inferior thoracic aperture?
Esophagus (at level of T10)
IVC (at level of T8)
Aorta (at level of T12)
35
What attaches to inferior thoracic aperture?
Diaphragm
36
Joints of thoracic wall:
Costovertebral joints
Costochondral joints
Sternocostal joints
37
Muscles of respiration:
```
Scalenes
SCM
Serratus anterior
Pectoral is major; minor
Iliocostalis lumborum
Quadratus lumborum
Serratus posterior superior and inferior
Lavator costarum
Transversus thoracic
Subclavius
```
38
Passive expiration results from:
Muscle relaxation and elastic recoil in lungs
39
Active expiration assisted by:
Abdominal wall muscle contraction
40
The female breast is usually located at what rib level(s)?
2-6
41
The nipple is an opening for:
15-20 lactiferous ducts
42
Where is the axillary process?
Breast tissue that extends along inferolateral margin of pec major and into the axilla
43
What is the space between breast and deep pectoral fascia called and what does it do?
Retromammary space; allows movement
44
What are the ligaments called that span from mammary gland to overlying dermis for support?
Suspensions ligaments
45
The suspensory ligaments do what?
Support the shape of the breast and the lobes of the mammary gland (lactating)
46
What part of the female breast contain numerous sebaceous glands?
Areola
47
The areola secrets oily protective substance to do what:
Lubricate nipple and areola
48
The __________ is the dilated region in each lactiferous duct.
Lactiferous sinus
49
What does the lactiferous sinus do?
Milk accumulates here during nursing
50
Milk is produced in the
Alveoli (acini) of the mammary gland
51
Where are the secretory acini located?
Lobules of mammary gland
52
Why does female breast enlarge at puberty?
Fat deposition
53
Why does female breast enlarge during pregnancy?
Gland hypertrophy and hyperplasia and fat deposition
54
Why does female breast enlarge during menstrual cycle?
Gland hypertrophy (preparatory... as though she’s expecting the sperm to hit the jackpot)
55
What are the 3 arteries that supply the breast?
Medial Mammary Artery (from Anterior Intercostal A (From Internal Thoracic A))
Lateral Thoracic Artery and Thoracoacromial Trunk (from Axillary A)
Posterior Intercostal A (from Thoracic Aorta)
56
What is the primary vein and secondary that drains the breast?
Axillary Vein via Lateral Thoracic V
Some: Internal Thoracic V via Medial Mammary V
57
Where does the lymph from nipple, areola and gland lobules drain?
Subareolar Lymphatic Plexus
58
Most lymph from female breast drains to:
Axillary lymph nodes through Anterior (Pectoral) Nodes
59
Medial quadrants in the breast drain lymph to:
Parasternal nodes or opposite breast
60
Lower quadrants in the breast drain lymph to
Inferior phrenic (abdominal) nodes
61
What are 2 individual lateral compartments containing lungs and pleurae?
Pulmonary cavities
62
What is the 1 central compartment containing all thoracic structures except lungs?
Mediastinum
63
What does the mediastinum do?
Completely separates pulmonary cavities from each other
64
What is double layered serous mesothelial sac surrounding and investing the lungs?
Pleura
65
What is simple squamous epithelium completely investing the lungs (including fissures)
Visceral pleura
66
Can visceral pleura be dissected from lungs?
No
67
What is simple squamous epithelium lining inner surface of each pulmonary cavity?
Parietal pleura
68
Can parietal pleura be dissected from peripheral structures?
Yes
69
What is the potential space between visceral pleura and parietal pleura?
Pleural cavity
70
What kind of pleura lines the internal surface of thoracic wall (ribs, intercostal spaces)?
Costal pleura
71
What separates costal pleura from peripheral structures?
Endothoracic fascia
72
What does endothoracic fascia do?
Provides surgical access without penetrating pleural cavity
73
What pleura covers lateral aspects of mediastinum?
Mediastinal pleura
74
What is the double layer of mediastinal pleura extending inferior from root of lung. This structure allows lung root structures to slide up/down during respiration.
Pulmonary ligament
75
What pleura covers superior surface of thoracic diaphragm on either side of mediastinum?
Diaphragmatic pleura
76
What pleura lines the cup-shaped dome over the apex of each lung?
Cervical pleura
77
Cervical pleura is reinforced by a membrane called:
Suprapleural membrane, a fibrous extension of endothoracic fascia
78
What is it called when parietal pleura transitions from one part to another? Ie. From diaphragmatic parietal pleura to costal parietal pleura
Pleural reflections
79
What is it called when two parietal pleura layers contact each other?
Pleural recess
80
Where is the sternal line of pleural reflection? (Describe location)
Anterior transition of costal pleura and mediastinal pleura
81
Where does the sternal line of pleural reflection happen on the right side?
Midline from sternal angle to 6th costal cartilage
82
Where does the sternal line of pleural reflection happen on the left side?
Midline to 4th costal cartilage lateral the 6th costal cartilage (because of heart)
83
Describe the location of costal line of pleural reflection
Peripheral transition of costal pleura and diaphragmatic pleura
84
Where does the costal line of pleural reflection happen on the right side?
Follows costal margin
85
Where does the costal line of pleural reflection happen on the left side?
Starts at midclavicular line (because of heart) and then follows costal margin
86
What is the right border of the heart?
Right atrium
87
What is the left border of the heart?
Left ventricle
88
What is the inferior border of the heart?
Right ventricle
89
What is the superior border of the heart?
Left and right atriums
90
What is the flow of the blood in the heart starting from the inferior vena cava or superior vena cava?
Right atrium through [tricuspid valve] —> right ventricle through [pulmonary semilunar valve] —> L/R pulmonary branch and arteries —> LUNGS —> L/R pulmonary veins —> left atrium through [bicuspid valve] —> left ventricle through [aortic semilunar valve] —> aorta —> arteries —> capillaries —> veins —> back to the inferior/superior vena cava
91
What type of joint is the manubriosternal joint?
symphysis
92
The manubriosternal joint creates what anatomical landmark?
sternal angle
93
What type of joint is the xiphisternal joint?
symphysis
94
The xiphisternal joint is a landmark for what four anatomies?
- inferior border of central thoracic cavity
- infrasternal (subcostal) angle
- inferior border of the heart
- superior border of the liver
95
For a typical rib (3-9), the inferior articular facet of the rib articulates with which which demifacet (superior or inferior) of which vertebral body (superior, inferior or same)?
superior, same
96
The crest on the head of the rib articulates with what structure? via what ligament?
articulates with the IVD via the intra-articular ligament
97
What type of joint is the costovertebral joint?
synovial
98
What type of joint is the costotransverse joint?
synovial
99
What ligament attaches rib tubercle to transverse process at the same vertebral level?
lateral costotransverse ligament
100
What ligament attaches rib neck to the transverse process one vertebral level above?
superior costotransverse ligament
101
Which ribs articulate with only one vertebral body?
1, 10, 11, 12
102
What type of joint is the costochondral joint?
synchondroses
103
What type of joint is the sternocostal joint?
synovial at rib 2-7 and synchondrosis at rib 1
104
What ligaments support the sternocostal joints?
anterior and posterior radiate sternocostal ligaments
105
The external intercostal muscle starts at ______ and end at _____.
rib tubercle: costochondral joint
106
What fills in the space from where the external intercostal muscles end (costochondral joint) to the sternum externally?
external intercostal membrane
107
What is the fiber direction of the external intercostal muscle?
anterior and inferior (fingers in pockets)
108
What is the action of the external intercostal muscle?
elevate ribs
109
The internal intercostal muscle starts at ______ and end at _____.
sternum: rib angle
110
What fills in the space from where the internal intercostal muscles end (rib angle) to the transverse process internally?
internal intercostal membrane
111
What is the fiber direction of the internal intercostal muscle?
inferior and posterior (fingers under shirt)
112
What is the action of the internal intercostal muscle?
depress ribs
113
What is the path of the 3rd-11th intercostal nerve, artery vein and in what order (from superior to inferior) are they usually traveling?
medially they travel between internal intercostal membrane and parietal pleura.
laterally they travel between the internal and innermost intercostal muscles.
usually in V.A.N. order
114
What is the fiber direction of the innermost intercostal muscle?
inferior and posterior (same as internal intercostal and subcostal)
115
What is the action of the innermost intercostal muscle?
depress ribs (same as internal intercostal and subcostal)
116
What is the fiber direction of the subcostal muscle?
inferior and posterior (same as internal and innermost intercostal)
117
What is the action of the subcostal muscle?
depress ribs (same as internal and innermost intercostal)
118
The transversus thoracis muscle spans from the _______ to ______?
inferior sternum: 2-6 costal cartilage
119
What is the action of the transversus thoracis muscle?
depress ribs
120
The action of all of the muscles of the thoracic wall is ______ except which muscle? What is the action of the exception?
depress ribs, except external intercostal muscles which elevated the ribs
121
Which muscle of the thoracic wall may also function in proprioception?
transversus thoracis
122
There are how many intercostal nerves and what are they formed by?
11 pairs formed by VPR of T1-T11
123
Which intercostal nerves are considered typical and who?
3-6, because they run in the costal groove
124
Which intercostal nerves are atypical and why?
1,2 because they do not run in the costal groove
| 7-11 because they run out of rib cage anteriorly and become thoracoabdominal nerves when they go into the abdomen
125
The VPRs of T12 form what nerve?
subcostal
126
Which dermatome is located at the umbilicus?
T10
127
Which dermatome is located at the nipple?
T3
128
What are the branches of the intercostal nerves and what do they supply?
- collateral branches supply muscles and pleura
- lateral and anterior cutaneous branches supply skin
- muscular branches
- rami communicates
129
The lateral cutaneous branch of the 2nd intercostal nerve gets a special name because it is part of the brachial plexus. What is the special name?
intercostobrachial nerve
130
White communicating rami tend to be located _____ to the gray rami.
lateral
131
White rami contain what kind fo fibers?
presynaptic sympathetic
132
Gray rami contain what kind fo fibers?
postsynaptic sympathetic
133
Communicating rami connect what two structures?
intercostal (spinal) nerves and sympathetic ganglion
134
What nerves supply the costal and peripheral diaphragmatic pleura?
intercostal nerves
135
What nerves supply the central diaphragmatic and mediastinal pleura?
phrenic nerves
136
How is the visceral pleura innervated?
visceral afferents only (no somatic innervation) which may cause referred pain
137
What is the pulmonary root?
hilum of the lung where vessels enter and exit the organ and are enclosed in pleura
138
What are the contents of the pulmonary root?
```
pulmonary artery
main bronchi
pulmonary vein
lymph vessels
bronchial arteries and veins
nerves of the ANS
```
139
What is the Carina and at what vertebral level is it located?
it is the internal ridge at bifurcation of the trachea. Located at around T5 and is area of sensitive cough reflex
140
Which main bronchus is shorter, wider, more vertical and forms 3 secondary bronchi?
the right bronchus
| right lung has 3 lobes to match the 3 right secondary bronchi
141
Which main bronchus passes inferior to aorta, anterior to the esophagus and forms 3 secondary bronchi
the left bronchus
| left lung has 2 lobes to match the 2 right secondary bronchi
142
How many bronchopulmonary segments does each lung have?
10
143
What separates each bronchopulmonary segment?
connect tissue seams with pulmonary veins running through (allows for surgical resection of individual segments.
144
Each bronchopulmonary segment is supplied by ______ and ______.
segmental (tertiary) bronchi and tertiary pulmonary arteries, they branch and travel together to each segment
145
Pulmonary arteries carry what kind of blood to the lung from which part of the heart?
deoxygenated blood from the right ventricle to the lung
146
The pulmonary trunk branches into how many pulmonary arteries?
2, right and left
147
Where in the pulmonary root is the pulmonary artery typically located?
superiorly (ABV)
148
Pulmonary veins carry what kind of blood from the lung to which part of the heart?
oxygenated blood to the left atrium
149
How many pulmonary arteries are there?
4, 2 right and 2 left
150
Where in the pulmonary root are the pulmonary veins typically located?
inferior and anterior (ABV)
151
What supplies blood to the lungs and visceral pleura? Where do they originate and how do they travel in the lungs?
bronchial arteries which originate from the aorta (occasionally from posterior intercostal a.) and travel with bronchi until anastomosing at respiratory bronchiole
152
Where does the right bronchial vein drain to?
azygos v.
153
Where does the left bronchial vein drain to?
hemiazygos v.
154
About what percentage of the blood is drained from the lung via the bronchial arteries? What drains the rest?
13%, the remained returns via pulmonary vein due to anastomoses
155
What is the order of SUPERFICIAL lymphatic drainage from the lungs?
superficial (sub pleural) lymphatic plexus (under pleura) -> bronchopulmonary (hilar) lymph nodes -> tracheobronchial nodes ->bronchomediastinal trunks -> then into the venous systems via the thoracic duct if on the left or right lymphatic duct
156
What is the order of DEEP lymphatic drainage from the lungs?
deep lymphatic plexus (in submucosa and septa) -> intrapulmonary or bronchopulmonary (hilar) lymph nodes -> tracheobronchial nodes ->bronchomediastinal trunks -> then into the venous systems via the thoracic duct if on the left or right lymphatic duct
157
Presynaptic parasympathetic nerves that supply the lungs travel in which nerve and synapse where?
travel in the vagus nerve (CN X) and synapse in the walls of the bronchi
158
What are the effects of parasympathetic innervation to the lungs?
bronchoconstriction
vasodilation
secretomotor
159
Sympathetic innervation for the lungs comes from what cord levels? Where do they synapse?
T2-T5, synapse in sympathetic trunk and postganglionic sympathetic neurons exit the trunk and follow blood vessels to the lungs
160
What are the effects of sympathetic innervation to the lungs?
vasoconstriction
inhibition of secretion
(bronchodilation is by lack of parasympathetic not presence of sympathetic)
161
pulmonary visceral afferents travel in which nerve?
vagus nerve, CNX
162
What are the reflexive control functions of pulmonary visceral afferents?
tactile sensations (cough reflex)
stretch receptors in bronchi
pressure receptors in pulmonary arteries (blood pressure)
chemoreceptors in pulmonary veins (blood gas)
163
Pulmonary visceral afferents are responsive to what stimuli?
chemical irritation
ischemia
excessive stretch
164
Pain impulses from visceral pleura and bronchi travels with _____ and may refer pain to ______ dermatomes.
sympathetics, T2-T5
165
Pain impulses from the trachea travel with _____ in the ______ nerve
parasympathetics, vagus
