Thorax Flashcards
0
Q
What makes up the thoracic wall skeleton?
A
12 pairs of ribs and costal cartilages
12 thoracic vertebrae and intervertebral discs
Sternum
1
Q
Ribs are classified as what type of bones and do they contain bone marrow?
A
Flat bones, and yes they have BM.
2
Q
Name the parts of sternum
A
Manubrium, body, xiphoid process
3
Q
Divide ribs into true, false and floating. What makes them fall into these categories?
A
1-7 true. Attached directly to sternum
8-10 false. Attached to the cartilage of the superior rib
11&12 floating. Not connected to sternum
4
Q
Where can you find the costal groove of a rib and what is its function?
A
On the internal surface of a rib. Protects the costal nerve/vessels.
5
Q
Name the parts of a typical rib and give main features of each
A
Head: has 2 facets for vertebra above and below it.
Neck: connects the head to the body at the level of tubercle
Tubercle: smooth, connects to transverse process
Body: thin, flat, curved
6
Q
You are about to perform a thoracocentesis on a patient in the ER. Would you choose to insert the needle just above or below a rib and why?
A
Just above the rib to avoid the vessels that run just below a rib.
8
Q
Name the atypical ribs
A
1,2,10,11,12
9
Q
The shortest, broadest, most curved and almost horizontal rib.
A
What is the 1st rib
9
Q
These ribs only have one facet on their heads.
A
1, 10-12
10
Q
How many grooves run on superficial surface of the 1st rib and what is its/their function?
A
2
Subclavian vessels run here.
11
Q
These ribs have no heads or tubercles
A
11 and 12
12
Q
The first two ribs are the strongest and it takes a great amount of force to break them. You have a patient with a fracture of these ribs what do you suspect and what tests would you do?
A
The injury must be worse that it looks. Orders CXR, MRI, CT to check for internal injuries.
14
Q
Characteristics of a thoracic vertebrae
A
Body, arch, 7 processes
BL costal facets
costal facets of transverse processes(except for inferior 2 or 3)
Long, inferior slanting spinous process
15
Q
Sternal angle or angle of Loius significance
A
RAT PLANT
Rib 2*
Aortic arch*
Tracheal bifurcation*
Pulmonary trunk Ligamentum arteriosum Azygous vein enters SVC Nerve plexi (cardiac and pulmonary) Thoracic duct
15
Q
Trapezoidal bone at level of T3-T4 with two BL clavicular notches
A
Manubrium
16
Q
Flat elongated bone forming the anterior part of thoracic cage
A
Sternum
17
Q
Bone on the anterior chest with costal notches
A
Body of sternum
18
Q
Sword like shaped structure
A
Xiphoid process
20
Q
Length of xiphoid is constant and never has a hole in it. T or F?
A
F
20
Q
Inflamation of a rib or the cartilage connecting a rib.
A
Costochondritis
21
Q
Name the thoracic apertures
A
Superior and inferior
22
Q
Modified sweat glands on anterior surface of the chest
A
Breasts
23
Q
Locate circular base of a breast
A
From lateral border of the sternum to midaxillary line.
25
What attaches breast to the skin?
Suspension ligament of Cooper
26
Define areola
Pigmented area around the nipple
26
Name the thoracic compartments
2 lateral - pulmonary
| 1 central - mediastinum
27
Accessory muscles of respiration
Pectoralis major/minor
Sarratus anterior
Scalenes
28
A fist in a balloon
What are pleurae (visceral and parietal)
29
Serous sack surrounding the lungs
Pleura
30
Differentiate btwn visceral and parietal pleura
Visceral - adherent to lungs, cannot be dissected form them
| Parietal - adherent to thoracic wall, mediastinum and diaphragm
31
Define pleural sleeve
Area of continuity of visceral and parietal pleurae enclosing the root of the lung
32
4 parts of parietal pleura
Costal, mediastinal, diaphragmatic and cervical
33
Name the otential space btwn the 2 pleurae with capillary layer of serous fluid
Pleural space
34
What are costodiaphragmatic and costomediastinal recesses?
Potential spaces in pleural cavity at the respective junctions
35
Name the lines of pleural reflection and define each.
Sternal - where costal becomes continuous with mediastinal anteriorly
Costal- where costal becomes continuous with diaphragmatic
Vertebral- where costal becomes continuous with mediastinal posteriorly
36
Define lung root
Connects lung to trachea and heart. Formed by structures entering and leaving the lung at the hilum
37
How many lobes in each lung
Right - 3
| Left - 2
38
Names and give the functions of lung fissures
Horizontal and oblique
| Divide lung into lobes
39
Locate cardiac notch and lingula
Margin of the left lung
40
What is lingula?
Projection of the upper lobe of the Left lung
41
A blunt superior end of the lung ascending into root of neck
Apex of the lung
42
3 surfaces and 3 borders of the lungs
Costal, mediastinal and diaphragmatic surfaces
| Anterior, posterior, inferior borders
43
Main bronchi pass from bifurcation of trachea to lung. T or F?
T
44
Left main bronchus is wider, shorter and more vertical than the right. T or F?
F. This is true about the right one.
45
What is carina?
A cartilaginous ridge within the trachea that runs antero-posteriorly between the two primary bronchi at the site of tracheal bifurcation
46
Pulmonary arteries raise from the pulmonary trunk at .....( hint: significant landmark)
Sternal angle.
47
Pulmonary arteries carry 'venous blood' and pulmonary veins carry 'arterial blood'. T or F?
T
49
This compartment contains almost all thoracic viscera, extends from superior thoracic apertures to diaphragm, from sternum to vertebrae, and primarily consists of air or fluid filled structures.
Mediastinum (central)
49
Give location of Inferior mediastinum and into what parts it divides.
From sternal angle to diaphragm
| Divided into anterior, middle and posterior
50
A part of mediastinum from superior thoracic aperture to sternal angle and the structures located here
```
Superior mediastinum:
SVC
Brachiocephalic vein
Arch of aorta
Thoracic duct
Trachea
Esophagus
Thymus
Vagus nerves
Left recurrent laryngeal nerve*
Phrenic nerve
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51
Name the smallest subdivision of inferior mediastinum, give its location and it's structures
Anterior mediastinum
From sternum to pericardium
Contains inferior part of thymus in kids
52
This part of inferior mediastinum contains the heart, pericardium, ascending aorta, pulmonary trunk, SVC, arch of azygous vein, main bronchi
Middle mediastinum
53
Locate the posterior mediastinum and name its structures.
```
Anterior to T5-T12.
Thoracic aorta
Thoracic duct
Azygous and Hemizygous veins
Esophagus and esophageal plexus
Thoracic sympathetic trunks
Thoracic splenic nerves
```
54
Double wall membrane enclosing the heart
Pericardium
55
What does the nerve supply to pericardium consist of.
Phrenic nerves, sympathetic trunks, vagus (X)
56
Cardiac cycle begins with diastole/systole and ends with diastole/systole.
Diastole( period of elongation and filling)
| Systole ( shortening and emptying)
57
Thick layer of heart - cardiac muscle
Myocardium
58
Name the heart wall formed by visceral layer of pericardium
Epicardium
59
Heart layer covering the valves
Endocardium
60
Give location and orientation of the heart's apex
Posterior to the left 5th intercostal space (9cm from median plane)
Directed anteriorly and to the left
61
Functions of fibrous rings in the heart
Keep valves open
Attachment for leaflets and cusps of valves
Attachment for myocardium
Electrical insulator between atria and ventricle
62
4 surfaces of the heart
Anterior, diaphragmatic, left and right pulmonary
63
Describe the base of the heart
Posterior aspect, formed by LA and slightly the RA.
| Receives the pulmonary veins and SVC/IVC
65
Anterior surface of the heart is aka as____ and consists of?
Sternocostal
| Mainly RV
65
Left pulmonary surface of the heart is made up of?
Mainly LV and forms cardiac impression of left lung
66
Diaphragmatic surface of the heart is aka as ____ and consists of?
Inferior
| LV and partially RV
67
Right pulmonary surface of the heart is made up of?
Mainly RV
69
What and where is the coronary sinus?
Collection of veins delivering blood from coronary circulation to RA. Located on posterior inferior surface of the heart, medial to IVC
69
Obliquely placed partition btwn R and L ventricles. What structure, pertaining to electricity, runs through it.
Intraventricular septum
| Right bundle of AV node
70
What is right auricle and its function?
Clonical pouch shaped projection on RA, increases its capacity
71
Give location of bi/tricuspid valves.
Tricuspid right heart
Bicuspid (mitral) left heart
Tri (3) right lung has 3 lobes
Bi (2) left lung has 2 lobes
72
What is conus arteriosus?
Conical pouch formed from upper RV that leads to pulmonary trunk. (cone)
73
Wall of the RA is slightly thicker than the one of LA. T or F?
False. It's the opposite
74
Wall of the LV is 4-5 times thicker than the wall of RV. T or F?
F. 2-3 times
75
What vessels supply the myocardium and where do they arise from?
Coronary arteries
| Right and left arise from aortic sinuses at proximal part of ascending aorta just above the aortic valve
76
This artery supplies RA, most of RV, part of LV, part of IV septum, SA node (60%), AV node (80%)
RCA
77
This artery arises from coronary sinus, runs in coronary sulcus, supplies the SA node, gives a right marginal branch.
RCA
78
This artery divides into LAD and circumflex.
LCA
79
This artery runs to the apex of the heart, then swings posteriorly to anastomoses with posterior IV branch of RCA.
LAD
80
This artery supplies LA, most of LV, part of RV, most of IV septum (ant2/3), SA node.
LAD
81
This structure initiates and regulates the impulses and is located at junction of SVC and RA
SA node
83
Small collection of nodal tissue in posteroinferior region of Intra atrial septum near coronary sinus
AV node
83
Name sequence of conducting system
SA nodes initiates impulse
Impulse reaches AV
Signal spread from AV node through AV bundle into R/L bundle bunches
Signal reaches purkinje fibers
84
What are purkinje fibers?
Right and left bundle branches of AV bundle travel along the IV septum and then into subendocardial branches called purkinje fibers.
85
Lymphoid organ in anterior chest, rich in blood supply undergoes involution after puberty.
Thymus
86
This great vessel is formed by union of internal jugular vein and subclavian veins.
Bravhiocephalic vein
87
Brachiocephalic veins merge to form .....
SVC
88
Left brachiocephalic is twice as long as the right one. T/F?
T
89
Left brachiocephalic vein receives lymph from thoracic duct. T/F?
T. Right gets it from right lymphatic duct
90
Returns blood from all structures superior to diaphragm except lungs and heart , ends at 3rd costal cartilage where it enters the RA.
What is SVC
91
Location of right phrenic nerve
Between SVC and mediastinal pleura
92
Which side of the vertebral column does the descending aorta run?
Left
93
What's the correlation between Ligamentum arteriosum and antibiotics in pregnancy.
May close prematurely (normally close shortly after birth) if antibiotics are taken in third trimester.
94
What is Ligamentum arteriosum?
A small ligament (remnant of fetal ductus arteriosus) attached to superior surface of the left pulmonary artery and the proximal descending aorta.
95
Name the branch of the aortic arch that is largest, anterior to trachea , posterior to left brachiocephalic vein, and what does it divide into?
Brachiocephalic trunk. Divides into mom on carotid and right subclavian arteries.
96
Second branch of aortic arch, posterior to Manubrium, ascends anteriorly to left subclavian artery.
Left common carotid artery
97
Branch of the aortic arch arising from posterior part, has no branches in mediastinum, as it leaves the thorax it passes posterior to left sternoclavicular joint and lateral to left common carotid.
Left subclavian artery
98
Position of vagus nerve in relation to common carotid arteries.
Lies posterolaterally to the arteries.
99
Vagus (x) nerve arises from which part of the brain?
Medulla
100
Describe the position of the right vagus nerve as it enters the thorax in relation to subclavian artery and what it gives rise to.
It runs anterior to subclavian artery and gives off the right recurrent laryngeal nerve.
101
Describe the position of the left vagus nerve as it enters the thorax in relation to adjunct arteries and what it gives rise to.
Enters thorax between left common carotid and left subclavian arteries and posterior to left brachiocephalic vein. It gives of the left recurrent laryngeal nerve.
102
The only motor supply to diaphragm.
Phrenic nerves
103
Location of trachea in relation to esophagus and where does it end?
Anterior to esophagus. Ends at sternal angle
104
Trachea does not incline right or left as it descent. T/F?
F. Inclines to the right a little.
105
Cartilaginous rings encircle the trachea completely. T/F?
F. Posterior surface is flat, rings incomplete.
106
Esophagus initially inclines to the left as it descends. What moves it back to median plane?
Aortic arch
107
Fibrousmuscular tube extending from pharynx to the stomach
Esophagus
108
Location of thoracic aorta
Posterior mediastinum
On the left side of T5-T12
Posterior to root of the lung, pericardium and esophagus.
109
Locate azygous vein
Descents on right side of aorta and accompanies it through aortic hiatus of diaphragm.
111
Esophagus is compressed in three places. Name them*
Aortic arch, left main bronchus, diaphragm
112
where does the 2nd rib attach anteriorly?
btwn manubrium and the body at sternal angle
