Anatomy: Thoracic Wall & Diaphragm Flashcards
What are the components of the conducting portion of the respiratory system?
Everything down till respiratory bronchioles:
1) Nasal cavities
2) Pharynx
3) Larynx
4) Trachea
5) Bronchi, Bronchioles, Terminal Bronchioles, Respiratory bronchioles
What are the functions of the conduction portion of the respiratory system?
Air conditioning prior to reaching respiratory portion:
1) Filtering
2) Warming
3) Moistening
What are the components of the respiratory portion of the respiratory system?
Respiratory bronchioles onwards:
1) Respiratory bronchioles
2) Alveolar ducts, alveolar sacs, alveoli
What is the function of the respiratory portion of the respiratory system?
Gaseous exchange
Which part of the respiratory system has both conducting and respiratory functions?
Respiratory bronchioles
The thorax is the _____ part of the trunk.
Superior
The thoracic wall consists of _____, ________, ______, and _____.
Skeleton, muscles, superficial fascia and skin
The thoracic cavity is a hollow space surrounded by _______ and _______that contains the heart, lungs and major vessels.
Rib cage and diaphragm
What are the functions of the thorax?
1) Breathing
2) Protection of vital organs
The thorax communicates with the neck via the ________.
Superior Thoracic Aperture (STA)
The thorax has 2 openings: ________ & _______.
STA and ITA
The Superior Thoracic Aperture is (narrower/broader) than the Inferior Thoracic Aperture.
STA is narrower than ITA
The Inferior Thoracic Aperture is closed by the __________.
Diaphragm
The thorax is separated from the abdomen by the ______.
Diaphragm
What are the borders of the STA?
1) T1 veterbra
2) 1st ribs + their costal cartilage
3) Superior border of manubrium (top of sternum)
What are the borders of the ITA?
1) T12 vertebra
2) Lower 6 costal cartilages
3) Xiphisternal joint
What is a Thoracotomy?
A Surgical procedure where the thoracic wall is opened to access the lungs, oesophagus, trachea, etc.
What are the structures that pass through the STA?
1) Trachea
2) Oesophagus
3) Lung apex + pleura + sibson fascia
4) Lymphatics: Thoracic duct
5) Nerves
- phrenic
- vagus
- recurrent laryngeal nerves
- sympathetic trunk
6) Blood vessels
- brachiocephalic trunk + veins
- left common carotid artery
- left subclavian artery
- internal mammary arteries
What is the thoracic outlet?
The space between the clavicle and 1st rib.
(contains (i) Subclavian artery (ii) Subclavian vein (iii) Brachial plexus))
What is Thoracic Outlet Syndrome (TOS)?
A group of disorders where the any of the components of the neurovascular bundle within the thoracic outlet are compressed. Can cause:
- pain in shoulders and neck
- numbness in fingers
The sternum is a ____________ bone in the ________ part of the thoracic cage.
flat, elongated bone in the anterior part of the
What are the 3 parts of the sternum?
Superior to inferior:
1) Manubrium
2) Body
3) Xiphoid process
Where is the sternal notch?
At the superior border of the Manubrium, in between the 2 articulating surfaces for both clavicles
Where is the Sternal angle/Angle of Louis?
Between the Manubrium and Body of Sternum
- @ the level of 2nd Sternocostal joint
- Corresponds to T4/5 Vertebra
What is the full name of CPR?
Cardiopulmonary Resuscitation
Where are chest compressions in CPR supposed to be delivered?
Body (center of sternum)
What is a Sternotomy?
A surgical procedure for opening the chest wall in order to access the heart and great vessels
Why is the sternum bone chosen for a bone marrow needle biopsy?
Because of its breadth and subcutaneous position
Ribs are _______ & ______bones, light weight & highly resistant. They contain _______________ which is used in _____________ haematopoiesis.
curved and flat bones
contain haematopoietic tissue which is used in medullary haematopoiesis
Which ribs are typical and atypical?
Atypical: 1-2, 10-12
Typical: 3-9
On the _______ aspect of a typical rib, the head has ____ articulating facet(s) for articulation with _________________.
posterior
head has 2 articulating facets
for articulation with the corresponding vertebra and 1 above it
The neck of a typical rib is the constricted portion between the______ and ______.
between the head and the tubercle
The tubercle of a typical rib is located at the junction of the _____ and _______.
neck and shaft
The tubercle of a typical rib has a smooth _________ , orientated externally for articulation with______ of the _______, and a rough ________ internally.
smooth articular facet, orientated externally for articulation with the ligaments of the transverse process of the corresponding spinal segment
rough non-articulating surface internally
The region of the shaft of a typical rib where it is most bent is known as?
costal angle
The internal surface of a typical rib’s shaft contain a ________ which protects _______.
Costal groove which protects the intercostal neurovascular bundle.
The 1st rib is the ______, _________, and _______ of the 7 true ribs. It has 2 grooves crossing its _______ surface for the ________, which are separated by _________.
broadest, shortest, and most sharply curved
2 grooves crossing its superior surface for the subclavian vessels, which are separated by a scalene tubercle and ridge
The 2nd rib is ________, ________ and ______ than the 1st rib.
thinner, less curved, and much longer than the 1st rib
Which of the ribs have only 1 facet on their heads?
1, 10, 11, 12
The 11th and 12th ribs are _____ and have no ___________.
Short and have no necks or tubercles
The bodies of the thoracic vertebrae are _____ sized & ______ shaped.
Medium sized and heart shaped
The spines of the thoracic vertebrae are _____ and incline (down/upwards)
long and incline downward
Most thoracic vertebrae have _______ on their _________ for articulation with _______, & on their ______ for articulation with ______.
Costal facets
i) on bodies for articulation with heads of ribs
ii) on transverse processes for articulation with tubercles of ribes
Which of the thoracic vertebrae have no costal facets on which part of the bone?
T11 & T12 have no costal facets on their transverse processes
Which joints of the thoracic wall are synovial?
1) Costovertebral (head of ribs and body of vertebrae)
2) Costotransverse (tubercle of ribs and transverse process of vertebrae)
3) Sternoclavicular (sternum and clavicles)
4) Interchondral (adjacent costal cartilages of ribs 6-10)
The joints between the vertebrae are known as?
Intervertebral joints
The joints between the head of ribs and body of vertebrae are known as?
Costovertebral joints
The joints between the tubercle of ribs and transverse process of vertebrae are known as?
Costotransverse joints
The joints between the ribs and costal cartilages are known as?
Costochondral joints
The joints between the sternum and costal cartilages are known as?
Sternocostal joints
The joints between the adjacent costal cartilages of ribs 6-10 are known as?
Interchondral joints
The joints between the sternum and clavicles are known as?
Sternoclavicular joints
The joints between the manubrium and the body of the sternum is known as?
Manubriosternal joint
The joint between the body of the sternum and the xiphoid process is known as?
Xiphisternal joint
Synovial joints generally allow (more/less) movement than cartilaginous joints.
more movement
Fibrous joints are usually (fixed/flexible) and have no joint cavity. eg. skull bones are connected by sutures
fixed
What is the embryological origin of skeletal muscles?
Endoderm
The origin of a muscle is also known as the _________ and is an attachement site that (does/does not) move during contraction.
proximal attachment
does not move during contraction
The insertion of a muscle is also known as the _______ and is an attachment site that (does/does not) move during contraction.
distal attachment
does not move during contraction
What are the 4 superficial muscles of the anterior thoracic wall?
1) Pectoralis major
2) Pectoralis minor (deep to Pectoralis major)
3) Serratus anterior (fan shapes @ midaxillary area)
4) Subclavius
What are the accessory muscles of respiration?
1) Pectoralis major
2) Pectoralis minor
3) Serratus anterior
4) Subclavius
How many ribs and intercostal spaces are there?
12 ribs, 11 intercostal spaces
What are the 3 types of deep muscles in the anterior thoracic wall? (superficial to deep)
1) External intercostal muscles
2) Internal intercostal muscles
3) Innermost intercostal muscles (Sternocostalis, transverse thoracis)
There are ______ pairs of external intercostal muscles. They run __________ and are used for _______ by_______.
11 pairs
run downwards and forwards
used for inspiration by elevating the ribs
There are ______ pairs of internal intercostal muscles. They run __________ and are used for _______ by_______.
11 pairs
run downwards and backwards
used for expiration by depressing the ribs
The neurovascular supply of the thoracic wall are the _______and run ______.
Intercostal arteries, intercostal veins, intercostal nerves
run in between the Internal intercostal muscles and the Innermost intercostal muscles
Thoracic spinal nerves exit the spinal column through the ________. Right after, they split into __________ & __________.
exit through the intervertebral foramina
split into ventral/anterior primary rami (intercostal nerve) and dorsal primary rami (supplies back)
What are the 4 branches of intercostal nerves (ventral/anterior primary rami)?
1) Anterior cutaneous
2) Lateral cutaneous
3) Muscular
4) Collateral
Which of the intercostal nerve branches are sensory in nature?
Anterior and lateral cutaneous
Which of the intercostal nerves are motor in nature?
Muscular and collateral
Which part of the spinal cord do the afferent anterior and lateral cutaneous nerves originate from?
Dorsal horn
Which part of the spinal cord do the efferent muscular and collateral nerves originate from?
Ventral horn
The location of collateral nerves has clinical significance because?
They run along the upper border of the rib and should be avoided during a Thoracentesis.
The two types of arteries in each intercostal space are known as?
Anterior and Posterior Intercostal Artery (AIA/PIA)
Each anterior intercostal artery (AIA) arises from ________ or ___________?
Internal mammary artery or its terminal branch (musculophrenic artery)
Each posterior intercostal artery (PIA) arises from ____________ or ____________.
ICS 1-2: Costocervical trunk
ICS 3-11: Thoracic aorta
Where does the internal mammary artery arise from?
Subclavian artery
The internal mammary artery is ______ from the sternal margin.
1-2cm
The internal mammary artery branches into the _______ and _______ at the ________.
Musculophrenic artery and Superior Epigastric artery
at the 6th ICS
The superior and inferior epigastric artery form an _______, which provides _______ in the event of ________
form an anastamosis
provides collateral circulation in the event of aortic obstruction
Which blood vessel is used in a Coronary Artery Bypass Graft (CABG)?
Internal Mammary Artery
The inferior epigastric artery is a branch of what blood vessel?
External Iliac Artery
Anterior intercostal veins drain into which blood vessels?
Internal Mammary Veins
Posterior intercostal veins drain into which blood vessels?
Azygos Venous System or Brachiocephalic Veins
The Azygos Vein terminates in what blood vessel?
Superior Vena Cava (SVC)
The Midsternal line is the intersection of the _____ plane and the ________.
Median plane and Anterior chest wall
The Midclavicular line passes though the ________ and is should be where the ________ is.
passes through midpoints of clavicle
where the Apex beat is
The Anterior axillary line runs vertically along the ______.
Anterior axillary fold
The Posterior axillary line runs vertically along the _______.
Posterior axillary fold
The Midaxillary line runs from the ________, parallel to ________
apex of the axilla (armpit)
parallel to the Anterior axillary fold
What are the arteries supplying the breast?
1) Internal mammary artery (perforating branches)
2) Anterior intercostal arteries
3) Axillary artery (lateral thoracic branch)
What are the veins supplying the breast?
1) Internal mammary veins
2) Intercostal veins (posterior & anterior)
3) Axillary vein (lateral thoracic tributary)
What are the nodes that the lymphatics supplying the breast pass through?
1) Internal thoracic nodes
2) Axillary nodes
** impt for spread of breast cancer**
What are the nerves supplying the breast?
Intercostal nerves 2-6 (anterior and lateral cutaneous branches only sensory)
The nipple is innervated by the ________.
4th intercostal nerve
The breast consists of which 6/7 types of tissue?
1) Mammary gland tissue
2) Fibrous tissue
3) Ligaments
4) Septa
5) Fat
6/7) Neurovascular tissue
The base/attached surface of the each breast extends vertically from __________, and transversely from __________.
Vertically from Ribs 2-6
Transversely from the Sternum to the Midaxillary line
The mammary glands of the breasts are modified _______ in the ______ tissue, anterior to the _________ and the ________.
modified sweat glands in the subcutaneous tissue
anterior to the pectoral muscles and anterior thoracic wall
During ________, ______ controls the growth of ducts, while ________ controls the growth of glandular buds.
puberty
Oestrogen: Ducts
Progesterone: Glandular Buds
(oestroGEN: generate ducts; PROgesterone: BUDding)
The nipple is usually at the level of the ________ and is thus innervated by _______.
4th ICS
Innervated by 4th intercostal nerve
The areola is a ring of ______ around the nipple.
pigmented skin
When evaluating for breast cancer it is important to remember that the upper lateral region of the breast can project around the lateral margin of the __________ and into the ______. The axillary process can also perforate the ______ and extended as far superiorly as the ______.
Upper lateral region can project around the lateral margin of the Pectoralis Major and into Axilla
Axillary process may perforate deep fascia and extend superiorly to the apex of the axilla
The lobes and lactiferous sinuses of the mammary glands are (deep/superficial) to the adipose (fat) tissue?
Deep to
Non-lactating women would have (more/less) fat tissue while lactating women would have (more/less) glandular tissue.
Non-lactating: more fat
Lactating: more glandular tissue
Each lobe of the mammary gland drains through a _______ and _____ onto other tip of the nipple. Each duct has an enlarged part called the _______ which serves as a reservoir for milk during lactation.
Each lobe drains through a lactiferous duct and sinus
Each duct has a lactiferous sinus which serves as a milk reservoir
The Retromammary space is formed by _______ and separates the _______ from the _______ to allow for ______________.
formed by loose connective tissue
separates breast from deep fascia
allows for movement of breast on the chest wall
The breast may become immovable on the chest wall following ____________________.
Invasion of tumour cells into/through the Retromammary space into the lymph nodes
What are the suspensory ligaments of Cooper?
Fibrocollagenous connective tissue in the breast
Suspensory ligaments of Cooper connect the _________ and the ________ to the ______________.
Clavipectoral fascia and Pectoral fascia to the dermis of the skin
How does cancer lead to pitting of the breast?
Carcinoma creates tension/shortens suspensory ligaments of Cooper which causes pitting
(peau d’orange: orange peel appearance if accompanied by inflammatory carcinoma)
Ipsilaterally, the internal thoracic (parasternal) group accounts for _____ of the breast’s lymphatic drainage, while the axillary (pectoral or medial group) accounts for ______.
Axillary (Pectoral + Medial groups): ~75%
Parasternal (internal thoracic group): ~25%
Other than the Ipsilateral Axillary and Parasternal nodes, the lymphatics of the breast can also _________ and go __________.
1) cross midline to contralateral lymphatics
2) go down to anterior abdominal wall
[not impt for M1 CA2]
What are 6 signs/symptoms of breast cancer?
1) Lump/thickening that feels diff from surrounding tissue
2) Change in size, shape or appearance
3) Changes to skin (dimpling)
4) Newly inverted nipple
5) Peeling, scaling or crusting of breast/areola
6) Peau d’orange (redness/pitting of skin like an orange)
What is a mammogram?
A radiological examination of the breast to screen for breast cancer
What is the principle muscle of inspiration?
Diaphragm
What are the 2 portions of the diaphragm?
1) Central aponeurotic part (central tendon)
2) Peripheral muscular part
Peripheral muscle fibres of the diaphragm arise from ______, ______ and _______, and converge to the ________.
Arise from:
1) Xiphoid process
2) Lower ribs
3) Upper lumbar vertebrae
Converge to central tendon
What nerve supplies the diaphragm?
Phrenic nerve (ventral ramus of C3-5 spinal nerves)
The phrenic nerve arises from __________ and descends through the thorax to innervate the ________. It provides:
1) ________ to ______ through ______ nerve fibres
2) ________ to ______through ______ nerve fibres
3) ________ to ______ through ______ nerve fibres
arises from anterior/ventral rami of C3-5 nerve roots
innervates diaphragm
1) Motor innervation to the diaphragm (motor fibres)
2) Sensory innervation to central part of diaphragm (sensory fibres)
3) Sympathetic innervation to blood vessels (sympathetic fibres)
Injury to a phrenic nerve will cause (ipsilateral/contralateral/bilateral) paralysis of ________.
Ipsilateral paralysis of the hemidiaphragm
What are the structures that pass through openings in the diaphragm and at what level?
T8: Inferior Vena Cava (8 letters)
T10: Oesophagus, Vagus nerve (both 10 letters)
T12: Thoracic duct (12 letters), Thoracic aorta, Azygos vein
True or false: The upper part of the abdominal cavity extends beneath the thoracic cage
True
What are the muscular movements involved in inspiration?
1) Contraction of external intercostal muscles
2) Contraction of diaphragm
During inspiration, contraction of external intercostal muscles _______ ribs, which increases (i) ___________ (________) and (ii) _______ (_______) of thorax.
elevate ribs which increases:
i) Transverse diameter (bucket handle movement)
ii) Antero-posterior diameter (pump handle movement)
True or false: Contraction of the internal intercostal muscles is the main mechanism of expiration
False
contraction of internal intercostal muscles AID in expiration; passive elastic recoil of thorax is the MAIN mechanism of expiration
Bucket-handle movement of ribs increase the ________ of the thorax by __________.
Increase the transverse diameter of the thorax by the contraction of external intercostal muscles and thus elevation of ribs (“sideways abduction movement”)
Pump-handle movement of ribs increase the ________ of the thorax by __________.
Increase the antero-posterior diameter of the thorax by the contraction of external intercostal muscles and thus elevation of ribs (“frontward abduction movement”)
The __________ depress the rib to aid in expiration whilst the __________ of the thorax is the main mechanism of expiration.
Internal intercostal muscles depress rib and aid in expiration
Passive elastic recoil of thorax is main mechanism
The middle parts of lower ribs move ______ when elevated (bucket-handle movement).
laterally
The increase in antero-posterior diameter during pump-handle movement is (greater/lesser) inferiorly (end of pump handle).
Greater
What is Congenital Diaphragmatic Hernia?
It is a type of hernia that occurs from a developmental defect in the diaphragm, leading to protrusion of abdominal contents into the thoracic cavity.
- occurs during fetal development when abdominal organs move into the fetus’ chest and crowd its lungs
What are 2 typical presentations of Congenital Diaphragmatic Hernia (CDH)?
1) Underdeveloped lungs
2) Hypoxemia
