Thorax Flashcards
(65 cards)
1
Q
What type of joint is intervertebral
A
symphysis (secondary cartilaginous) articulates with vertebral bodies and intervertebral disc
2
Q
costotransverse/ costovertebral
A
synovial plane of joint ribs and vertebrae
3
Q
sternocostal
A
primary cartilaginous (1st) synovial plan joints (2nd-7th) sternum and costal cartilages
4
Q
sternoclavicular
A
saddle type of synovial joint sternum and clavicle
5
Q
costocartilage
A
primary cartilaginous joint ribs and costal cartilages
6
Q
interchrondal
A
synovial plane joint costal cartilages
7
Q
boundaries of superior thoracic aperture
A
posteriorly by T1 vertebra laterally by ribs 1 and CC anteriorly by superior border of manubrium
8
Q
boundaries of inferior thoracic aperture
A
thoracic cavity communicated with abdomen posteriorly T12 v posterolaterally 11 and 12 ribs anteriolaterally by joined CC by ribs 7-10 (costal margin) anteriorly xiphisternal joint
9
Q
True ribs
A
1-7 attach directly to sterunm
10
Q
false ribs
A
8-10 cartilages join to cartilage of rib above
11
Q
floating ribs
A
11 and 12
12
Q
A
13
Q
Atypical ribs
A
1,2, 10-12
14
Q
typical rib
A
3-9
15
Q
A
16
Q
rib 1 vs rib 10 to 12
A
similar but one facet on heads
17
Q
characterstic features of thoracic vertebrae
A
- bilateral superior and inferior costal facets
- atypical thoracic vertebrae have single whole facet instead of demifacets
- costal facets on transverse process for ribs
- long inferior slanting spinous process
18
Q
A
19
Q
A
20
Q
structures that pass through superior thoracic aperture
A
trachea
oesophagus
lung apex
thoracic duct
common carotid and subclavian aa L and R
subclavian, brachiocephalic and internal jugular vv
phrenic and vagus nn
21
Q
structures that pass through inferior thoracic aperture
A
oeseophagus
thoracic duct
abdominal aorta
inferior VC
22
Q
movements of thoracic wall during inspiration
A
- bucket handle movements of superior ribs
- pump handle movement of sternum
- contraction of external and internal muscles raise rib towards the rib above- raises rib cage
23
Q
movements of thorax during expiration
A
passive
diaphragm, intercostals and other muscles relax decreasing intrathoracic volume and increasing intrathoracic pressure expelling air from lungs
24
Q
role of costal cartilages
A
contribute to elasticity of thoracic wall preventing blows from fracturing sternum
25
where is the weakest part of the rib
anterior to angle
26
surface markings of the parietal pleura
lie closest behind sternal angle
parallel down to 4th CC
L indented due to cardiac notch to 6th CC
R continues down to 6th CC
both go to rib 8 at mid clavicular line
rib 10 at mid axillary line
rib 12 lateral border of erector spinal muscle
27
surface markings of the visceral pleura
reflections closest at plane of sternal angle
parallel down to rib 4
L intended (cardiac notch) R continues to CC6
crosses rib 8 at mid axillary line
cross rib 10 lateral border erector spinae muscle
28
what is a pleural reflection and where are they
lines along which the (parietal) pleura change direction (reflect) from one wall of tje pleura cavity to another
sternal- anteriorly: sharp, costal to mediastinal
costal- inferiorly: sharp, costal to diaphagmatic
vertebral- posterioly: rounder, costal to mediastinal
29
What are the recesses in the pleural cavity
pleural cavities not full in expiration
costodiaphragmatic recess
costomediastinal recess (L is larger than R)
30
parts of the parietal pleura
cervical
costal
diaphragmatic
mediastinal
31
surface markings of oblique fissure
rib 2 posteriorly to rib 6 anteriorly
32
surface markings of horizontal fissure of R lung
rib 4 to oblique fissure
33
what is the ligula and where is it
tongue like process on the superior lobe of the left lung
34
what is the endothoracic fascia
thin fibro-areolar layer between internal aspect of thoracic cage and lining of pleural cavities
35
36
37
what are the three borders of the lungs
anterior where costal and mediastinal surfaces meet
inferior border where diaphragmatic surface separates from costal and mediastinal
posterior border where costal and mediastinal surfaces meet
38
what are the three surfaces of the lungs
costal surface
mediastinal surface
diaphragmatic surface
39
what supports trachae and bronchi
C shaped rings of hyaline cartilage
40
41
42
What is the difference between the right and left main bronchus
the right is wider and shorter and runs more vertically
- more likely for foreign bodies to enter right bronchus
the left passes to arch of aorta and anterior to oesophagus and thoracic aorta to reach the left hilum
43
what do main bronchus divide to?
lobar bronchi (secondary)
segmental bronchi (tertiary) supply bronchopulmonary segments
terminal bronchioles
respiratory bronchioles supply alveolar ducts which give rise to alveolar sacs
44
vascular supply of bronchopulmonary segments
(segmental bronchus)
tertiary branch of pul. artery
intersegmental parts of pul. veins
45
how many arteries and veins supplies the lungs?
1 pul artery
2 pul veins
46
which level does the pulmonary trunk arise from
sternal angle
47
describe the course of the pulmonary arteries
pass to the root of lung and give of a branch to the superior lobe before entering hilum
divides into lobar and segmental arteries
48
what do the bronchial arteries supply
blood to the structures of roots of lungs, supporting tissues of lung and visceral pleura
small bronchial arteries supplies superior oesphagus, main bronchi and respiratory bronchioles
49
where does the right bronchial artery arise from
superior posterior intercostal artery
thoracic aorta with right 3rd posterior IC artery
left superior bronchial artery
50
what do the bronchial veins drain
where do they drain
proximal part of the roots of lungs
right drains into azygous vein
left drains into accessory hemi-azygous vein
51
What do the superfical lymphatic plexus drain
and where do the vessels drain into
lies deep to visceral pleura
drains lung parenchyma (tissue) and visceral pleura
vessels drain into **bronchopulomnary (hilar) lymph nodes**
52
what do the deep lymphatic plexus drain and where do vessels drain into
located on submucosa of bronchi and peribronchial connective tissue
drains structures that form root of lung
drain into **pulmonary lymph nodes** with drain into **bronchopulmonary hilar lymph nodes**
53
where does the bronchopulmonary lymph nodes drain into and then what happens
**tracheobronchial lymph nodes**
superior and inferior to bifurcation of trachea
these then drain into **right and left bronchomediastinal lymph trunks** that terminate at venous angles (junction of subclavian and internal jugular)
right merges with branches to form **right lymphatic duct**
left terminates in the **thoracic duct**
54
55
What are the nerves of the visceral pleura and what are their functions?
pulmonary plexus located anterior and posterior to root of lungs
parasympathetic: vagus
- motor to SM of bronchioles (bronchiolecontrisctor)
- inhibitory to pulmonary vessels (vasodilator)
- secretory to glnds of bronchial tree (secretomotor)
sympathetic: sympathetic trunk/ sympathetic ganglion cells in paravertebral sympathetic ganglia
- inhibtory to bronchial msucles (bronchodilator)
- motor to pul. vessels (vasoconstrictor)
- inhibitory to alveolar glands
56
which nerves supply to parietal pleura?
phrenic
intercostal nerves
57
How many bronchopulmonary segments does the right and left lungs have?
what is the clinical important of these segments?
R: 10 lobes
L: 8-10 as some fuse
smallest functionally independent region of a lung
smallest area that can be isolated and removed
58
pneumothorax
air fills pleural cavity due to punctured lung
may result in collapsed lung
59
postural drainage of lungs
gravity and percussion (clapping on the chest and/or back) to loosen the thick, sticky mucus in the lungs so it can be removed by coughing.
60
carcinoma of bronchus and lungs
bronchial: arises from epithelium of bronchial tree
metastasises widley due to arrangement of lymphatic
transported through pulmonary veins, left heart and to aorta to brain/ body
lung cancer caused by smoking
61
drainage of fluid from lungs
thoracentesis:hypodermic needle through IC space into cavity
must avoid damage to IC nerves and vessels- high enough to avoid collateral branches
pneumo thorax: safe triangle Lower border of axilla to the 5th intercostal space; the lateral edge of pectorails major and the lateral edge of latissimus dorsi
62
which bronchopulmonary segments do bronchial secretions tend to drain when the patient is nursed in supine position? what are these segments most commonly the sites of?
superior and posterior segment of inferior lobe
pneumonia
63
site of puncture of cricothryoid membrane to gain direct access to airways
what structures might be damaged
why is the site used different for an in dwelling airway
between thyroid prominence and cricoid cartilage
trachea
doesnt damage vocal chords
life saving if not possible to intubate and ventilate
64
what structures would you see with a bronchoscope down the airway if cancer had spread?
* carina- sagittal plane
* tracheobronchial lymph nodes in angle between main bronchi are enlarged- cancer
* if carina is distorted and widened and immobile
65
the importance of carina clinically
changes are important diagnostic signs
