Anatomy: Thorax Flashcards
1
Q
What are the three parts of the sternum?
A
Manubrium
Body
Xiphoid process
2
Q
What is another name for the sternal angle?
A
Angle of Louis
3
Q
What is the sternal angle used as a landmark for?
A
Apex of heart
4
Q
Which rib attaches at the level of the sternal angle?
A
2nd rib
5
Q
How can you externally find the sternal angle?
A
3 fingers below the jugular notch
6
Q
Which ribs are true ribs?
A
1-7
7
Q
Which ribs are false ribs?
A
8-12
8
Q
Which ribs are floating ribs?
A
11-12
9
Q
Why are ribs 11 and 12 called ‘floating’?
A
There is no costal cartilage to connect to the sternum
10
Q
What is the difference between true and false ribs?
A
False ribs do not have individual cartilage that attaches it to the sternum
11
Q
What are the borders of the superior thoracic aperture?
A
T1
Margins of 1st rib
Manubrium
12
Q
What defines the border of the inferior thoracic aperture?
A
Diaphragm
13
Q
What are the symptoms of thoracic outlet syndrome?
A
Neck, shoulder and arm pain
Numbness
Impaired circulation to UL
14
Q
What is the jugular notch used to landmark?
A
Level of great vessels
15
Q
What is the vertebrate level of the jugular notch?
A
T1/T2
16
Q
What is the vertebrate level of the sternal angle?
A
T4
17
Q
What is the vertebrate level of the the top of the diaphragm/top of xiphoid process?
A
T9
18
Q
What is the vertebrate level of the posterior attachment of the diaphragm?
A
T12
19
Q
Where are the pleural cavities relative to the mediastinum?
A
Pleural cavities are on either side of the mediastinum
20
Q
What is the relative location of the vessels and nerve between the ribs?
A
Vein is superior
Artery is middle
Nerve is inferior
21
Q
What do the intercostal vessels and nerves run between?
A
Internal intercostal muscles
Innermost intercostal muscles
22
Q
What is another name for the internal thoracic artery?
A
Mammary artery
23
Q
What artery is often used in coronary bypass surgery?
A
Internal thoracic artery
24
Q
Where does the internal thoracic vein drain into?
A
Subclavian vein
25
What are the two branches of the internal thoracic artery?
Musculophrenic artery
| Superior epigastric artery
26
Which direction are the external intercostal muscle fibres?
Inferiorly and medially
27
What direction are the internal intercostal muscle fibres?
Inferiorly and laterally
28
How do the external intercostal muscles attach to the sternum?
Membrane
29
How do the internal intercostal muscles attach to the sternum?
Muscles attach directly
30
What direction are the innermost intercostal muscles fibres running?
Interiorly and laterally
31
Which of the intercostal muscles contract for inspiration?
External intercostals
32
Which of the intercostal muscles contract for expiration?
Internal and innermost intercostals
33
What muscles are active in passive breathing?
External intercostals
Internal intercostals
Diaphragm
34
What muscles are active in exerted breathing?
Any muscles that are attached to the ribs and or sternum
35
How many openings are there in the diaphragm?
3
36
What is the highest/first opening in the diaphragm called? What structures pass through?
T8 caval
| IVC, R phrenic nerve
37
What is the middle opening in the diaphragm called? What structures pass through?
T10 esophageal
| Esophagus, vagus nerve
38
What is the lowest opening in the diaphragm called? What structures pass through?
T12 aortic
| Aorta, azygos vein, hemiazygos vein, thoracic duct
39
What do the internal thoracic, musculophrenic, pericardiophrenic, aorta and inferior phrenic arteries all supply?
Diaphragm
40
What nerve provides the motor innervation for the diaphragm?
Phrenic
41
What nerves provide the sensory innervation for the diaphragm?
Phrenic and lower intercostals
42
Other than the phrenic nerve, what other area of the body is innervated by ventral rami from C4 and 5 nerve roots?
Shoulder region
43
Why could there be referred pain from the heart or diaphragm to the shoulder region?
Because the ventral roots C4 and 5 supply the phrenic nerve and sensory to the shoulder region
44
What ribs does the breast cover?
Ribs 2-6
45
Where do the breasts develop?
Along a milk/mammary line
46
What is the purpose of the retromammary space?
Allows the breast to move freely
47
What are the suspensory ligaments in the breast tissue called?
Ligaments of Cooper
48
What is the purpose of suspensory ligaments in the breast?
Divdie lobes
49
Where are lactiferous glands found in the breast tissue?
Lobules
50
Where do the lobules drain into in breast tissue?
Lactiferous duct
51
Where does the lactiferous duct drain into in breast tissue?
Lactiferous sinus
52
What are the four arteries that supply the breast tissue?
Internal thoracic/mammary artery
Intercostal arteries
Thoracoacromial trunk
Lateral thoracic artery
53
Rather than veins, how is the breast tissue drained?
Lymphatic system
54
Where are the lymph nodes located that drain the breast tissue?
Axilla
55
The visceral pleura on the lungs extends down to which intercostal space anteriorly?
6th
56
The visceral pleura on the lungs extends down to which intercostal space laterally?
8th
57
The visceral pleura on the lungs extends down to which intercostal space posteriorly?
10th
58
The parietal pleura on the lungs extends down to which intercostal space anteriorly?
8th
59
The parietal pleura on the lungs extends down to which intercostal space laterally?
10th
60
The parietal pleura on the lungs extends down to which intercostal space posteriorly?
12th
61
What structure does the trachea push into during development to form the pleura?
Coelomic cavity
62
At what point is the visceral pleura continuous with the parietal pleura surrounding the lungs?
Pulmonary ligament
63
What are the four types of parietal pleura that surrounds the lung?
Costal
Diaphragmatic
Mediastinal
Cervical
64
What is the recess between the ribs and the diaphragm of the lung pleura called?
Costodiaphragmatic recess
65
Between which ribs would you need to puncture to enter the costodiaphragmatic recess?
Between the 8th and 10th intercostal spaces laterally
66
Where would you find the costomediastinal recess relative to the heart?
Anterior to the heart
67
Which side has a larger costomediastinal recess?
Left side
68
Which rib does the upper lobe of the lung extend down to (level of horizontal fissure)?
Rib 6
69
What is a open pneumothorax?
Hole in the pleura remains open on inspiration and expiration
70
What is a tension pneumothorax?
Hole in the pleura closes on expiration
71
Which of the pneumothorax can you expect to see a shift of the mediastinum during inspiration?
Both open and tension
72
Which o the pneumothorax can you expect to see a shift of the mediastinum during expiration?
Tension
73
Which of the pneumothorax is the most dangerous?
Tension
74
What separates the upper and middle lobes of the lung?
Horizontal fissure
75
What serapes the middle and lower lobes of the lung?
Oblique fissure
76
How many lobes of the lung does the left side have?
2
77
How many lobes of the lung does the right side have?
3
78
What are the five structures passing through the hilum of the left lung?
```
Pulmonary artery
Bronchus
Pulmonary vein
Bronchial artery
Lymph nodes
```
79
What are the five structures passing through the hilum of the right lung?
```
Pulmonary artery
Bronchus
Pulmonary vein
Bronchial artery
Lymph nodes
```
80
Which lung is the pulmonary ligament on?
Both!
81
Which lung hilum has more openings?
Right
82
Why does the hilum have more openings than the left?
The right primary bronchi branches earlier than the left
83
Which opening in the hilum of the lung is most superior?
Pulmonary artery
84
Which opening in the hilum of the lung is most posterior?
Bronchi
85
Which opening in the hilum of the lung is most inferior?
Pulmonary vein
86
Which muscle wraps around the trachea in incomplete rings ?
Trachealis
87
What is the function of the trachealis muscle?
Prevents trachea compression with swallowing food
88
Which of the primary bronchi is a swallowed object most likely to get stuck in?
Right
89
What are most swallowed objects in the right lung?
Right primary bronchi is wider and more vertical with the trachea
90
What is the ridge called that separates the right and left primary bronchi?
Carina
91
How many secondary bronchi are on the right side?
3
92
How many secondary bronchi are on the left side?
2
93
How many tertiary bronchi are in the lungs?
8-10
94
What are lobar bronchi?
Secondary bronchi
95
What are segmental bronchi?
Tertiary bronchi
96
What is a bronchopulmonary segment?
Group of tertiary bronchi
97
What is in the anterior mediastinum?
Fat
Lymph nodes
Thymus
98
When does the body have a thymus gland?
Only in development
99
What is the thymus gland replaced by?
Fat
100
What produces T cells in adults after the thymus gland degenerates?
Bone marrow
101
What is in the middle mediastinum?
Heart
Pericardium
Phrenic nerves
102
What is in the superior mediastinum?
```
SVC
Brachiocephalic artery
Brachiocephalic vein
Aorta (and branches)
Pulmonary trunk
Vagus nerve
Recurrent laryngeal
Phrenic nerve
```
103
What is in the posterior mediastinum?
```
Thoracic duct
Esophagus
Descending aorta
Azygos vein and hemiazygos veins
Sympathetic trunk
Vagus nerve
Phrenic nerve
```
104
Where is the SVC relative to the aorta?
Right
105
Where is the aorta relative to the pulmonary trunk?
Right
106
Which brachiocephalic vein is longer?
Left
107
Where are the pulmonary veins relative to the bronchi?
Inferior to the bronchi
108
What are the two types of pericardium around the heart?
Fibrous pericardium
| Serous pericaridum
109
What is the outermost layer of pericardium?
Fibrous pericardium
110
What difference can you SEE between the fibrous pericardium and the serous pericardium?
Fibrous pericardium is white and the serous pericardium is shiny/wet
111
Where does the fibrous pericardium attach?
Top of diaphragm
112
What are the two types of serous pericardium?
Parieal and visceral
113
What is the purpose of the serous pericardium?
Creates a space that allows the heart to move
114
What is the purpose of the visceral pericardium?
Creates fluid that decreases friction of heart movements
115
The is the visceral serous pericardium also known as?
Epicardium
116
What are the three layers of the heart (from outermost to innermost)?
Epicardium
Myocardium
Endocardium
117
Between which layers is the pericardial cavity?
Between the parietal and visceral - serous - pericardium.
118
Which side of the heart is involved in pulmonary circulation?
Right side
119
Which side of the heart is involved in systemic circulation?
Left side
120
Which side of the heart is under higher pressure?
Left
121
Is there fat on a normal adult heart?
Yes
122
What is the path of blood through the heart - starting with the SVC/IVC?
```
SVC/IVC
Right atrium
Right ventricle
Pulmonary trunk
Pulmonary arteries
Pulmonary veins
Left atrium
Left ventricle
Aorta
```
123
What is the position of the pulmonary arteries relative to the pulmonary veins in the middle mediastinum?
Pulmonary arteries are superior
124
What makes up the base and apex of the heart?
Left ventricle
125
What part of the heart does it lay on?
Left atrium on posterior side
126
Which view is the left ventricle the largest from?
Posterior
127
50 year women admitted with shortness of breath after shovelling heavy snow. She was coughing and had noticeable leg swelling. She was a heavy smoker but no history of prior heart disease or high BP. pO2 levels are low. What could be the cause?
Blood clot on pulmonary (right) side of circulation - causing shortness of breath.
Blood is backed up - causing swelling in legs.
128
Where is the right auricle of the heart found?
Extension of the right atria over to the base of the aorta
129
What is the purpose of auricles in the heart?
Storage space
130
From an antihero view, what is the largest portion of the heart?
Right ventricle
131
What separates the right and left ventricle - anteriorly?
Anterior interventricular sulcus
132
What separates the left ventricle and left atrium?
Antrioventricular groove
133
What separates the right and left ventricles - posteriorly?
Posterior interventricular sulcus
134
Where are pectinate muscles found?
Right atrium
135
What are pectinate muscles?
Ridges in the walls of the right atrium
136
Where is the fossa ovalis?
Right artium
137
What is the part of the right ventricle where the penctinate muscles form a ridge?
Crista terminalis
138
What is the function of the fossa ovalis?
Was a opening during development between the right and left atrium so blood could bypass the unformed lungs
139
What symptoms could you get if the fossa ovalis did not close at birth?
Low blood oxygen levels - most noticeable during exercise
140
What separates the right and left atrium?
Interatrial septum
141
Where is the opening of the coronary sinus found?
Right atrium
142
Where is the coronary sinus relative to the fossa ovalis in the right atrium?
Opening of coronary sinus is more medial
143
What separates the pulmonary trunk from the right ventricle?
Pulmonary/semilunar valve
144
What are the three cusps of the semilunar valve?
Anterior
Right
Left
145
Do the semilunar valves have associated cordae tendinae?
No
146
What are the three cusps of the tricuspid valve?
Septal
Posterior
Anterior
147
Where is the tricuspid valve found?
Right ventricle
148
What separates the right atrium and right ventricle?
Tricuspid AV valve
149
Are papillary muscles exclusive to their attached cusps?
No
150
How many papillary muscles are there in the right ventricle?
3
151
Where is the moderator band found?
Right ventricle
152
What is the moderator band made up?
Bridge of cardiac muscle
153
What are trabecular carnae?
Muscular ridges/columns on the walls of the ventricles
154
Where are trabecular carnae found?
Right and left ventricles
155
What is the function of the trabecular carnae?
Improve heart contraction efficiency
| Their contraction pulls on the cordae tendinae preventing back flow
156
What is the only smooth walled chamber in the heart?
Left atrium
157
What are the three cusps of the aortic valve?
Posterior
Right
Left
158
How many cusps are associated with the AV valve between the left atrium and ventricle?
2
159
What separates the left atrium and left ventricle?
Bicuspid valve
160
What is another name for the mitral valve?
Bicuspid valve
161
How many papillary muscles are associated with the bicuspid valve?
2
162
What is pathologic ventricular hypertrophy?
Increased resistance to blood flow causing the left ventricle to hypertrophy causing inefficiency.
163
What is "athlete's heart"?
Chambers and muscle mass enlarge causing increased SV and decreased HR.
164
Does "athlete's heart" make the heart more efficient or inefficient?
More efficient
165
When is the AV valves open?
During atrial contraction
166
When is the AV valves closed?
During ventricular contraction
167
What causes the AV valves to close?
Pressure of blood pushing against the valve.
168
What structures help keep the AV valves shut during ventricular contraction?
Papillary muscles and trabecular carnae
169
What is the purpose of the moderator band?
Acts as a shortcut to the anterior papillary muscle in the right ventricle so the papillary muscles can contract at the same time as the ventricle.
170
When is the semilunar valves open?
During ventricular contraction
171
When is the semilunar valves closed?
During atrial contraction
172
There can you listen to the semilunar valves?
2nd intercostal space
173
Where can you listen to the AV valves?
5th intercostal space
174
What is a heart murmur?
Irregular heart sounds from the valves not closing properly allowing for retrograde blood flow through the heart
175
What makes the first heart sound?
AV valves closing
176
What makes the second heart sound?
SL valves closing
177
What does the left aortic sinus give rise to?
Left coronary artery
178
What is the first branch of the left coronary artery?
Anterior interventricular/left anterior descending artery
179
What is the terminal branch of the left coronary artery?
Circumflex artery
180
What does the left aortic sinus give rise to?
Right coronary artery
181
What is the first branch of the right coronary artery?
Marginal artery
182
What is the second branch of the right coronary artery?
Posterior inter-ventricular artery
183
What is the first branch of the coronary sinus?
Small cardiac vein
184
What is the second branch of the coronary sinus?
Middle cardiac vein
185
What is the terminal branch of the coronary sinus?
Great cardiac vein
186
Which veins drain into the right atrium anteriorly?
Anterior cardiac veins
187
What drains in to the right atrium posteriorly?
Coronary sinus
188
What runs with the coronary sinus?
Right circumflex artery
| Right coronary artery
189
What runs with the small cardiac vein?
Marginal artery
190
What runs with the middle cardiac vein?
Posterior interventricular artery
191
What runs with the great cardiac vein?
Anterior interventricular artery
192
What vessels run in the anterior inter ventricular sulcus?
Anterior interventricular artery/left anterior descending artery
Great cardiac vein
193
What vessels run in the posterior interventricular sulcus?
Posterior interventricular artery
| Middle cardiac vein
194
What runs along the margin of the right atrium and right ventricle?
Right coronary artery
195
A blockage in the left coronary artery would effect which area of the heart?
Left ventricle
Left atrium
Interventricular septum
196
A blockage in the circumflex artery would effect which area of the heart?
Posterior left ventricle
197
A blockage in the anterior inter ventricular artery would effect which area of the heart?
Left ventricle
| Interventricular septum
198
A blockage in the right coronary artery would effect which area of the heart?
Right atrium
| Right ventricle
199
A blockage in the marginal artery would effect which area of the heart?
Anterior right ventricle
200
A blockage in the posterior inter ventricular artery would effect which area of the heart?
Posterior right ventricle
201
Where do the coronary arteries arise from?
Aorta at the level of the aortic valve
202
How is blood directed into the coronary arteries?
When the aortic valve closes and blood pools, the blood is able to drain into the coronary arteries.
203
What does myogenic mean?
Heartbeat originates within the heart
204
What does auto rhythmic mean?
The heart depolarizes spontaneously and regularly - without any external nerve innervation
205
What is the sinus rhythm?
Set by SA node and conducted by AV node and Perkinje fibres
206
What effect does the vagus nerve have on the heart?
Decrease heart rate
207
What effect does sympathetic stimulation have on the heart?
Increase heart rate
208
Where is the SA node located?
In right atrium near the SVC
209
What structure is the AV node close to?
Opening to coronary sinus
210
Where is the atrioventricular bundle located?
In septum
211
What is another name for the atrioventricular bundle?
Bundle of HIS
212
What is mainly responsible for ventricular contraction?
Purkinje fibres
213
Where do the Purkinje fibres start?
Apex of heart
214
What is -normally- the pacemaker of the heart?
SA node
215
The first heart sound marks the beginning of what phase of the cardiac cycle?
Systole
216
The second heart sound makes the beginning of what phase of the cardiac cycle?
Diastole
217
During fetal development, if the blood does not pass through the fossa ovale, how is it able to still bypass the lungs?
Ductus arteriosus connects the pulmonary trunk to the aorta so no blood travels into the pulmonary arteries
218
What is the remnants of the ductus arteriosus in adults?
Ligamentum arteriosus
219
What is the remnants of the ductus venosus in adults?
Ligamentum venosum
220
What is the remnants of the umbilical vein in adults?
Ligamentum teres
221
What is the remnants of the umbilical cord in adults?
Median umbilical ligament
| Umbilicus
222
What is the remnants of the umbilical arteries?
Obliterated umbilical arteries
| Medial umbilical ligament
223
What type of blood flows through the ductus venosus?
Oxygenated
224
What type of blood flows through the umbilical vein?
Oxygenated
225
What type of blood flows through the umbilical arteries?
Deoxygenated
226
How is lymph directed around body?
Muscle pumps (no valves)
227
What filters lymph?
Spleen
| Lymph nodes
228
What is the function of lymphatic vessels?
Removes tissue fluid
| Returns blood proteins
229
What is the lymphatic system for?
Immune defense
| Transports triglycerides from intestines
230
How does the lymphatic system help with immune defence?
Produces lymphocytes that attack foreign bodies
231
What are the three lymphatic tissues?
Thymus gland
Spleen
Nodes
232
How does the spleen help with immune defence?
Removes RBC from blood
233
Lymphatic vessels are found in all tissues and organs except for...?
```
Eye
CNS
Cartilage
Bone
Inner ear
```
234
Where does the right lymphatic duct drain into?
Right subclavian vein at the junction of the brachiocephalic vein
235
What drains into the right lymphatic duct?
Right upper limb
Right thorax
Right head
Right neck
236
Where does the thoracic duct drain into?
Left subclavian vein at junction of brachiocephalic vein
237
What drains into the thoracic duct?
```
Lower limb
Abdomen
Left upper limb
Left thorax
Left head
Left neck
```
238
What collects lymphatic fluid in the abdomen that leads into the thoracic duct?
Cisterna chyli
239
What are symptoms of decreased lymphatic system functioning?
```
Fluid build up causing elephant leg or heart failure
Autoimmune disease (ie. HIV/AIDS, Hasimoto's disease)
```
240
What structures does the thoracic duct sit between in the posterior mediastinum?
Descending aorta on medial side and azygos vein on lateral side
241
Where is the thoracic duct relative to the esophagus?
Posterior
242
Where is the esophagus relative to the aorta?
To the right (medial)
243
A blockage in the descending aorta at the level of the aortic hiatus could have secondary symptoms such as..?
Blockage of lymphatic duct
244
Are the three branches of the descending aorta in the posterior mediastinum?
Posterior intercostals
Bronchial artery
Esophageal artery
245
What supplies the lung tissue with blood?
Bronchial arteries
246
What drains into the azygos vein?
Right posterior intercostal veins
Accessory hemiazygos vein
Hemiazygos vein
Right lumbar veins
247
At what level does the accessory hemiazygos and hemiazygos vein drain into the azygos vein?
T8
248
Where does the azygos vein drain into?
SVC
249
What drains into the accessory hemiazygos vein?
Left posterior intercostal veins
250
What drains into the hemiazygos vein?
Left posterior intercostal veins
| Lumbar veins
251
Where is the sympathetic trunk located in the posterior mediastinum?
Posterior to the descending aorta
| On other side of vertebral bodies
252
What does the rami communicante connect?
Sympathetic chain to intercostal nerves
253
Where does the sympathetic chain ascend to?
Into the neck
254
Where do white mater rami communicante travel?
From spinal cord to the sympathetic trunk
255
Where do grey mater rami communicante travel?
From sympathetic trunk to intercostal nerves
256
40 year old male was diagnosed with a cancerous tumour that was invading the superior/medial aspect of the upper right lobe of his right lung. He was experiencing difficulty swallowing, coughing, shortness of breath and mild fill pain in the right side of his chest and shoulder. He returned to the clinic with tingling of the right medial side of his forearm. Lack of perspiration of right side of face. Right pupil was permanently constricted and right eyelid dropping slightly. Lymph nodes were enlarged. What nerves could be effected? What could be compressed?
Coughing from lack of lung functioning and irritation of vagus nerve
Swallowing because of constriction of esophagus
Dilated pupils/lack of sweat because of sympathetic trunk compression
