Anatomy thorax and neck S1-8 Flashcards
What is the upper border of the thorax?
The clavicle
What are the articular surfaces of the clavicle?
the acromium process of the scapular and the sternum
What are the areas of the sternum?
The manubrium, body and xiphoid process
What is the name for the angle between the body and manubrium sternum?
Angle of louis
What is the marking of the angle of louis?
The 2nd costal cartilage
What way are intercostal spaces named?
the 2nd spaces is below the 2nd rib
What are the vertical ways to split the thorax?
The midline, mid-clavicular line anterior axillary, mid axillary line and posterior axillary line.
What is the insertion of the pectoralis major?
The humerus
What is the origin of the pectoralis major?
the medila 2 thirds of the clavicle and the sternum
What are the three compartments of the thorax?
The mediastinum and the left and right pleural cavities
What is the upper extend ot the pleural cavities?
Above the first rib
How many thoracic vertebrae are there?
12
How many cervical vertebrae are there?
7
How many ribs are there?
12
How many layers of intercostal muscle are there?
3
What is material connects the ribs to the strernum?
costal cartilage
How many articulations do the ribs have?
3
What are the articulations of the rib?
head articulates with body of vertebra and the one above the tip with the costal cartilage. some with the transverse process of the rib as well
Which ribs articulate with the costal cartilage to the sterunm?
1-7
Which ribs do not direcly articulate with the sternum?
8-10
what are floating ribs
Ribs 11 and 12 only articulate with the spine
Which structures pass through the superior thoracic aperture?
the subclavian artery also brachiocephalic trunk and veins internal jugular vein common carotid artery, oesophagus and trachea also phrenic and vagus nerves plus others
What is the superior thoracic aperture?
ring around superior aspect of the first rib and the T1 vertbral body and superior margin of the the manubrium sternum
What is the path of structures destined for the upper limb?
over the first rib
What passes through the inferior thoracic apeture?
oesophagus and vagus nerve and descending aorta
What is the inferior thoracic aperture?
body of the 12th vertebra rib 12 and distal end of 11 te cartilage of 10 to 8th ribs and ten and the xiphoid process
Which dome of the diaphragm is higher?
The right
How high can the right dome of the diaphragm get
To the 5th rib
What structures penetrate the diaphragm?
The oesophagus, inferior vena cava, the aorta passes posteriorly
What splits the mediastinum into inferior and superior areas?
the sternal angle
What defines the anterior middle and posterior areas of the mediastinum?
the pericardium
What passes through the root of the lung?
Lymphatics pulmonary veins and artery and the airways
What is the most clinically significant recess of the lungs?
the costodiapragmatic recess which is inferior between the thoracic wall and the diaphragm
Which is anterior the trachea or oesphagus?
The trachea
What is the axillary inlet?
they allow structurs from the superior thoracic inlet into the upper limb
What forms the axillary inlet?
the superior margin of the scapula the clavival and the lateral margin of the first rib
How does the IVCpass through the diaphram?
through the central tendo of the diaphram at the vertebral level of T8
How does the oesophagus pass though the diaphram?
It passes throug the muscular area of the diaphram to the left of the midline at the T10 level
How does the aorta pass the diaphragm?
posteriorly at the level of T12
What does the breast tissue consist of?
Secretory glands, superficial fasia, and overlying skin
Where do the lymphatics of the breast arise from?
for lateral parts it is the axillary region for the other it is tje thoracic ones
What level is te sternal plane?
T4/5
What happens at T4/5?
Sternal angle, 2nd rib anteriorly, separation of mediastinum, marks the aorta arch, passes the superior vena cava where it penetrates the pericardium the trachea bifurcates and the superior limit of the pulmonary trunk
What is the left right shunt in the thorax?
The left brachiocephalic vein crossing to join the right brachiocephalic forming the superior vena cava.
There are also the emiasagos and acessory(superior) veins which drain the thorax from the neurovasuclar bundles beneath the ribs. the flow into the azygous on the right and into the SVC
Which vessels supply the rib area?
The intercostal vessels from the aorta that run under the ribs. there are also the internal thoracic arteries which come from the subclavian arteries.
which dermatmes are in the thorax?
C4 C5 above clavicle, the T2 to T9 which roughly follow the levesl of the ribs
What are some dermotome landmarks?
T4 nipples, T10 umbilicus
Where are the sympathetic chain roots?
T1-L2 anterior rami
What is the innervation of the diaphragm?
C345 the phrenic nerve
What are the some muscles that attach to the ribs?
levator costarum serratus posterior superior and serratus posterior inferior. also internal innermost and external intercostal muscles
Which intercostal muscles are most active during inspiration?
external
Which intercostal muscles are most active during expiration?
internal and innermost
Which direction do the internal intercostal muscles go?
up and out
Which direction do the external intercostal muscles run?
down and in
What is the drainage of the breast lymphatics?
most of the tissue which is in the upper outer quadrant of the breast drains to axilliary lymph nodes
Which costal cartilage is next to the angle of louis?
second costal cartilage
What forms the anterior axillary fold?
The lower edge of the pectoralis major muscle
What is the origin of sarratus anterior?
upper 8 ribs
What is the insertion of the scapula?
medial border of the scapular
What is the clinical importance of the left cephalic vein?
It is used for passing wires into the heart and for pacemakers
What is the internal mammary artery/ internal thoracic?
A vertical artery that supplies the ribs and the diaphragm
Where is the lung connected to the mediastinum?
At the of the lung
Which nerves carry sensation from the parietal and visceral pleura?
The parietal pleaura is supplied by the same nerves as the thoracic tissue, spinal nerves t1-t12 the visceral is innervated by the vagus and sympathetic
What is a bronchopulmonary segment?
it has a feeding artery broncus and run tot he centre of the segment and branch to supply an area there are ten segments or each side they are anatomically separate
What are the structures at the hilum of the lung?
Main bronchus pulmonary artery two pulmonary veins bronchial artery lymphatic vessels braches of the vagus and sympathetic nerves
how do the lungs help with the return of blood?
During inspiration the pressure in the thorax drops and this aids with blood return to the heart
What is the sensory supply to the diaphragm?
The phrenic nerve C345 roots
What are the surface markings of the lungs?
Lowest from midclavicular th rib tip, mid axillary 8th tip, posteriorly 10th rib
What are the margins of the pleura?
They are 2 ribs lower than the lungs, midclavicular 8th, midaxillary 10th posterior 12th rib.
What is intercostal recession?
when a patient is having difficulty taking a breath and have to create a very negative pressure in the thorax and the intercostal muscles get sucked in
What are the surfaced of the lung?
Costal diaphragmatic and mediatinal
Where is the best to listen to left upper lobe?
Most places on the front on the left
Where is the best place to listen to the left lower lobe?
The axillary line lower down or anywhere on the lower posterior thorax
Where is the best place to listen to the right upper lobe?
The top anterior thorax
where is the best place to listen to the right middle/ linguillar lobe?
The lower anterior medial area
Where is the best place to listen to the right lower lobe?
Most places other than superiorly on the posterior thorax
where is the origin of the phrenic nerve?
Anterior Rami of C3-C5 nerve roots
Where does the coracoid process of the scapula project?
Anteriorly
Where does the acromium of the scapula project?
Laterally
What happens when you move medially to the intercostal muscles?
They become a membrane especially external intercostal
Where do the nerurovasular bundles go?
They go under the rib above it and very close
Which is above the pulomnary artery or vein?
the veins are lower
Where does the phrenic nerve go with respect to the hilum?
deep to pleura and anterior to the hilum of the lung.
Where does the phrenic nerve pass through the diaphragm?
With the IVC on the right, on the left
Where does the azygous vein enter the main vein?
in th vena cava above the heart
What is the path of the phrenic nerve on the left?
it passes anterior to the hilum of the lung
Where does the vagus nerve pass with respect to the hilum?
posterior to the hilum of the lung gives off recurrent laryngeal nerve under the arch of the aorta on the left
What is the ligumentum arteriousis?
It is a remnant of the ductus arteriousis a shunt from the pulmonary artery to the aorta the redcurrant goes under this
Where is the definition of the superior mediastinum?
first rib and T4
Where is the inferior mediastium?
T4 to T9
what is the bulge that marks the Sulcus terminalis crastae terminalis?
Where vagus and sympathetic nerves contact the SAN
Where should you listen to the apex beat of the heart?
5th intercostal space in the left midclavicular
Where should you listen to the aorta?
2nd intercostal space just to edge of sternum
What are subcostales?
Muscles running vertically between ribs
where do the upper thoracic arteries come froem?
The subclavian artery
Where do most intercostal arteries come from?
the thoracic aorta
Where are the main lymph nodes in the thorax?
Axillary, subcapsular, pectoral, parasternal, intercostal and diaphragmatic lymph nodes
At what level does the IVC pass through the diaphragm?
At TVIII
At what level does the oesophagus pass through the diaphragm?
At TX