Thorax Flashcards
(192 cards)
1
Q
The thorax represents what region?
A
axial region
2
Q
What is the thorax characterized by?
A
bony, expandable cage (rib cage)
3
Q
What does the rib cage protect?
A
cardiopulmonary + GI viscera
4
Q
What does the rib cage permit?
A
respiratory movements
5
Q
The bony thoracic cage is made up of how many paired ribs?
A
12
6
Q
The ribs connect the _____ vertebrae posteriorly w the _____ anteriorly.
A
thoracic, sternum
7
Q
What does the thoracic cavity contain?
A
heart, lungs, esophagus, other associated structures
8
Q
The contents of the thoracic cavity are organized into 3 main regions, what are they?
A
right pulmonary artery, left pulmonary artery, midline mediastinum
9
Q
T/F all structures in the thorax are self-contained in the thoracic cavity:
A
FALSE - only some structures are self-contained in the thoracic cavity
(others pass thru the thorax from the neck to the abdomen)
10
Q
Some structures pass through the thorax from the neck to reach what cavity?
A
to reach the abdominal cavity
(from neck to abd)
11
Q
Palpation is often used to identify important surface landmarks of the thorax during a physical exam. What are the bony landmarks of the thorax?
A
- sternoclavocular joint
- jugular (suprasternal notch)
- sternal angle
- xiphoid process
- costal margin
12
Q
What bony landmark is used to assess musculoskeletal impairment?
A
sternoclavicular joint
13
Q
What bony landmark is used to assess aortic pathology?
A
juglar (suprasternal) notch
14
Q
What bony landmark is a demarcation between superior and inferior mediastinal regions?
A
sternal angle
15
Q
What bony landmark overlies the T6 dermatome?
A
xiphoid process
16
Q
What bony landmark is used to assess hepatomegaly (liver enlargement)?
A
costal margin
17
Q
There are imaginary direction lines that allow for consistent and reliable anatomical description in the thorax. What are they?
A
- anterior midsternal lines
- clavicular lines (bilateral)
- anterior, mid, posterior axillary lines
- posterior median line
18
Q
For examination and diagnostic purposes, the breast is divided into four quadrants. What are they?
A
- superior lateral
- superior medial
- inferior lateral
- inferior medial
(imagine vertical and horizontal lines are drawn through middle of nipple)
vertical = 12-6 o’ clock
horizontal = 9-3 o’ clock
19
Q
What quadrant of the breast articulates with the axillary process?
A
superior lateral
20
Q
What type of approach should be taken when palpating the breast to ensure a thorough assessment?
A
systemic approach
21
Q
Describe how you would palpate the breasts during a physical exam (hint: systemic approach):
A
- use pads of 2-4 digits
- keep fingers flat
- apply pressure to asses levels of depth
systemic approach to palpation
22
Q
What should you always remember to include when palpating the breast during a physical exam?
A
the axillary process
23
Q
What are the two common methods used for palpation of the breasts?
A
- spiral method
- vertical strips
24
Q
Describe the spiral method used for breast palpation:
A
palpate outwardly from the nipple using concentric circles
25
Describe the vertical strips method used for breast palpation:
palpate medial to lateral in a superior/inferior strip pattern
26
What type of construction does the thoracic wall have?
semi-rigid
27
What lines the inner surface of the thoracic wall?
serous parietal pleural layer
28
What two layers create two pleural cavities within the thoracic cage?
1. serous parietal pleural layer
2. visceral layer
29
The thoracic cage is formed by a combination of what type of structure?
bony and cartilaginous
30
What are the bony and cartilaginous structures that form the thoracic cage?
- sternum
- 12 pairs of ribs and costal cartilages
- thoracic vertebrae 1-12 (with associated intervertebral discs)
31
Name the 3 parts of the sternum from superior to inferior:
manubrium, body, xiphoid process
32
The manubrium articulates laterally with what three things?
- clavicle (sternoclavicular joint)
- first costal cartilage
- body (inferiorly)
33
The manibrium articulates inferiorly with what?
the body
34
What is the palpable landmark between the junction of the manubrium and body?
sternal angle (Angle of Louis)
35
Imagine a line is drawn posteriorly from the sternal angle through the intervertebral disc between T4 and T5. This divides the central thorax into what two mediastinal regions?
superior and inferior mediastinal regions
36
Which lymph node is the first lymph node into which a breast tumor drains?
sentinel lymph node
37
What are 4 general rib features?
- head
- neck
- tubercle
- body
38
Ribs 1-7 are classified as what?
true (direct)
39
Ribs 8-10 are classified as what?
false (indirect)
40
Ribs 11-12 are classified as what?
floating (no articulation)
41
Floating ribs have no connection to the sternum, as they terminate where?
in the abdominal wall musculature
42
The head of the ribs articulate with the what of the adjacent thoracic vertebra?
demifacets on the bodies of the adjacent thoracic vertebrae
43
The inferior head facet articulates with the vertebrae that corresponds to what?
to the rib numerically
44
T/F the neck of the ribs is present in ribs 11-12:
FALSE (the neck of ribs 11-12 is NOT present)
45
What region connects the neck of the ribs to the head?
tubercle region
46
At the transition between the neck and body of the ribs, the tubercle articulates with the corresponding _____ _____ process:
thoracic transverse
47
What part of the rib serves as an attachment site for ligamentous support?
tubercle
48
What part of the rib is thin, flat, and long?
body
49
The body of the rib is marked by the _____ _____ laterally and an internal _____ _____.
costal angle, costal groove
50
What part of the rib contains an intercostal neurovascular bundle?
the costal groove of the body
51
The distal, anterior end of the rib body articulates with what?
costal cartilages
52
What do the costal cartilages of the rib articulate with?
the sternum
53
1% of the population has an accessory cervical rib. This rib may articulate with what vertebra?
C7
54
An accessory cervical rib in 1% of the population could potentially contribute to what type of syndrome?
thoracic outlet syndrome
55
What is thoracic outlet syndrome?
the accessory rib puts pressure on the subclavian artery or lower brachial plexus trunk or both
(1% of the population)
56
What are the sx of thoracic outlet syndrome?
- numbness
- tingling in C7-C8 nerve distribution
- pain
- temperature changes in upper limb
57
How many thoracic vertebrae contribute to the posterior boundary of the thoracic cage?
12
58
Thoracic ____ serve as attachment sites for ligamentous, muscular, capsular, and costal structure.
processes
59
What are the two thoracic apertures?
1. superior thoracic aperture
2. inferior thoracic aperture
60
What is another name for the superior thoracic aperture?
thoracic inlet
61
Which thoracic aperture is small and kidney-shaped?
superior thoracic aperture
62
Which thoracic aperture is large and irregularly shaped?
inferior thoracic aperture
63
T/F the superior thoracic aperture is bound by the manubrium anteriorly:
TRUE
64
T/F the superior thoracic aperture is bound by the 1st rib pair laterally:
TRUE
65
T/F the superior thoracic aperture is bound by the T1 vertebral body posteriorly:
TRUE
66
The superior thoracic aperture is bound by 3 things, what are they?
1. manubrium (anteriorly)
2. 1st rib pair (laterally)
3. T1 vertebral body (posteriorly)
67
What allows for structural continuity between the neck and thorax?
superior thoracic aperture
68
T/F the inferior thoracic aperture is bound by the xiphoid process anteriorly:
TRUE
69
T/F the inferior thoracic aperture is bound by the costal arch and 12th rib pairs laterally:
TRUE
70
T/F the inferior thoracic aperture is bound by the 12th vertebral body posteriorly:
TRUE
71
The inferior thoracic aperture is bound by what?
1. xiphoid process (anteriorly)
2. costal arch & 12th rib pairs (laterally)
3. T12 vertebral body (posteriorly)
72
What closes off the inferior thoracic aperture?
the muscular diaphragm
73
Openings within the diaphragm allow for communication of structure between what two cavities?
thorax and abdomen
74
Respiration requires that the thoracic cage be able to expand and retract. What does it mean to "expand"?
increase volume
75
Respiration requires that the thoracic cage be able to expand and retract. What does it mean to "retract"?
decrease volume
76
When the thoracic cage expands, is this facilitating inspiration or expiration?
inspiration
77
When the thoracic cage retracts, is this facilitating inspiration or expiration?
expiration
78
What two things allow for thoracic cage movement and volume changes?
1. articulations between the vertebra, ribs, costal cartilages, and sternum
2. contraction and relaxation of diaphragm
79
The movement and volume of the thoracic cage changes in 3 planes. What are they?
1. anterior/posterior plane
2. lateral plane
3. superior/inferior plane
80
This plane allows for thoracic cage movement and volume changes and is analogous to a water pump handle.
anterior/posterior plane
81
This plane allows for thoracic cage movement and volume changes and is like a bucket hat.
lateral plane
82
This plane allows for thoracic cage movement and volume changes and has a dome-shaped appearance.
superior/inferior plane
83
Which plane of the thoracic cage involves the upward rational movement of ribs 1-6 and anterior movement of the sternum?
anterior/posterior plane
84
Which plane of the thoracic cage involves elevation of the lower ribs, where the lateral portions swing superolaterally?
lateral plane
85
Which plane of the thoracic cage involves contraction and relaxation of the muscular diaphragm?
superior/inferior plane
86
T/F in the superior/inferior plane of the thoracic cage, contraction of the diaphragm flattens the muscle to increase volume:
TRUE
87
T/F in the superior/inferior plane of the thoracic cage, relaxation of the diaphragm resumes its dome-shaped appearance:
TRUE
88
The upper ribs are similar to a pump-handle because they increase what?
increase anterior/posterior volume
(hint: get pumped UP for anatomy)
(upper ribs = pump-handle)
89
The lower ribs are similar to a bucket-handle because they increase what?
increase lateral volume
(hint: buckle DOWN and study hard)
(lower ribs = bucket-handle)
90
What muscles of the thoracic wall assist in respiration and are arranged in 3 layers?
intrinsic muscles
91
What are the 3 intrinsic muscles of the thoracic wall that assist in respiration?
1. superficial
2. intermediate
3. deep
92
The intrinsic muscles of the thoracic wall receive innervation and blood supply from what? (hint: 3 things)
- intercostal nerves (thoracic anterior rami)
- arteries
- veins
93
What is another name for the intercostal nerves?
thoracic anterior rami
94
The superficial layer of the thoracic wall contains what muscles?
external intercostal muscles
95
The external intercostal muscles of the superficial layer of the thoracic wall span the intercostal space from the _____ to the _______ _______.
tubercle to the costochondral junctions
96
The external intercostal muscles run in an inferomedial direction from superior to _____ ribs.
inferior
97
The external intercostal muscles are replaced anteriorly by external intercostal membranes along the costal cartilage to the ______.
sternum
98
The internal intercostal muscles of the intermediate layer of the thoracic wall span the intercostal space from the _____ and _____ ______.
sternum and costal cartilages
99
The deep layer of the thoracic wall is also called what layer?
incomplete layer
100
The muscles that span two intercostal spaces in the deep layer of the thoracic wall are called what?
subcostal muscles
101
T/F the diaphragm is considered an intrinsic muscle of the thoracic wall:
FALSE
the diaphragm is not an intrinsic muscle
102
What is the dome-shaped muscle in the thoracic wall?
diaphragm
103
What are the 3 posterior openings in the diaphragm and what vertebral levels do they correlate to?
IVC, esophagus, aorta
T8, T10, T12
"I EAT APPLES AT 8, 10, AND 12"
104
What are the accessory respiratory muscles that contribute to the thoracic wall and aid in respiratory function?
1. serratus posterior superior
2. serrates posterior inferior
3. levator costrum
105
What muscles play a role in proprioception of the thoracic cage?
accessory respiratory muscles
(serratus posterior superior, serratus posterior inferior, levator costrum)
106
The axioappendicular, neck, and abdominal muscles attach to what 3 structures?
1. ribs
2. sternum
3. costal cartilages
107
The external intercostal muscles are most active during _____?
inspiration
remember: "EX-IN"
108
internal intercostal muscles are most active during _____?
expiration
remember "IN-EX"
109
The anterior rami that trail inferior to the 12th rib are called what?
subcostal nerves
110
From superior to inferior, what makes up the intercostal neuromuscular bundle?
vein, artery, nerves
remember "VAN"
111
The intercostal nerves gives off to what branches?
lateral and anterior cutaneous branches
112
The diaphragm receives motor innervation from what nerve?
phrenic nerve (C3-C5)
113
Internal thoracic arteries arise from what?
thoracic arteries
114
What two intercostal arteries anastomose?
posterior and anterior intercostal arteries
115
What do the posterior intercostal vein drain?
thoracic wall (via azygos venous system)
116
What do the anterior intercostal veins drain?
internal thoracic veins
117
What two things does the female breasts contain?
mammary glands and adipose tissue
118
The lobules within the female breast are supported by what?
suspensory ligaments (Cooper's ligaments)
119
What general area can you find the female nipple?
6th intercostal space
120
What is a reliable landmark to locate the male nipple?
4th intercostal space
121
How many stages are there in the Tanner Stages of Breast Development?
5
122
What does the Tanner Stages of Breast Development assess?
if a female adolescent is developing normally
123
Describe the Tanner Stages of Breast Development:
1 - papillae elevations
2. - palpable buds, areolae enlarge
3. - elevation of contours, areolae enlarge
4. - form secondary areolar mounds
5. - adult breast contour
124
The breast drains glandular tissue first into what?
subareolar plexus (deep to nipple)
125
The subareolar plexus is continuous with what?
circumareolar plexus
126
The circumareolar plexus communicates with what?
the contralateral breast
127
75% of breast lymph drainage travels laterally toward what?
axillary lymph nodes
128
25% of breast lymph drainage travels medially via what?
parasternal nodes
129
The R/L pleural sac is formed by what?
continuous serous membrane
130
What serous membrane lines the inner surface of the thoracic cavity?
parietal pleura
131
What serous membrane lines the surface and fissures of the lung?
visceral pleura
132
The pleural sac can be described as a "fist in an inflated balloon" what does the fist represent in this analogy?
the lung
133
The pleural sac can be described as a "fist in an inflated balloon" what does the outer surface of the balloon represent in this analogy?
parietal pleura
134
The pleural sac can be described as a "fist in an inflated balloon" what does the inner surface of the balloon in contact with he fist represent in this analogy?
visceral pleura
135
The pleural sac can be described as a "fist in an inflated balloon" what does the air/space in the balloon represent in this analogy?
pleural cavity
136
The pleural sac can be described as a "fist in an inflated balloon" what does the wrist represent in this analogy?
root of lung (where 2 layers are continuous)
137
The space between the parietal and visceral pleura is called what?
pleural cavity
138
What separates the costal parietal pleura from the internal surface of the thoracic cage?
endothoracic fascia
139
The costodiaphragmatic recess is a common site for what?
fluid accumulation
140
The visceral pleura is supplied by what?
bronchial arteries
141
Sensory innervation from parietal pleurae is mediated by:
phrenic and intercostal nerves
142
Sensory innervation from visceral pleurae is mediated by:
GVA fibers
143
Which pleura is pain sensitive? (hint: parietal or visceral)
parietal pleura
144
Which pleura is pain insensitive? (hint: parietal or visceral)
visceral pleura
145
Where does lymph from the visceral pleura drain into?
superficial lymphatic plexus
146
What are the arteries that supply the thoracic wall, diaphragm, and parietal pleura?
intercostal, internal thoracic, and musculophrenic arteries
147
Where the costal parietal pleura and media spinal pleura meet is called what?
costomediastinal recess
148
What lymph nodes travel in the lung hilum?
bronchopulmonary nodes
149
What lymph nodes drain at the tracheal bifurcation?
tracheobronchial nodes
150
What do air-filled, fuild-filled, and solid-filled lungs sound like?
resonant, dull, flat sound
(respectively)
151
What are the lobes of the right lung?
superior, inferior, middle
152
How many bronchopulmonary segments does the right lung have?
10
153
How many fissures does the right lung have and what are they?
2 - horizontal & oblique
154
How many lobes does the left lung have and what are they?
2 - superior and inferior
155
How many bronchopulmonary segments does the left lung have?
8
156
How many fissure(s) does the left lung have. What is it called?
1 oblique fissure
157
The left lung has two notches, what are they called?
cardiac notch and lingual notch
158
The skeleton of the trachea is composed of what?
C-shaped cartilaginous rings
159
The trachea bifurcates into what?
R/L primary bronchi
160
What is the ridge of cartilage that serves as an important visual landmark at the tracheal bifurcation?
carina
161
The primary bronchi divide into what?
multiple secondary (lobar) bronchi
162
Which bronchi supplies each bronchopulmomary segment?
tertiary (segmental) bronchi
163
The vagus nerve travels _____ to the bronchi.
posterior
164
The R primary bronchus is ____ and ____ than the L primary bronchus
wider and shorter
165
The L primary bronchus is ____ and ____ than the R pulmonary bronchus
narrow and longer
166
Where do bronchial arteries arise from?
thoracic aorta or thoracic intercostal branches
167
Bronchial arteries supply what? (hint: two things)
lung parenchyma and root structures
168
Bronchial veins drain structures supplied by:
bronchial arteries near root of lung
169
Respiratory structures receive autonomic innervation from what?
pulmonary plexus
170
Anterior pulmonary plexus is located anterior to what?
tracheal bifurcation
171
The R bronchomediastinal lymph trunk drains into what?
R lymphatic duct
172
The L bronchomediastinal lymph trunk drains into what?
thoracic duct
173
Lymph from the bronchopulmonary lymph nodes drains to where?
superior and inferior tracheobronchial lymph nodes
174
Brachiocephalic veins are formed by junction of what?
internal jugular and subclavian veins
175
The R & L brachiocephalic veins join to form SCV, which drains into what?
R atrium of heart
176
Where does the trachea bifurcate?
sternal angle
177
What does the thoracic duct travel between?
esophagus and L vagus nerve (duck between 2 gooses)
178
Preganglionic sympathetic:
lateral horn spinal cord thoracic levels
179
Postganglionic sympathetic:
thoracic sympathetic ganglia
180
Preganglionic parasympathetic:
medulla
181
Postganglionic parasympathetic:
in walls of viscera
182
Blood from mother is distributed to the fetus from placenta via:
left umbilical vein
183
What controls venous return of the heart?
azygos and internal thoracic vein tributaries
184
What are the major branches of the heart?
SA nodal
R marginal
AV nodal
Posterior IV
185
The R atrium has a smooth inner surface called what?
sinus venarum
186
The R atrium has a rough inner surface called what?
pectinate muscle
187
What is the small oval depression within the sinus venarum?
fossa ovalis
188
What is the rough muscle of the inner surface of the R ventricle called?
tabeculae carne muscle
189
What is the smooth membranous portion of the IV septum?
conus arteriosus
190
What is visible from inside the L atrium?
valve of foramen ovale
191
What are the inner structures of the left ventricle? (hint: there's 3)
1. papillary muscles (anterior/posterior)
2. trabecular carneae
3. chord tendineae
192
Explain the "try before you buy" analogy:
tricuspid valve comes before bicuspid valve in sequence of blood flow through the heart
