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c2 > applied anatomy of the thorax > Flashcards

applied anatomy of the thorax Flashcards

1
Q

what’s the largest muscle in the chest wall?

A

pectoralis major

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2
Q

what actions can pectoralis major do?

A

flexion
adduction
internal rotation

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3
Q

what are the attachment points of pectoralis major?

A

o Attaches to clavicle, sternum, ribs and humerus

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4
Q

where is pectoralis minor found?

A

underneath pectoralis major

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5
Q

where does pectoralis minor attach?

A

to the scapula and ribs

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6
Q

what are the attachment points of sternocleidomastoid?

A

mastoid process

sternum and clavicle

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7
Q

what nerve innervates the sternocleidomastoid?

A

spinal accessory nerve

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8
Q

what are the attachment points of the rectus abdominis?

A

costal margin and xiphoid process

pubic symphysis

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9
Q

what muscles are used in inspiration?

A

pec major, pec minor, SCM, external intercostals

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10
Q

what muscle is used in forced expiration?

A

rectus abdominis

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11
Q

what supplies the serratus anterior and what are the spinal levels?

A

long thoracic nerve C5-C7

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12
Q

where does the long thoracic nerve run?

A

runs on the superficial border of the muscle

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13
Q

what is the clinical relevance of the long thoracic nerve?

A

if you’re removing all the axillary lymph nodes in a radical mastectomy then it’s easy to damage this nerve  winging of the scapula

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14
Q

how do intercostal nerves leave the spinal cord?

A

through the IV foramen

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15
Q

where do posterior intercostal arteries branch from?

A

thoracic aorta

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16
Q

where do anterior intercostal arteries branch from?

A

internal thoracic artery

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17
Q

where do anterior intercostal veins drain?

A

into the internal thoracic vein

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18
Q

where do posterior intercostal veins drain?

A

azygos –> superior vena cava

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19
Q

where are neurovascular bundles found?

A

innermost intercostal layer and internal intercostal

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20
Q

what is the pupose of thoracocentesis?

A

done to sample pleural fluid

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21
Q

how is thoracocentesis done?

A
  • Needle inserted superior to rib to avoid damage to intercostal nerves
  • Upright patient will have fluid accumulate in the costophrenic recess
  • 9th mid-axillary line during expiration avoids the inferior border of the lung
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22
Q

what condition can a ruptured posterior intercostal artery caused?

A

haemothorax

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23
Q

where is a chest drain done?

A

5th intercostal space in the mid-axillary line

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24
Q

why does a chest drain happen higher in the chest than a thoracocentesis?

A

Happens higher up than thoracocentesis bc you’re trying to avoid the liver

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25
Q

what nerve innervates the diaphragm?

A

phrenic nerve

C3-C5

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26
Q

where does the vena cava enter the diaphragm?

A

T8

27
Q

where does the oesophagus enter the diaphragn?

A

T10

28
Q

at what level is the aortic hiatus?

A

T12

29
Q

what does the parietal pleura cover?

A

thoracic wall and superior surface of diaphragm

30
Q

what does the visceral pleura cover?

A

covers external lung surface

31
Q

where is the pleural cavity found?

A

between the pleural layers

32
Q

which pleural layer produces pleural fluid?

A

parietal pleura

33
Q

what is the function of pleural fluid?

A

o Reduce the friction when you breathe
o Keeps the lungs stuck to the parietal layer
oKeeps the lungs inflated

34
Q

explain the nerve supply of the visceral pleura

A

same as the lungs: sympathetic and parasympathetic. Not able to perceive pain

35
Q

explain the nerve supply of the parietal pleura

A

same as the chest wall: innervated by the intercostal nerves and the phrenic nerve. Can feel pain.

36
Q

what aspect of the chest wall are the intercostal nerves found?

A

lateral

37
Q

what aspect of the chest wall is the phrenic nerve found on?

A

medial

38
Q

when would you feel a tumour in the lung tissue?

A

when it got so big until it touched the parietal pleura

39
Q

on a normal chest x ray, should the pleura be visible?

A

no

40
Q

how is the costophrenic recess formed?

A

parietal pleura continues 2 ribs inferior to the lungs

ends up with a space under the inferior border of the lung

41
Q

why is it best to look for a pleural effusion using a lateral view?

A

Diaphragm is deeply domed so the deepest point of the CPR is at the back of the chest cavity.

42
Q

when can you see an effusion with a lateral view?

A

when there’s about 100ml of fluid

43
Q

when can you see an effusion with an AP view?

A

need about 200ml of fluid

44
Q

where is the apex of the lungs?

A

2cm above the clavicles

45
Q

where is the cardiac notch?

A

4th rib

46
Q

where are the borders of the lungs found?

A

6th rib - MCL
8th rib - MAL
10th rib

47
Q

what are the pleural boundaries?

A

ribs 8, 10 and 12

48
Q

describe the respiratory tree

A

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

49
Q

describe the structure of the trachea

A

C shaped rings of cartilage anteriorly and smooth muscle posteriorly

50
Q

how is the right bronchus different to the left?

A

more vertical and larger

51
Q

what is the clinical relevance of the right bronchus being vertical?

A

anything aspirated is more likely to go to the right lung. Aspiration pneumonia is more likely to occur in the right lung

52
Q

how many lobar bronchi do we have for each lung?

A

3 lobar bronchi in the right lung

2 lobar in the left

53
Q

how many ribs should you normally see above the diaphragm on an x-ray?

A

5-7

54
Q

how does hyper-expansion of the lungs look on an x-ray?

A

when more than 5-7 ribs can be seen above the diaphragm

55
Q

explain the process of emphysema?

A
  • Destruction of alveolar walls leading to permanent enlargement of air spaces
  • Surface area dramatically reduced
  • Loss of elastic tissue so less recoil of the lungs
  • Narrowed bronchioles
  • COPD – emphysema
56
Q

why is there hyperextension of the lungs in emphysema?

A

o When air leaves the bronchioles, lungs will elastic recoi.
o COPD – less elastic recoil and bronchioles aren’t supported by as much tissue bc it’s all been destroyed. Air cant leave  gets trapped
o Air doesn’t get expired so the lungs become hyperinflated

57
Q

what divides the superior and inferior mediastinum?

A

angle of louis

58
Q

what does the superior mediastinum contain?

A

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

59
Q

describe the passage of the recurrent laryngeal nerve in the body?

A

branch of vagus nerve which loops around the arch of the aorta on the left and the subclavian artery on the right. Runs back up to the larynx where it supplies the vocal cords

60
Q

where is the posterior mediastinum?

A

• Anterior to vertebrae T5-T12, inferior to sternal angle and posterior to pericardium

61
Q

what does the posterior mediastinum contain?

A

azygos (and hemi-azygos), vagus, oesophagus, thoracic duct, thoracic aorta

62
Q

what spinal levels are the sympathetic chain ganglion?

A

T1-L2

63
Q

what does the sympathetic trunk control?

A

fight or flight response; pupil dilation, bronchodilation, cardiac acceleration, inhibition of digestion, filling of the bladder, peripheral vasoconstriction, piloerection

c2 (37 decks)

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