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CR2 > Applied Anatomy of the Thorax > Flashcards

Applied Anatomy of the Thorax Flashcards

Revise anatomy of the thoracic wall and understand the clinical relevance Surface anatomy Understand the functional anatomy and nerve supply of the pleura Understand some simple lung pathologies

1
Q

What is the function of the pectoralis major?

A

Flexion of the arm, medial rotation, adduction of the arm and accessory muscle in respiration as attached to rib cage to help lift it up

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2
Q

What is the function of the pectoralis minor?

A

Accessory muscle for inspiration

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3
Q

What are the pectoralis major and minor innervated by/

A

C5-T1 lateral and medial pectoral nerves

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4
Q

Where is the SCM?

A

Goes from the mastoid process around the neck to the sternum

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5
Q

What is the function of the SCM?

A

Helps to elevate the chest

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6
Q

What innervates the SCM?

A

Accessory nerve

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7
Q

Where is the serratus anterior?

A

Underside of the scapula and wraps around the chest

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8
Q

What is the serratus anterior innervated by/

A

Long thoracic nerve

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9
Q

What is abnormal about the long thoracic nerve?

A

It is superficial to the muscle it innervates - serratus anterior

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10
Q

How do you get scapula winging?

A

If you damage the long thoracic nerve, for example if you are removing axillary lymph nodes.

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11
Q

What is the function of the external intercostal muscles?

A

Elevate rib cage

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12
Q

What is the function of the internal and innermost intercostal muscles?

A

Depress the rib cage

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13
Q

What are the intercostal muscles innervated by?

A

Intercostal nerves

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14
Q

Where is the rectus abdominis?

A

Attaches to the costal margin, runs down in front of the abdomen and attaches to the pubic symphysis

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15
Q

What is the function of the rectus abdominis?

A

Forced expiration

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16
Q

What is the rectus abdominis innervated by?

A

Mainly intercostal nerves but also subcostal nerve

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17
Q

What direction do the intercostal muscles travel in/

A

External - hands in pockets inferiorly and anteriorly

Internal and innermost - opposite so superiorly and posteriorly

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18
Q

Where do the intercostal muscles lie?

A

Between the ribs

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19
Q

What does the posterior intercostal artery arise from?

A

Thoracic aorta

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20
Q

What does the anterior intercostal artery and vein arise from?

A

Internal thoracic artery and vein

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21
Q

Where does the neurovascular bundle lie?

A

Between the internal and innermost, in the costal groove, just inferior to the rib

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22
Q

Why is thoracocentesis done?

A

To sample pleural fluid

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23
Q

Where is thoracocentesis done?

A

superior to the rib, inferior part of the pleural cavity to get into the costophrenic recess where fluid will accumulate, 9th mid axillary line during expiration

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24
Q

Why is thoracocentesis done in that location?

A

To avoid lung so don’t get a pneumothorax, avoid intercostal nerves

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25
Q

What is a chest drain used for?

A

Pneumothorax to drain fluid out

26
Q

Where is a chest drain done?

A

In the safe triangle

5th intercostal space in the mid-axillary line

27
Q

What is the border for the safe triangle?

A

Apex below the axilla
Lateral border of the pectoralis major
Anterior border of the latissimus dorsi
Line superior to level of nipple

28
Q

What passes through the diaphragm and where?

A

IVC - T8
oesophagus - T10
aorta - T12

29
Q

A 53-year-old man presented to the emergency department with a glasgow coma scale score of 15 after sustaining a stab wound to the posterior neck. The MRI shows complete transection of the spinal cord at the level C7/T1.
Where would he experience sensory loss?
How would this affect his ability to breathe?

A

Below the level of lesion
Can still breathe as major muscle diaphragm is still innervated and SCM is unaffected. Rectus abdominis and intercostal muscles not innervated but pec minor and `major will have lost some innervation so may be weaker.

30
Q

Which pleura of the lungs is more sensitive to pain?

A

Pariteal

31
Q

Why is the parietal pleura more sensitive to pain?

A

have a somatic nerve supply

32
Q

What is the parietal pleura innervated by?

A

Costal surface - intercostal nerves
mediastinal surface - phrenic nerves
diaphragmatic surface - intercostal and phrenic

33
Q

Why are the visceral pleura not very sensitive to pain?

A

Pain detected by sympathetic nerves which don’t detect well

34
Q

What do the parietal pleura cover?

A

thoracic wall and superior surface of diaphragm

35
Q

How is a pneumothorax seen on chest x ray?

A

visceral pleura edge is seen

very black region above it

36
Q

What forms the costophrenic angle?

A

Lower edge of the parietal pleura

Extends 2 ribs lower than inferior border of lung

37
Q

A 32 year old woman sustained a gunshot wound to the right 4th intercostal space. Above the nipple. A chest radiograph demonstrated complete collapse of the lung.

A further radiograph 20 mins later demonstrated an air/fluid level in the pleural cavity.
How would this be seen on a x-ray?

A

Blunted costophrenic angle indicating fluid in the cavity

38
Q

Where is the apex of the lung?

A

2cm above the clavicle

39
Q

Where is the cardiac notch?

A

At the 4th rib

40
Q

At which ribs are the borders of the lungs found?

A

Inferior border - 6th rib
Mid clavicular line - 10th rib
Mid axillary line - 8th rib

41
Q

At which ribs are the pleura found?

A

inferior border - 8th rib
Mid clavicular line - 12th rib
Mid axillary line - 10th rib

42
Q

What are the differences in the right and left lung?

A

R - superior middle and inferior lobe

L - superior and inferior lobe

43
Q

What do the horizonal and oblique fissures separate?

A

Horizontal fissure separates superior and middle lobe

Oblique fissure separates middle and inferior lobe

44
Q

How do you distinguish between the pulmonary artery, pulmonary vein and bronchus?

A

Pulmonary artery is always above the vein as comes off from the heart at a higher level
The bronchus has cartilage in the walls, thicker wall and has a less regular shape

45
Q

Where does the trachea bifurcate?

A

At the sternal angle (T4/T5) carina

46
Q

What is the difference between the R and L bronchus and what is the significance of this?

A

L goes up horizontal angle but R is more vertical

This means aspiration of anything is normally to R

47
Q

What is the difference between bronchioles and the bronchus?

A

Bronchioles don’t have cartilage in walls but bronchus does

48
Q

What is the order of divisions from the trachea to the alveoli?

A

trachea - main bronchus - lobar bronchus - segmental bronchi - conducting bronchioles - terminal bronchioles - respiratory bronchioles - alveolar ducts - alveolar sacs

49
Q

What is a sign of hyperexpansion on an x-ray?

A

more than 7 ribs intercepting the diaphragm meaning diaphragm is compressed downwards
should be 5-7 ribs intercepting diaphragm

50
Q

What are the features of emphysema?

A

Destruction of alveolar walls = permanent large air spaces
Surface area reduced
Elastic tissue loss so less recoil
narrowed bronchioles

51
Q

Why is less elastic recoil a problem in emphysema?

A

Alveolar collapse as air gets trapped in alveoli themselves as don’t get pushed out in expiration = hyperexpansion

52
Q

What are the parts of the mediatstinum?

A

Superior and inferior separated by sternal angle - T4/T5

inferior has posterior, middle and anterior

53
Q

What does the anterior mediastinum contain?

A

Thymus remnants

54
Q

What does the middle mediastinum contain?

A

Heart and pericardium

55
Q

What does the superior mediastinum contain?

A

great vessels, oesophagus, trachea, thymus, phrenic nerve, vagus nerve, thoracic duct, recurrent laryngeal nerves

56
Q

What is the course of the recurrent laryngeal?

A

branch of the vagus which branches within the thorax and loops around the arch of aorta on the left and subclavian artery on the right, then run back up to larynx to supply vocal cords

57
Q

What does the posterior mediastinum contain?

A 
azygos and hemi azygos
vagus
oesophagus
thoracic duct
thoracic aorta
(4 BIRDS + THORACIC AORTA)
58
Q

What are the roots of the symp chain ganglion?

A

T1-L2 + stellate ganglion

59
Q

What does the symp do in fight or flight?

A 
Pupil dilation 
Bronchodilation
Cardiac acceleration
Inhibition of digestion
Filling of the bladder
Peripheral vasoconstriction
Piloerection
60
Q

A 75 year old life-long smoker presents with a persistent cough, hoarse voice and a pinpoint pupil in his right eye;
where is tumour?

A

stellate ganglion affected as pinpoint pupil
hoarse voice - recurrent laryngeal
tumour must be at apex of right lung

CR2 (35 decks)

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