Thorax Flashcards
1
Q
Sternal angle
A
- change in direction from manubrium to sternum
- 140 deg
- where rib counting begins
bifurcation of trachea into 2 brachia - IV disks between T4 & T5
- Pulmonary trunk divides into left and right pulmonary arteries before entering the lungs
- palpable landmark at end of costal cartilage
2
Q
true ribs
A
ribs 1-7
attach directly to sternum
3
Q
false ribs
A
ribs 8-10
- cartilages are joined to the rib immediately superior to them
- indirect connection to sternum
4
Q
floating/free/vertebral ribs
A
ribs 11 & 12
- cartilage doesn’t connect to sternum
end in posterior abdominal musculature
5
Q
typical rib #
A
ribs 3 - 9
6
Q
typical rib head
A
- wedge shaped
- 2 facets separated by crest of head
- one for articulation with numerically corresponding vert
- one for articulation with vertebrae superior to it
7
Q
typical rib head
A
connects head with body at the level of the tubercle
8
Q
typical rib tubercle
A
- smooth, articular part for corresponding transverse process of the vertebra
- rough, nonarticular part for the attachment of the costotransverse ligament
9
Q
typical rib shaft
A
- thin, flat, curved
- greatest curvature at the costal angle
- costal groove - internal surface that protects intercostal nerves & vessels
10
Q
atypical rib #
A
1, 2, 10, 11, 12
11
Q
rib 1 features
A
(atypical)
- broadest, shortest, most sharply curved rib
- head
- single facet that articulates with T1 (typical ribs have 2 facets)
- two transversely directed grooves over superior surface of subclavian vein (under clavicle & over rib 1)
12
Q
rib 2 features
A
- thinner, less curved and longer than 1st rib
- head
- 2 facets for articulation
- tubercle for muscle attachment
- atypical shape & size
13
Q
ribs 10-12 features
A
have one facet on head
14
Q
ribs 11 & 12 features
A
short
no neck
no tubercle
15
Q
true & atypical ribs
A
1 & 2
16
Q
true & typical ribs
A
3 - 7
17
Q
false & typical ribs
A
8 & 9
18
Q
false & atypical ribs
A
10
19
Q
floating & atypical ribs
A
11 & 12
20
Q
subcostal space
A
below 12th rib
21
Q
subcostal nerve
A
anterior rams of spinal nerve T12
22
Q
manubrium
A
- superior part of sternum
- trapezoidal
- at levels of the bodies of T3 & T4
- Jugular notch - superior border
- clavicular notch - articulated w medial end of clavicle – fuses w cartilage of rib 1
23
Q
sternal body
A
- connects to manubrium via syphosis joint
- T5 - T9 vertebral level
- longer & narrower than manubrium
- Costal notches – articulates with costal cartilages
24
Q
xiphoid process
A
T10 vertebral level
- smallest & most variable part of sternum
- midline marker for the upper limit of the liver/central tendon of the diaphragm/inferior border of heart
25
thoracic outlet syndrome
compression of nerves & arteries to the lower neck & upper limb
26
costoclavicular thoracic outlet syndrome
compression of subclavian artery -- this runs under clavicle and over first rib
- pressure put on the shoulder can cause arteriole compression, -- this causes decrease in circulation to the upper extremity
- pallor & coldness
PEDIATRIC ISSUE WITH BACKPACKS
27
symphysis joints examples
- intervertebral
| - manubriosternal
28
synovial joint examples
```
plane joints-
costoverebral
costotransverse
sternocostal (at ribs 2-7)
interchondral
```
saddle joints-
sternoclavicular
29
cartilage joint
sternocostal (at 1st rib to manubrium)
costochondral
xiphisternal
30
retromammary space
loose connective tissue behind breast, allowing movement on deep pectoral fascia
31
mamillary glands
reproductive accessory in females
- suspensory ligaments
- modified sweat glands
32
lymphatic drainage of breast
- lateral quadrant is responsible for greater than 75% of lymph via axillary lymph nodes to subclavian lymphatic trunk
- important for OTs b/c: women with breast cancer may need to do a mastectomy -- often with this axillary lymph nodes are removed, causing secondary lymphadema
- OT Job: lymphadema management of the upper extremity
33
Anterior rami of T12
subcostal nerves
- abdominal innervation most likely
- runs under rib 12
- communicates with L1
34
Anterior rami of T1-T11
intercostal nerves
| - runs under the intercostal groove of the first 11 ribs
35
Posterior rami
supplies bones, joints, deep muscles, and skin of the back in the thoracic region
36
posterior intercostal arteries
- branches of the thoracic aorta
- run in intercostal spaces 3 - 11
(spaces 1 & 2 are supplied by subclavian artery)
37
internal thoracic arteries
- branches of subclavian
- runs vertically, deep to costal cartilage, 1 inch lateral to sternum
- in spaces 1-6 --- gives off a pair of anterior intercostal arteries that come together with poster intercostal arteries
- at level 6 of costal catlage it bifurcates into:
- -- musculophrenic artery
- --superior epigastric artery
38
musculophrenic artery
- from the bifurcation of the internal thoracic arteries at costal level 6
- helps support diaphragm
- gives off anterior intercostal arteries to lower spaces
39
superior epigastric artery
- continues into abdominal wall
| - runs on deep surface of rectus abdominis muscle
40
posterior intercostal veins
- drains into azygos vein of the superior vena cava
41
anterior intercostal veins
- drains into internal thoracic veins to brachiocephalic veins on each side
42
pleurisy
inflamed surfaces rub -- painful
43
Pleural cavity
- space enclosed by thoracic wall
- 3 compartments
- 2 pulmonary cavities (lateral)
- 1 mediastinum (central)
44
Pleurae
serous sac consisting of 2 membranes that invests and encloses each lung
- holds lunging place - surface tension creates a force between visceral and parietal pleura
45
visceral pleura
- covers the lungs
- adherent to all lung surfaces
- can't be dissected from lungs
46
parietal pleura
- lines pulmonary cavities
| - adheres to thoracic wall, mediastinum & diaphragm
47
pleural sleeve
encloses root of lung
48
root of lung
only area that attaches the lung to anything
49
pleural ligament
inferior to root
- continuity between parietal and visceral pleura
- between lung & mediastinum
50
pleural cavity
potential space between visceral and parietal pleura
- - if you get stabbed in the lung that space is there (upon lung collapse)
- capillary layer of serous pleura fluid to lubricate surfaces and allow for frictionless gliding during breathing
51
surface tension
provides cohesion that keeps lungs surface in contact with thoracic wall
52
costal pleura
covers internal surface of thoracic wall -- separated from wall by endothoracic fascia
53
mediastinum pleura
covers lateral aspect of mediastinum
54
diaphragmatic pleura
covers superior surface of diaphragm at each side of mediastinum
55
cervical pleura/cupula of pleura
forms a cup shaped dome over apex of lung
56
lines of pleural reflection
lines along which the parietal pleural changes direction from one wall of the parietal cavity to the other
57
sternal line of pleural reflection
where costal pleura becomes continuous with mediastinal pleura anteriorly
58
costal line of pleural reflection
where costal pleura becomes continuous w diaphragmatic pleura inferiorly
59
vertebral line of pleural reflection
where costal pleura becomes continuous with the mediastinal pleura posteriorly
60
pleural recesses
space where lungs don't extend and parietal pleural touches vertebral pleura
61
costodiaphragmatic recesses
potential spaces between peripheral diaphragmatic pleura and costal pleura
62
costomediastinal recesses
potential spaces between costal pleura and mediastinal pleura (posterior to sternum)
63
pulmonary collapse
- too much air enters pleural cavity - surface tension holding visceral to parietal pleura breaks
- lungs collapse to elastic recoil
- potential space becomes real space
64
pneumothorax
- air into pleural cavity (bullet wound, rib fracture)
65
hydrothorax
fluid accumulation into pleural cavity (b/c of pleural effusion)
66
hemothorax
blood accumulation in pleural cavity
67
chylothorax
lymph accumulation in pleural cavity (b/c of torn thoracic duct)
68
pleuritis
```
inflammation of pleurae
- makes smooth surfaces rough = friction
visceral pleura constanty rubbing on rough surface
- sharp stabbing pain
especially during exertion
```
69
hilum
area on medial surface of each lung
| - at the point at which the structures forming the root enter and leave the lung
70
fissures
divide lobes into lungs
71
right lung
- 3 lobes
- horizontal & oblique fissure
- larger and heavier
- shorter and wider
72
left lung
- 2 lobes
- only oblique fissure
- cardiac notch at anteroinferior aspect of the superior lobe
73
lingula
extension below the cardiac notch slides in and out of the costomediastinal recess during respiration
- small jutting piece
74
apex
point
- blunt superior end of lung
ascends above the level of 1st rib and into root of neck
75
3 surfaces
costal, mediastinal, diaphragmatic
76
pneumonectomy
- removal of a lung
77
lobectomy
removal of a lobe
78
segmentectomy
removal of one or more brachopulmonary segments
| -- knowledge of segment is removed and used during drainage and clearance techniques - pneumonia and cystic fibrosis
79
right main bronchus
wider, shorter, and runs more vertically than the left (as it passes directly to the hilum)
80
left main bronchus
passes inferolaterally, inferior to the arch of the aorta and anterior to the esophagus and thoracic aorta
81
pulmonary arteries
go to the lungs
| O2 poor - just for O2/CO2 exchange in the lungs
82
bronchiole arteries
goes to lungs
supply lungs with O2
left bronchiole art: from thoracic aorta
right bronchiole art: from superior posterior intercostal artery, trunk off thoracic artery, OR superior bronchiole artery
83
bronchiole veins
drain only proximal root of lungs
- majority of bronchiole artery supply drained by pulmonary veins
right: drains into azygos vein
left: drains into accessory hemiazygos vein
84
pulmonary embolism
- obstruction of a pulmonary artery
| - embolism from leg travels to the right side of the heart to the lung through a pulmonary artery
85
large embolism
- occlusion of pulmonary artery
| - acute respiratory distress
86
medium embolism
- occlusion of artery to bronchopulmonary segment
87
pulmonary infarct
necrotic lung tissue
| - pulmonary segment dies off
88
parasympathetic fibers - efferent
(from vagas nerve CNX)
- motor to smooth muscle of bronchial tree (BRONCHOCONSTRICTER)
- inhibitory to pulmonary vessels (VASODIALATOR)
- secretory to glands of the bronchiole tree
89
parasympathetic fibers - afferents
(from vagas nerve CNX)
- to bronchiole mucosa -- tactile with cough reflexes
- bronchiole muscles - stress receptors
- interalveolar connective tissue
90
Blood pressure levels
- taken at pulmonary arteries
- O2 poor
- when sending blood to the lungs we do not care how oxygenated it is - only care how effective the blood is in getting there
- pressure determines effectiveness
91
blood gas levels
- taken at pulmonary veins
- O2 rich -- just came from the lungs
- need to measure how effective my lungs were in oxygenating
92
sympathetic fibers
- inhibitory to bronchiole muscle (BRONCHODIALATION)
- Motor to pulmonary vessels (VASOCONSTRICT)
- inhibitory to alveolar glands of bronchiole tree
- decrease secretion of alveolar branch during constriction
