Anatomy - Thorax Flashcards
1
Q
Dermatomes of the thorax and abdomen
A
C4, T2 - Upper chest where arms attach.
T4 nipples
T10 umbilicus
L1 Genitalia
2
Q
Which rib is atypical
A
Rib 1
3
Q
Which ribs are true ribs
A
2-7
4
Q
Which ribs are false ribs
A
8-12
5
Q
With which vertebra does rib 1 articulate?
A
T1
6
Q
Thoracic wall has 3 muscle layers. Outer layer contains
A
External intercostals - down and forward
7
Q
Thoracic wall has 3 muscle layers. Intermediate layer contains
A
Internal intercostals - down and backwards
8
Q
Thoracic wall has 3 muscle layers. Inner layer contains
A
Innermost intercostals and transversus
9
Q
Pump handle action of breathing
A
All ribs drawn together and raised up towards the fixed first rib. The anterior aspect of each rib rises above the posterior end.
10
Q
Bucket handle action of breathing
A
The lateral aspect of each rib is raised. The false ribs open anteriorly like a book. This increases the anterior diameter of the chest.
11
Q
In quiet respiration rib elevation is carried out by which muscles
A
External intercostals with support from scalene muscles
12
Q
In forced inspiration rib elevation is supported by
A
pectoral muscles, sternocleidomastoid, serratus anterior and latissimus dorsi
13
Q
Abdominal breathing is facilitated by
A
Contraction of the diaphragm which increases the vertical diameter of the thorax
14
Q
The intercostal groove of the upper rib contains
A
The neurovascular bundle
15
Q
The intercostal space contains (3)
A
Muscle layers - three - external, internal, transverse
Fascia - endothoracic fascia, lined internally by parietal pleura
Neurovascular bundle - containing Intercostal vein, artery and nerve
16
Q
Chest drain or pleural aspiration site
A
5th interncostal space, midaxillary line, just over the lower rib
17
Q
Surface markings of the diaphragm from (3)
A
Xiphoid process
Lower 6 costal cartilages
First 3 lumbar vertebrae
18
Q
Surface markings of the diaphragm to (1)
A
Central tendon
19
Q
Diaphragm central tendon sits
A
Behind xiphisternal joint
20
Q
Right dome of diaphragm sits at
A
Level of upper border of 5th rib midclavicular line
21
Q
Left dome of diaphragm sits at
A
Level of lower border of 5th rib midclavicular line
22
Q
Aortic opening of diaphragm at vertebral level
A
T12
23
Q
Aortic opening through diaphragm contains (3)
A
Aorta
Azygous vein
Thoracic duct
24
Q
Oesophageal opening of diaphragm at veterbral level
A
T10
25
Oesophageal opening through diaphragm contains (4)
Oesophagus
Right and left vagus nerves
Oesophageal branches of left gastric vessels
Lymphatics from lower 1/3 oesophagus
26
Vena caval opening of diaphragm sits at veterbral level
T8
27
Vena caval opening through diaphragm contains (2)
Inferior vena cava
| Branches of right phrenic nerve
28
Congenital diaphragmatic hernias (4)
Bochdalek's hernia
Absence of diaphragm
Absence of central tendon
Morgagni hernia
29
Bochdalek's hernia
Hernia through pleuriperitoneal canal, more common on left which closes last
30
Morgagni hernia
Small defect in anterior diaphragm close to sternum
31
Acquired hiatus hernia (2)
Sliding - raised intra-abdominal pressure and obesity. Stomach slides through oesophageal opening causing relflux.
Rolling - Fundus of stomach passess alongside oesophagus into chest. No refulx but can become strangulated or perforate.
32
Emergency thoracotomy approach
Stand on the left, abduct left arm. Incision starts medial end 5th intercostal space, extend laterally into the axilla along the top of the 6th rib. Use rib retractors and tough scissors to divide the sternum into the right 5th intercostal space. OPen the pericardium, close myocardial defects and or perform cardiac massage.
33
Thoracic inlet boundaries
T1 vertebra, medial borders of 1st ribs, superior border of manubrium
34
Thoracic inlet contains
```
Oesophagus
Trachea
Subclavian arteries
Aortic arch
Subclavian veins
Brachiocephalic trunk
```
35
Branches of the aortic arch R-L
Brachiocephalic arch splitting into right common carotid and right subclavian
Left common carotid artery
Left subclavian artery
36
Posterior to the trachea in the neck is the (2)
Oesophagus
| Recurrent laryngeal nerve
37
Lateral to the trachea n the neck is the (3)
Thyroid isthmus at 2-4th tracheal rings
Carotid sheath
Anterior jugular veins
38
Trachea origin
Below cricoid cartilage of the larynx at the level of C6
39
Trachea termination
At the sternal angle at the level of T4 where it splits into left and right main bronchus
40
Anterior relations of the trachea in the mediastinum (6)
```
Sternum
Thymus
Left brachiocephalic vein
Origin of brachiocephalic artery
Origin of left common carotid artery
Arch of aorta
```
41
Posterior relations of the trachea in the mediastinum (2)
Oesophagus
| Recurrent laryngeal nerve
42
Right sided relations of the trachea in the mediastinum (3)
Azygous vein
Right vagus nerve
Pleura
43
Left sided relations of the trachea in the mediastinum (6)
```
Arch of aorta
Left common carotid artery
LLeft subclavian artery
Left vagus nerve
Left phrenic nerve
Pleura
```
44
The thymus is
Lymphatic tissue moulded around the great vessels and trachea
45
The thymus lies
In anterior mediastinum between manubrium and pericardium
46
Change in size of thymus over time
Large at birth, getting bigger until puberty when it involutes
47
Blood supply of thymus
Inferior thyroid and internal thoracic arteries
48
Fibrous pericardium role
Strong outer layer. Fuses with the outer layer of the great vessels that pass through it.
49
Serous pericardium role
Parietal layer - Lines fibrous pericardium, reflects around the roots of the great vessels, becomes continuous with the
Visceral layer - closely applied to the heart, forms a cavity between the parietal layer that contains pericardial fluid to lubricate the movement of the heart
50
Right heart border is
right atrium
51
Left heart border is
Left atrium
| Left ventricle
52
Superior heart border is
Roots of great vessels
53
Inferior heart border is
Right ventricle
| Apex of left ventricle
54
Surface markings of the heart - apex
Left 5th intercostal space 9cm from midline
55
Surface markings of the heart - superior border
2nd left costal cartilage, 1.5cm from edge of sternum to 3rd right costal cartilage 1.5cm from sternum
56
Surface markings of the heart - right border
3rd right costal cartilage to 6th right costal cartilage, 1.5cm from sternum
57
Surface markings of the heart - left border
2nd costal cartilage to apex of heart 5th intercostal space 9cm from midline
58
Surface markings of the heart - inferior border
6th right costal cartilage to apex of heart 5th intercostal space 9cm from midline
59
Tricuspid valve sits
Between right atrium and right ventricle.
60
Mitral valve sits
Between left atrium and left ventricle
61
Pulmonary valve sits
Guards pulmonary orifice
62
Aortic valve sits
Guards aortic orifice
63
Surface marking of tricuspid valve
Behind right half of sternum opposite 4th intercostal space
64
Surface marking of mitral valve
Behind left half of sternum opposite 4th costal cartilage
65
Surface marking of pulmonary valve
Behind medial end of 3rd left costal cartilage and sternum
66
Surface marking of aortic valve
Behind left half of sternum opposite 3rd intercostal space
67
Auscultation point for tricuspid valve
Right sternal edge, 5th intercostal space
68
Auscultation point for mitral valve
Apex beat
69
Auscultation point for pulmonary valve
Left sternal edge 3rd costal cartilage
70
Auscultation point for aortic valve
Right sternal edge, 2nd intercostal space
71
Ascending aorta originates from
Base of left ventricle. Runs upwards and forwards to lie behind right half of sternum.
72
Pulmonary trunk originates from
Upper part of right ventricle. It runs upwards, backwards and to the left.
73
Ascending aorta terminates at
At the sternal angle it becomes the arch of the aorta
74
Pulmonary trunk terminates at
Terminates at the concavity of the aortic arch by dividing into left and right pulmonary arteries
75
SA node sits in the
Wall of the right atrium
76
The AV node sits in the
wall of the interatrial spetum
77
The bundle of His is
Divided into left and right branches and transmits to Purkinje fibres. It sits in the interventricular septum
78
Purkinje fibres do what
Conduct impulses to left and right ventricles. They are in the subendocardial tissue
79
Right coronary artery supplies (4)
Right ventricle
SA node (in 60% of people)
Parts of the atria
Parts of the interventricular septum including the AV node
80
Left coronary artery supplies (4)
Left ventricle
SA node (in 40%) of people
Parts of the atria
Parts of the interventricular septum
81
Emergency Pericardiocentesis approach
18G needle on a syringe and 3way tap. Insert needle below xiphisternum, direct superiorly and posteriorly towards tip of right scapula. Aspirate as advancing until blood is aspirated.
82
Vertebral levels of the oesophagus
C6-T10
83
Constriction point of cervical oesophagus
Where pharynx joins upper end - 6cm from incisors
84
Constriction point of thoracic oesophagus
Where left bronchus and aortic arch cross, 25cm from incisors
85
Constriction point of abdominal oesophagus
Where oesophagus passes through diaphragm, 41cm from incisors
86
Nerve supply of cervical oesophagus (2)
Recurrent laryngeal
| Sympathetic fibres from middle cervical ganglion
87
Nerve supply of thoracic oesophagus (3)
Vagus nerve
Sympathetic trunk
Greater splanchnic nerve
88
Nerve supply of abdominal oesophagus (2)
Vagal plexus
| Oesophageal plexus
89
Visceral pleura nerve supply (1)
Pulmonary plexus - feels stretch not pain
90
Parietal pleura nerve supply (2)
Intercostal nerve
Phrenic nerve
Feels stretch and pain
91
Surface markings of pleura - top
Sternoclavicular joint to 2.5cm higher than clavicle 1/3rd along.
92
Surface markings of pleura - right (4)
6th costal cartilage
8th rib - midclavicular line
10th rib midaxillary line
12th rib border of erector spinae
93
Surface markings of pleura - left (5)
```
4th costal cartilage indents laterally separated from the chest wall by the pericardium, meaning the left 4th and 5th rib have no pleura medially.
Then same as right -
6th costal cartilage
8th rib - midclavicular line
10th rib midaxillary line
12th rib border of erector spinae
```
94
Right lung lobes
Upper
Middle
Lower
95
Right lung fissure
Transverse
| Oblique
96
Left lung lobes
Upper
Lower
Lingula - between oblique fissure and cardiac notch
97
Left lung fissure
Oblique
98
Lung roots contain (6)
```
Bronchi
Pulmonary artery
Pulmonary veins
Lymph vessels
Bronchial vessels
Nerves
```
99
Lung roots are
surrounded by tubeal sheath of pleura, connecting lung roots to mediastinum
100
Surface anatomy of lung - Superior
Sternoclavicular joint to inner third/outer 2/3 junction of clavicle with apex 2.5cm above clavicle
101
Surface anatomy of lung - anterior
Right lung - Sternoclavicular joint to sternal angle, down to xiphisternal joint.
Left lung same but deviates laterally at 4th costal cartilage for the cardiac notch, then down to xiphisternal notch
102
Surface anatomy of lung - lower border
6th rib at midclavicular line
8th rib at midclavicular line
10th rib adjacent to veterbral column
103
Surface anatomy of lung - posterior
Spinous process of C7 down to T10 4cm from midline
104
Surface anatomy of the lung - Oblique fissure
Spine of the scapula down, anterior and lateral along the 6th rib to the 6th costochondral junction
105
Surface anatomy of the lung - Horizontal fissure
Along 4th costal cartilage to meet the oblique fissure in the midaxillary line
106
Superficial lymph drainage of lung
Over the surface then via bronchopulmonary nodes in the hilum
107
Deep lymph drainage of the lung
Deep plexus along course of bronchi and pulmonary vessels to the bronchopulmonary nodes in the hilum
108
From the hilum lymph drains via
the tracheobronchialnodes and into the bronchomediatinal trunks
109
The pulmonary plexus contains
efferent and afferent autonomic nerve fibres from the sympathetic trunk
parasympathetic fibres of the vagus nerve
110
Sympathetic efferent fibres cause
Bronchodilation
| Vasoconstriction
111
Parasympathetic efferent fibres cause
Bronchoconstriction
| Vasodilation
