Part I through page 462 Flashcards
(144 cards)
1
Q
Sternal Angle is the site of what?
A
where the manubrium and body of sternum meet. articulation site for 2nd rib.
2
Q
How many true tribs?
A
Upper 7 pairs
3
Q
How many false ribs?
A
lower 5 pairs. 8-10 are false, 11 and 12 are floating.
4
Q
What forms the costal margin?
A
costal cartilage from ribs 8,9, 10 articulating with the costal cartilage of rib 7
5
Q
Costovertebral joint
A
head of rib articulates with bodies of 2 vertebrae. Tubercle with the transverse process of corresponding vertebrae. Synovial
6
Q
Sternocostal joint
A
fibrous joint between costal cartilages 1-7 and lateral margin of sternum.
7
Q
Interchondral joint
A
fibrous between costal cartilages
8
Q
Which muscle runs downward and forward in the intercostal space and is involved with inspiriation?
A
External intercostal- most superficial. Does not have direct contact with sternum
9
Q
The neurovascular bundles in the intercostal space lay between what two muscles?
A
inner intercostal and innermost intercostal/transversus thoracis.
10
Q
How many intercostal spaces are there?
A
11
11
Q
This muscle runs upward and forward in the intercostal space……
A
inner intercostal
12
Q
what is the order from superior to inferior for the neurovascular bundle in the intercostal spaces?
A
Vein, artery, nerve
13
Q
Where would you place a needle for aspirating the thorax to prevent damaging the neurovascular bundle?
A
On the upper border of the rib
14
Q
The ventral ramus of the intercostal nerves supply what regions?
A
They supply the intercostal muscles, lateral cutaneous, anterior cutaneous
15
Q
The dorsal ramus of the intercostal nerves supply what regions?
A
skin and muscle of the posterior wall.
16
Q
The internal thoracic artery divides into what two arteries and where?
A
superior epigastric and muscular phrenic at the level of the 6th or 7th rib.
17
Q
How many anterior intercostal arteries are supplied by the internal thoracic artery?
A
the upper 6
18
Q
The lower 5 anterior intercostal arteries are supplied by which artery?
A
musculophrenic
19
Q
How many posterior intercostal arteries are supplied by the thoracic aorta?
A
the lower 9
20
Q
Which artery supplies the upper 2 posterior intercostal arteries?
A
the superior intercostal artery off of the costocervical trunk
21
Q
Anterior intercostal veins drain into which major vein?
A
The internal thoracic vein
22
Q
The posterior intercostal veins on the left side drain into which vein?
A
hemiazygos vein
23
Q
The posterior intercostal veins on the right side drain into which major vein?
A
Azygos vein (which drains into the SVC)
24
Q
The visceral layer and parietal layer of pleura form what at the hilum of the lung?
A
The pulmonary ligament, which is inferior to the hilum. It allows for expansion of veins.
25
Which nerves innervate the parietal layer of pleura?
the intercostal and phrenic nerves- highly sensitive to pain.
26
Costal pleura is separated from the intercostal muscles by....
the endothoracic fascia.
27
The cupula parietal pleura covers what part of the lung?
The apex.
28
The visceral pleura is supplied blood by which artery?
Bronchial artery
29
What innervates the visceral pleura?
Autonomic innervation.
30
Disease of the apex of the lung could lead to what symptoms?
Paralysis of intrinisc muscles of the hand (T1) and Horner's syndrome (loss of synmpathetics to the eye)
31
Are the recesses of the pleura occupied by the lung?
not usually, only during deep inspiration.
32
The extent of the pleura can be marked by which ribs? (from sternum, mid-clavicular, and axillary regions)
ribs 8, 10, 12
33
The extent of the lungs can be marked by which ribs? (from sternum, mid-clavicular, and axillary regions)
ribs 6, 8, 10 respectively.
34
Describe a pneumothorax....
The pleural cavity becomes filled with air. It can also be filled with blood or pus. Must be remvoed using a needle.
35
Inflammation of the pleura leads to pain where?
Since the parietal pleura is innervated by intercostal nerves,pain is to the cutaneous regions (thoracic/abdominal wall).
36
The right mediastinal surface is related to what structures?
heart, IVC, SVC, azygos vein, and espohagus.
37
The left mediastinal suface is related to what structures?
heart, arch of aorta, thoracic aorta, and espophagus.
38
Describe the location of the veins, bronchi, and pulmonary arteries in the hilum
The pulmonary veins are vental, bronchi are posterior, and the pulmonary arteries are between them.
39
Which main bronchus has a greater tendency to have foreign bodies become stuck in it?
The right main bronchus. It is wider, shorter, and more vertical.
40
Where must you listen on a person to hear their lower lobes of the lungs?
The posterior chest wall.
41
Pulmonary veins drain into which part of the heart?
The left atrium.
42
What autonomic system is targeted by anti-asthma medications?
The parasympathetic system
43
The vagus nerve provides what kind of sensation to the lungs and is responsible for what actions?
It supplies parasympathetic control to the lungs. Activation= increased mucous secretion and constriction of bronchial muscles.
44
Sympathetic activation of the lungs leads to what actions?
dilation of the bronchi and reduction of mucous secretion.
45
What is the "pump-handle" motion of inspiration?
Elevation of ribs 2-7 increases anteroposterior diameter because the sternum moves forward.
46
What causes the bucket-handle motion of inspiration?
The elevation of the lower ribs leading to an increase in transverse diameter.
47
List the contents of Middle mediastinum (5 things)
heart, pericardium, root of great vessels, root of lungs, phrenic nerves.
48
The outer layer of pericardium that attaches to the superior surface of the diaphragm is called?
The fibrous pericardium. (It extends to great vessels to diaphragm, not directly attached to the heart. It moves the heart when you breathe. Inspiration- heart puleld downward.
49
The serous pericardium has what two parts? and describe them.
Parietal layer- internal to the fibrous pericadium. Doesn't touch the surface of the heart.
Visceral pericardium- lines the heart. aka epicardium
50
Areas of Auscultation: 2nd left intercostal space close to the sternum
pulmonary valve
51
Areas of auscultation: 2nd right intercostal space close to sternum
aortic valve
52
Areas of Auscultation: left 5th intercostal space at the mid-clavicular line....
mitral/bicuspid valve
53
Areas of Auscultation: just to the left of the lower sternum near 5th intercostal space....
tricuspid valve
54
Which part of the heart receives the inferior and superior vena cavas?
the right atrium. forms the sinus of the venae cavae/sinus venarum.
55
What is the sulcus terminalis cordis?
A groove which separates the sinus venarum form the rest of the atrium.
56
Which parts of the heart contain pectinate muscles?
the right/left atria. Begin at crista terminalis (ridge)
57
What is fossa ovalis?
A depression which represents the remains of the embryonic foramen ovale.
58
What is the junction between the right ventricle and the pulmonary trunk called?
conus arteriosus or infundibulum.
59
Trabeculae carnae are found in what chambers of the heart?
Right/left ventricle.
60
Describe the tricuspid valve....
3 valve cusps= septal, anterior posterior. Connected to papillary muscles by the chordae tendinae.
61
The septo-marginal trabecula is what?
Part of conduction system of the heart. found only in the right ventricle. Also called the moderator band.
62
The left atrium receives which veins?
4 pulmonary veins (2 inferior/2 superior) Left/right.
63
Which valves have a tricuspid morphology?
3 out of the 4 have 3 cusps. The only one with 2 is the left atrioventricular or mitral/bicuspid valve.
64
How many times thicker is the left ventricle from the right ventricle?
3 times thicker
65
The interventricular septum has two components. Name/describe their location.
1) muscular component- lower 2/3rds
| 2) membraneous component- upper 1/3rd
66
What component of the interventricular septum is most affected by defects?
The membraneous component is more affected. Usually involves the septal cusp of the tricuspid valve because it attaches to the membraneous component.
67
What are the three cusps of the pulmonary valve?
anterior, right, left
68
Name the 4 branches off of the Right Coronary artery
atrial branch, nodal artery, marginal partery, posterior interventricular
69
The coronary sinus drains which veins?
great cardiac vein, middle cardiac vein, small cardiac vein, posterior cardiac vein.
70
Which node of the heart is the pacemaker?
The sino-atrial node.
71
What does the anterior mediastinum contain?
The thymus and fatty tissue.
72
What is the plane of separation of the superior and inferior mediastinum?
The sternal angle and TV4/5
73
What are the three branches coming off of the arch of the aorta?
The right brachiocephalic, the left common carotid, and the left subclavian arteries.
74
Contents of the superior mediastinum:
arch of aorta and roots, brachiocephalic veins and SVC, vagus, phrenic, left recurrent laryngeal, sympathetic trunks, trachea, esophagus, thoracic duct, thymus gland.
75
The brachiocephalic vein is formed by which 2 veins?
The subclavian and internal jugular veins. each side of the body has a brachiocephalic vein.
76
Route of the right vagus nerve:
descends on right side of trachea posterior to the root of the lung. Gives branches to lung and continues to form the posterior esophageal plexus. The right recurrent loops around the subclavian artery.
77
Route of the left vagus nerve:
Descends anterior ot the arch of the aorta and posterior to the root of the lung. Supplies the lungs and espophagus. The left recurrent laryngeal nerve loops posteriorly on the left side of the ligamentum arteriosum and ascends.
78
Phrenic nerves supply what kinds of innervation?
It supplies motor to the diaphragm and sensory to the pericardium and pleura.
79
Contents of the posterior mediastinum are:
Thoracic aorta, esophagus and vagal plexuses, thoracic duct, azygos vein, sympathetic trunks, lymph nodes.
80
Path of the descending (thoracic) aorta.
Starts at TV4 and descends to the left of the vertebral bodies. It gradually slants right and leaves the thorax at TV12 behind the diaphragm.
81
The esophagus begins and ends where?
The cricoid cartilage (CV6) to the stomach at TV 10.
82
The blood supply to the esophagus is supplied by which arteries?
The inferior thyroid artery, thoracic aorta, and L gastic artery.
83
What veins drain the esophagus?
inferior thyroid veins, azygos system, and the left gastric veins.
84
What are the three locations where the esophagus narrows?
1) at its origin
2) where its crossed by the left main bronchus
3) its terimination
Foreign objects will likely get caught in these regions.
85
What is the path of the thoracic duct?
It begins from the cysterna chyli which lies between the abdominal aorta and the right half of the diaphragm. It passes into the mediastinum. Starts on the right side. Crosses to the left at level of TV5.
86
What regions of the body are not drained by the thoracic duct?
right side fo the head and neck, right upper limb, and right thorax.
87
The azygos vein is located on which side of the thorax?
the right side
88
the hemiazygos vein is located on which side of the thorax?
the left side.
89
What two veins form the azygos vein?
The right subcostal and ascending lumbar veins.
90
What veins drain into the azygos vein?
It drains the right posterior intercostal veins and the hemiazygos veins. It empties into the SVC
91
What two veins form the hemiazygos vein?
The left subcostal and ascending lumbar vein.
92
What fibers form the Greater splanchinc nerve?
T5-10. It is sympathetic.
93
What nerve fibers form the Lesser splanchnic nerve?
T9-11
94
What nerve fibers form the least splanchnic nerve?
T12
95
What is the most lateral structure in the posterior mediastinum?
The sympathetic trunk. It rests on the neck of the ribs.
96
Splanchnic nerves innervate which region of the body?
The abdomen
97
Camper's fascia
Most superficial fatty layer in the abdomen. Contains superficial blood vessels.
98
Scarpa's fascia
deep membraneous layer, attaches to deep thigh fascia inferior to inguinal ligament. Acts as a guirdle.
99
List the layers of fascia in the abdomen from superficial to deep:
Campers, Scarpas, deep muscles fascia, transversalis fascia, extraperitoneal fascia, and peritenium.
100
The transversalis fascia is derived from what fascia?
The thoracolumbar fascia.
101
What muscles form the conjoined tendon?
internal abdominal oblique and the transversum abdominis.
102
What is the rectus sheath?
Dense connective tissue enclosing the rectus abdominis muscle.
103
The aponeurosis of which muscle forms the inguinal ligament?
The external abdominal oblique.
104
What structure lies in the midline of the abdomen between the two rectus muscles and serves as an attachment point?
The linea alba.
105
What is formed by the aponeuroses at the lateral border of the rectus abdominis?
the linea semilunaris.
106
What forms the anterior layers of the rectus sheath?
The aponeuroses of the external oblique and anterior half of the internal oblique. The rectus abdominis is posterior to this.
107
What forms the posterior layers of the rectus sheath?
The posterior half of the aponeurosis of the internal oblique and the transversus abdominus. Posterior to this lies the transversalis fascia and extraperitonial fascia.
108
Below the umbilicus what changes about the rectus sheath?
The aponeuroses of the internal oblique and the transversus abdominis pass anterior to the rectus sheath. Inferior to the arcuate line the rectus abdominis is in contact with the transveralis fascia.
109
What nerves innervate the anterior abdominal wall?
1) spinal nerves T7-T11 (intercostal) give rise to the toracoabdominal nerves.
2) the subcostal nerve (T12)
3) L1- iliohypogastric and ilioinguinal nerves.
110
The ilioinguinal nerves supply what part of the body?
external genitalia
111
The neurovascular plane of the abdomen lies between which two muscles?
the transversus abdominis and the internal abdominal oblique.
112
What dermatomes correspond to: a)xipohid process, b) umbilicus, c) pubis?
T7, T10, L1
113
What part of the rectus sheath does the superior epigastric artery travel in?
The posterior rectus sheath.
114
What artery does the superior epigastric artery anastomose with?
the inferior epigastric artery.
115
Which artery does the inferior epigastric artery branch from?
It branches form the external iliac artery before the external iliac artery passes inferior ot the inguinal ligament.
116
Describe the course of the inferior epigastric artery:
It courses superiorly and mediallly in the extraperitoneal CT and penetrates the transversalis fascia.
117
What arteries supply the abdomen? (Hint: 6)
superior epigastric, inferior epigastric, deep circumflex, superficial circumflex ilaic, superficial epigastric, intercostals.
118
Which vein do the posterior intercostals and subcostal veins drain into?
the azygos system.
119
Which vein runs longitudinal within the superficial fascia of the lateral thorax?
thoracoepigastric vein. It drains into SVC via the lateral thoracic.
120
What is caput medusa?
when portal vein hypertension occurs it causes retrograde flow through the umbilical veins leading to their swelling.
121
What drains the superficial lymphatics of the anterior abdominal wall?
The axillary and superficial inguinal nodes.
122
Lymphatics from the abdominal wall muscles drain into what nodes?
lumbar, parasternal, and external iliac nodes
123
The inguinal canal transmits what structure in males? in females?
The ductus deferens and round ligament.
124
What makes up the lateral floor of the inguinal canal?
the inguinal ligament (formed by external oblique).
125
What makes up the medial floor of the inguinal canal?
The lacunar ligament
126
What makes up the lateral anterior wall of the inguinal canal?
The aponueorsis of the external abdominal oblique plus the lower fibers of internal abdominal oblique arising from the inguinal ligament.
127
What makes up the medial anterior wall of the inguinal canal?
aponeurosis of the external abdominal oblique-> superficial inguinal ring.
128
What makes up the medial posterior wall of the inguinal canal?
The fiberrs of the internal abdominal oblique arch over the spermatic cord. Rest is formed by the transversus abdominis.
129
What makes up the lateral posterior wall of the inguinal canal?
Transversalis fascia
130
What abdominal muscle gives rise to the cremasteric muscle?
Int. abd. oblique
131
What function does the gubernaculum have?
it draws the testes down into the scrotum.
132
List the layers of fascia covering the spermatic cord from inner to outer:
internal spermatic fascia, middle spermatic fascia, external spermatic fascia.
133
Which fascia gives rise to the deep inguinal ring?
The internal spermatic fascia
134
The deep inguinal ring is located where in relation to the inferior epigastric vessels?
lateral to the epigastric vessels.
135
Which nerve innervates the cremasteric muscle?
genitofermoral nerve (L1-L2)
136
What are the borders of the inguinal triangle?
Weak spot: inguinial ligament, inferior epigastric vessels, and lateral border of rectus abdominis muscle.
137
Describe a direct inguinal hernia:
abdominal contents protruding through the inguinal triangle. Does not protrude throught hte superficial inguinal ring into the scrotum. It is medial to the epigastric vessels.
138
Describe the coverings of a direct inguinal hernia: (internal to external)
peritoneum, extraperitoneal CT, transveralis fascia, conjoint tendon, external abdominal oblique aponeurosis and fascia.
139
Describe an indirect inguinal hernia:
Protrusion of the abdominal content through the inguinal canal. Lateral to inferior epigastric. Usually enters the scrotum.
140
Which type of hernia occurs lateral to the epigastric vessels?
indirect inguinal hernia.
141
What is an underlying reason for indirect inguinal hernias?
Patent processus vaginalis.
142
The median umbilica fold is remnant of what embryonic structure?
the urachus
143
The medial umbilical folds are defined by the remnants of which embryonic structure?
the umbilical arteries.
144
The lateral umbilical folds are formed by which structure?
the inferior epigastric arteries as they course medially and superiorly to enter the rectus sheath.
