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Anatomy > Block 2 Thoracic Wall > Flashcards

Block 2 Thoracic Wall Flashcards

1
Q

Where does heart reside? and put stethoscope

A

Mid clavicular line, T4-5th intercostal space. sternal angle

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2
Q

Where does heart reside in patient with cardiomegaly?

A

below 5th intercostal space, lateral to mid clavicular space

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3
Q

if heart on right what is it called?

A

dextrocardia

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4
Q

anterior boundaries of thoracic cage?

A

anterior: sternum, costal cartilages, ribs

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5
Q

posterior boundaries of thoracic cage?

A

posterior: thoracic vertebrae, ribs

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6
Q

lateral border of thoracic wall?

A

ribs

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7
Q

the thoracic/chest is described as a space between what

A

between neck and abdomen

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8
Q

thoracic wall covered outside by ______ and______

A

skin outside and muscles attaching the shoulder girdle to the trunk

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9
Q

thoracic inlet vs outlet

A

inlet anatomically, outlet clinically
outlet- vasculature leaves

but same thing

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10
Q

thoracic wall is lined with

A

parietal pleura

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11
Q

functions of thoracic wall?

A
  • protect internal air- and fluid filled organs
  • provide rigid exterior wall to prevent collapse of elastic lungs
  • provide attachment and support to upper limbs
  • provide auxiliary lung expansion
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12
Q

thoracic inlet boundary?

A

anterior: upper border of sternum
posterior: 1st thoracic vertebrae
each side: 1st rib and 1st cartilage
sloping downwards and inwards

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13
Q

needle in intercostal space?

A

NV bundle within costal groove, insert above the costal bone.

if do below, hit intercostal bundle

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14
Q

number of thoracic vertebrae and number of typical thoracic vertebrae number vs atypical

A

there are total of 12 vertebrae
T2-T9 they are called typical
1, 10, 11, 12 are atypical

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15
Q

typical vertebrae characteristics

A

body: heart shape and carries 2 demi facet at its side
transverse process: has facet for rib tubercle of same number
spine: long, pointed and directed downward and backward
vertebral foramen: small and circular

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16
Q

sternum parts and levels of the thoracic vertebrae

A

3 parts

Manubrium: lies opposite T3, T4

Body: lies opposite T5 to T8

Xiphoid: opposite of T9

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17
Q

structures of sternum and their locations

A

anterior: in front of heart
superior: above heart
posterior: behind heart

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18
Q

true ribs are?

A

attached to sternum, upper 7 pairs

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19
Q

typical rib

A

A typical rib is a long twisted flat bone

•Borders:

  • Superior
  • rounded, smooth
  • Inferior
  • sharp, thin
  • The inferior border overhangs and forms the costal groove, which accommodates the intercostal vessels and nerve.
  • The anterior end:
  • attaches to the corresponding costal cartilage.
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20
Q

typical rib parts

A

Parts:•head, neck, tubercle, shaft, and angle.
•The head has two facets for articulation with the numerically corresponding vertebral body and that of the vertebra immediately above.
•The neck is a constricted portion situated between the head and the tubercle.
•The tubercle is a prominence on the outer surface of the rib at the junction of the neck with the shaft- It has a facet for articulation with the transverse process of the numerically corresponding vertebra
•The shaft is thin and flattened and twisted on its long axis.
•Its inferior border has the costal groove.

•The angle is where the shaft of the rib bends sharply forward.

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21
Q

joints of sternum: manubrium and sternum

A

The manubriosternal joint is a cartilaginous joint between the manubrium and the body of the sternum.

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22
Q

joints of ribs, head, transverse process, costal cartilages

A

head of rib -> The 1st rib and the three lowest ribs have a single synovial joint with their corresponding vertebral body

Joints of the Tubercles of the Ribs•
The tubercle of a rib articulates by means of a synovial joint with the transverse process of the corresponding vertebra (This joint is absent on the 11th and 12th ribs.)

Joints of the Ribs and Costal Cartilages
•These joints are cartilaginous joints. No movement is possible.

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23
Q

costovertebral joint

A

Rib has same number as the inferior vertebra and its transverse process

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24
Q

joints of the costal cartilages with the sternum

A
  • The 1st costal cartilages articulate with the manubrium, by cartilaginous joints that permit no movement
  • The 2nd to 7th costal cartilages articulate with the lateral border of the sternum by synovial joint
  • Additionally, the 6th, 7th, 8th, 9th, and 10th costal cartilages articulate with one another along their borders by small synovial joints.
  • The cartilages of the 11th and 12th ribs are embedded in the abdominal musculature.
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25
Q

atypical vertebrae numbers

A

1, 10, 11, 12

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26
Q

expiration vs inspiration pressures

A

inspiration pressure of thorax less than atmospheric, breathe in

expiration opposite

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27
Q

clinical communication of thoracic inlet

A

clinically, the chest cavity communicates with the root of the neck through an opening called the thoracic outlet. •

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28
Q

why is it called an thoracic outlet?

A

It is called an outlet because important vessels and nerves emerge from the thorax here to enter the neck and upper limbs

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29
Q

boundaries of thoracic inlet

A

Anatomically:•Called thoracic inlet or the superior thoracic aperture

.•Boundaries:
•Anteriorly: the superior border of the manubrium

  • Posteriorly: the first thoracic vertebra (T1)
  • Laterally: first pair of ribs & the costal cartilage

•Relations:
•Anterior: Clavicle articulates & manubrium•Superior: The root of the neck
Inferior: superior mediastinum

•Superolateral: The brachial plexus

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30
Q

injry below 5th rib stab what structures affected in possibly which cavity

A

we reached the abdominal cavity, prob affect something in here now

ie spleen behind 9-11th ribs on left side

liver is behind ribs 9-11 on the right side

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31
Q

structures that pass through thoracic inlet

A

trachea
•oesophagus
•thoracic duct
-apices of the lungs

  • Nerves
  • phrenic nerve
  • vagus nerve
  • recurrent laryngeal nerves
  • sympathetic trunks
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32
Q

structures that pass through thoracic inlet nerves

A

trachea
•oesophagus
•thoracic duct
-apices of the lungs

Nerves
•phrenic nerve
•vagus nerve
•recurrent laryngeal nerves
•sympathetic trunks

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33
Q

vessels that pass through the the thoracic inlet

A

Arteries
•left and right common carotid arteries
•left subclavian arteries

Veins
•internal jugular veins
•brachiocephalic veins
•subclavian veins

•Lymph nodes and lymphatic vessels

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34
Q

boundaries of thoracic wall

A

anterior: sternum, costal cartilages, and ribs
posterior: thoracic vertebrae andribs
laterally: ribs

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35
Q

what makes T1 atypical

A

small body, long horizontal spine, upper complete facet on the body

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36
Q

what makes T11 and T12 atypical

A

complete facet on the body, inferior articular facet directed laterally, short blunt spine

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37
Q

what makes T2-T9 typical

A

facets on the body and transverse processes for articulation with ribs, circular or heart shaped body, the spine is long tapering and directing backwards and downwards

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38
Q

what are the atypical ribs?

A

1st, 2nd, 10th, 11th and 12th

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39
Q

what are the floating ribs and why?

A

11 and 12, they have no anterior connection with the other ribs or with the sternum

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40
Q

what are the false ribs and why?

A

ribs pair 8, 9, 10 are false ribs because they don’t articulate directly with sternum, they articulate with anteriorly with the costal cartilages of the ribs above

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41
Q

characteristics of atypical first rib?

A

shortest, and is C-shaped
anterior end: cup shape
posterior end: head, neck, and tubercle
head: one facet
surfaces: superior and inferior

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42
Q

what muscle attaches to upper and anterior border of first rib?

A

the scaleneus muscle

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43
Q

what is anterior to the scaleneus muscle and first rib?

A

the subclavian vein crosses the rib, posterior to the muscle attachment, the subclavian artery and the lower trunk of the brachial plexus cross the rib and lie in contact with the bone

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44
Q

characteristics of the 2nd rib?

A

the 2nd rib has twice the length of the first rib
head has 2 facets
surfaces of shaft are in between that of the 1st and typical

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45
Q

movements of ribs and costal cartilages

A

•Movements of the Ribs and Costal Cartilages•The 1st ribs and their costal cartilages are fixed to the manubrium and are immobile. The raising and lowering of the ribs during respiration are accompanied by movements in both the joints of the head and the tubercle, permitting the neck of each rib to rotate around its own axis.

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46
Q

what is the thoracic outlet characterized by?

A

forms by vertebra T12, rib 12, costal margin, and xiphoid process.

it is bounded inferiorly by the dome of diaphragm.

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47
Q

what can a fracture of lower ribs result in?

A

diaphragmatic hernia

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48
Q

the lower boundary of diaphragm is problematic because?

A

Lower boundary arches up so high that a stab wound below rib 5 can pierce the abdominal cavity

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49
Q

how many intercostal spaces are there?

A

there are 9 anterior and 11 posterior

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50
Q

each intercostal space contains what?

A

intercostal muscles: (external, internal, and transversus thoracis)

an intercostal nerve

intercostal vessels: intercostal arteries (anterior and posterior)

intercostal veins (anterior and posterior)

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51
Q

order of superficial intercostal muscles? from superficial to deeper

A

external intercostal muscles, internal intercostal muscles, innermost intercostal muscles

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52
Q

external intercostal muscle origin and insertion

A

origin: from the lower border of the rib above
insert: into the outer lip of upper border of a rib below the origin

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53
Q

external intercostal muscle action

A

elevate the ribs during inspiration

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54
Q

external intercostal muscle innervation

A

intercostal nerves

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55
Q

the external intercostal runs how through the intercostal space? how do fibers run

A

the fibers are directed from above downwards and forwards toward the belly, they attach more anteriorly than origin

the muscle begins from the posterior end of the intercostal space close to the tubercle of the rib and ends at the costochondral junction where it is replaced by external or anterior intercostal membrane

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56
Q

internal intercostal muscle origin and insertion

A

origin: floor of costal groove
insertion: inner lip of upper border of rib below

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57
Q

internal intercostal muscle action

A

depresses the rib downwards during expiration

58
Q

internal intercostal muscle innervation

A

intercostal nerves

59
Q

the internal intercostal runs how through the intercostal space? how do fibers run

A

the fibers are directed from above, diagonally inferior and posteriorly toward the back. the attach more posteriorly than origin

it begins from the anterior end of the space close to sternum and ends at the angle of the rib where it is replaced by posterior or internal intercostal membrane

60
Q

what is the internal intercostal membrane traversed by

A

it is partly traversed by the nerve and vessels which splits each muscle into 2 parts:

Outer: internal intercostal
inner: innermost intercostal

61
Q

deep muscles of the intercostal space?

A

innermost intercostals, subcostales, and transversus thoracis

62
Q

how many anterior intercostal arteries are there?

A

2 small arteries in each of the 9 spaces

63
Q

subcostalis muscle where found?

A

thin band
lower 6 spaces
only in the posterior part of spaces

64
Q

subcostalis origin and insertion

A

origin: inner surface and lower border of rib above
insertion: upper border of 2nd and 3rd rib below

65
Q

the upper 6 anterior intercostal arteries arise from what structure?

A

the internal mammary artery aka the internal thoracic artery

66
Q

the lower 3 anterior arteries arise from what structure

A

the musculophrenic artery

67
Q

the 1st and 2nd posterior intercostal arteries arise from what

A

the 1st and 2nd posterior intercostal artery arise from the the superior intercostal artery of the costocervical trunk from the 2nd part of the subclavian artery

68
Q

the lower 9 posterior intercostal arteries and subcostal arteries arise from what?

A

the descending thoracic aorta

69
Q

in each space the posterior intercostal artery and its collateral branch ________ with the 2 ________ intercostal arteries

A

anastomose with the 2 anterior intercostal arteries

70
Q

how many anterior intercostal veins are there?

A

2 in each of the 9 spaces, so a total of 36 (18 each side)

71
Q

the 1st, 2nd, and 3rd anterior intercostal veins drain into what

A

join the internal mammary vein aka the internal thoracic vein

72
Q

the 4th, 5th, and 6th anterior intercostal veins join?

A

the venae commitantes of internal mammary artery

73
Q

the 7th, 8th, and 9th anterior intercostal veins join?

A

the venae commitantes of the musculophrenic artery

74
Q

the internal mammary vein drains into what

A

the innominate (brachiocephalic vein)

75
Q

how many posterior intercostal veins are there?

A

there are one each of the 11 spaces, so 22 total (11 on each side)

76
Q

the 1st right posterior intercostal vein drains into?

A

right innominate vein

77
Q

the right 2nd, 3rd, and sometimes the 4th posterior intercostal vein drains into what?

A

they unite to form right superior intercostal vein which drain into the azygos vein

78
Q

the right sided 5th-11th and subcostal veins drain into ?

A

azygos vein

79
Q

the left 1st posterior intercostal vein drains into

A

left innominate vein

80
Q

the left 2nd, 3rd, and sometimes 4th posterior intercostal veins join to form what?

A

the left superior intercostal vein which drains into the left innominate vein

81
Q

the left 5th, 6th, 7th, and 8th posterior intercostal veins form?

A

the superior hemiazygos vein which join to the azygos vein

82
Q

the left 9th, 10th, and 11th posterior intercostal veins and subcostal veins form ?

A

they form the inferior hemiazygos vein which drains into the azygos vein

83
Q

the intercostal nerves are formed by the ______ of spinal thoracic nerves from T_ to T_

A

anterior/ventral primary rami of spinal thoracic nerves from T1-T11

84
Q

the typical intercostal nerves are T_ to T_

A

T3-T6 are typical

85
Q

T12 spinal nerve is also called what

A

subcostal nerve

86
Q

the atypical intercostal nerves are

A

T1, T2, T7-T12

87
Q

order of NV bundle in costal groove

A

VAN

Vein is superior
Artery
Nerve most inferior

88
Q

course of typical intercostal nerves T_ to T_? which eventually forms the what nerve?

A

from T3-T6 the intercostal nerves are ventral rami of spinal thoracic nerves that leave the intervertebral foramen to reach the intercostal space. They run between pleura and posterior intercostal membrane. The nerve(s) pierces the internal intercostal muscle splitting it into the internal intercostal (proper) and the innermost intercostal. Runs between internal intercostal muscle and pleura. Pierces internal intercostal muscle, anterior intercostal intercostal membrane, pectoralis major and deep fascia to become anterior cutaneous nerve.

89
Q

intercostal nerve branches

A
  • white and grey communicans with sympathetic ganglion
  • collateral branch to intercostals
  • lateral cutaneous branch to skin
  • anterior cutaneous
  • muscular branches
  • pleural sensory branches
  • peritoneal branches
  • articular branches
90
Q

1st intercostal nerve

A

joined to the brachial plexus, by a branch that is equivalent to the lateral cutaneous branch

91
Q

the 2nd intercostal nerve

A

joined the medial cutaneous nerve of the arm, by a branch called the intercostobrachial nerve (corresponds to lateral cutaneous branch)

92
Q

in angina pectoris and myocardial infarcation pain, pain referred to _____ of arm by what nerve?

A

medial side of the arm by the 2nd intercostal nerve ie the medial cutaneous nerve of the arm

93
Q

the upper 6 intercostal nerves supply _____ , _____, and _____ in each space

A

supply skin, parietal pleura, and intercostal muscles in each space

94
Q

tube thoracostomy procedure

A
  • skin incision at anterior axillary line
  • incise skin over one below space to be pierced
  • scalpel and eventually tube must pass through skin, fascia, intercostal muscles (EIM, IIM, innermost IM) , and parietal pleura
  • incise through intercostal space to upper border of rib to avoid injuring the intercostal vessels and nerve
  • advance tube posteriorly and superiorly in the pleural space to avoid puncturing lungs or other structures in cavity
95
Q

radicular artery

A

comes from posterior intercostal artery run along the posterior and anterior roots of the spinal nerves and supply them with blood. a clot in radicular artery causes infarction to spinal cord

96
Q

the internal thoracic artery or internal mammary artery supplies what

A

supplies the anterior wall of the body from clavicle to the umbilicus

97
Q

the internal thoracic artery is a branch of what?

A

it is a branch of the first part of the subclavian artery in the neck

98
Q

the internal thoracic artery descends vertically on _____ behind ______ just ______ to the sternum. The internal thoracic artery ends in the ______ intercostal space by dividing into the ________ and ______ arteries

A

descends vertically on the pleura behind the costal cartilages just a fingerbreadth length lateral to the sternum. The internal thoracic artery ends in the 6th intercostal space by dividing into the superior epigastric artery and musculophrenic artery

99
Q

the internal thoracic artery branches to form the _____ for the upper _____ intercostal spaces

A

2 anterior intercostal arteries for the upper 6 intercostal spaces

100
Q

the internal thoracic artery branches into _____ arteries which accompany the terminal branches of the corresponding ______ nerves

A

perforating arteries which accompany the corresponding intercostal nerves

101
Q

the internal thoracic branches to form the __________ artery, which accompanies the phrenic nerve and supplies the ______

A

pericardiaphrenic artery, accompanies the phrenic nerve and supplies the pericardium

102
Q

the internal thoracic artery has ____ major branches? which are ?

A
  • Anterior intercostal arteries in the 6 upper intercostal spaces
  • perforating arteries
  • percardiaphrenic artery
  • mediastinal arteries
  • superior epigastric artery
  • musculophrenic artery
103
Q

the internal thoracic artery branches to this artery that supplies contents of the anterior mediastinum (eg thymus)

A

mediastinal arteries

104
Q

the internal thoracic artery branches to the _______ which enters the rectus sheath of the anterior abdominal wall and supplies _______ as far as the _______

A

superior epigastric artery, supplies the rectus muscle as far as the umbilicus

105
Q

the internal thoracic artery branches to the _______ which runs around the costal margin of the diaphragm and supplies _______

A

musculophrenic artery supplies the lower intercostal spaces (lower 3 anterior ICAs) and the diaphragm

106
Q

the internal thoracic vein accompanies ________ and drains into the _______ on each side

A

the internal thoracic vein accompanies the internal thoracic artery and drains into the brachiocephalic vein on each side

107
Q

the superior intercostal aka the supreme intercostal artery derives from _____ which is a branch from the ____ part of the _____ artery. the SIA forms what intercostal arteries and supplies what

A

superior intercostal artery derives from the costocervical trunk which is a branch of the 2nd part of the subclavian artery. the superior intercostal artery forms the posterior 1st and 2nd intercostal arteries and supplies the first and 2nd intercostal spaces

108
Q

the azygos vein connects the ___ with the _____

A

connects IVC with SVC

109
Q

the azygos vein begins in abdomen from back of the _____ at the level of _____

A

back of the IVC at level of L2

110
Q

the azygos vein enters the thorax through the ______ of the diaphragm on the _____ side of the aorta and the _____

A

the azygos vein enters thorax through aortic opening of the diaphragm on the right side of the of the thoracic duct and the aorta

111
Q

in the ______ mediastinum, the azygos vein passes behind ______ of and root of _____ lung

A

in the posterior mediastinum, the AV passes behind the right border of the esophagus and root of right lung

112
Q

in the _____ mediastinum at level of T_, the azygos vein crosses above the root of _____

A

superior mediastinum at level of T4, the azygos vein crosses above the root of the right lung

113
Q

the azygos vein enters the ____ of the SVC

A

enters middle back of the SVC

114
Q

in the azygos vein, blood flows ____ to the ____ vena cava, entering the SVC on the _____ side. This allows an alternate route back to the ____ when the _____ or ___ is blocked

A

blood flows superiorly to superior vena cava, entering the SVC on the posterior side. this allows an alternate route back to the heart when the IVC or SVC is blocked.

115
Q

the thoracoepigastric vein provides what

A

an alternate circulation route when there is liver disease

116
Q

superficial lymphatic drainage, the _____ drain 75% of the lymph from breast and the ____ nodes drain rest

A

axillary nodes most, parasternal drain rest

117
Q

what structure is closely associated with the axillary nodes? what does this mean clinically

A

the long thoracic nerve is in close association. Removal surgical of axillary nodes can accidentally hit LTN, causing winging of scapular

118
Q

the diaphragm is a _____ and tendinous ______ that separates the ____ cavity above from the ____ cavity below

A

it is a thin muscular and tendinous septum that separates thoracic/chest cavity above from abdominal cavity below

119
Q

what pierces the diaphragm?

A

structures that pass between chest and abdomen

120
Q

diaphragm shape

A

it is dome shaped (left and right dome)

121
Q

the right dome of the diaphragm reaches what structure

A

upper border of the 5th rib

122
Q

the left dome of the diaphragm reaches what structure

A

reaches lower border of 5th rib

123
Q

the diaphragm consists of 2 parts which are

A
  • peripheral muscular part (arises from the margins of the thoracic opening)
  • centrally placed tendon
124
Q

the diaphragm origin is divided into 3 parts which are?

A
  • a sternal part (from the posterior surface of the xiphoid process)
  • a costal part (from the deep surfaces of the lower six ribs and their costal cartilages)
  • a vertebral part (raising by vertical columns or crura and from the arcuate ligament)
125
Q

the right crus originates from

A

the bodies of the upper 3 lumbar vertebrae (L1, L2, L3) and their IVDs

126
Q

the left crus originates from

A

the bodies of the upper 2 lumbar vertebrae (L1 and L2) and their IVDs

127
Q

lateral to the crura the diaphragm arises from the ______ and ______ ligament

A

medial and lateral arcuate ligament

128
Q

the medial arcuate ligament extends from _____ to the tip of ________ of ______

A

the medial arcuate ligament extends from the side of the body of the L2 vertebrae to the tip of the transverse process of the 1st lumbar vertebrae

129
Q

the lateral arcuate ligament extends from _____ to the lower border of _________

A

from the tip of the transverse process of the first lumbar vertebra to the lower border of the 12th rib

130
Q

the medial borders of the two crura are connected by a ______ which crosses over the the anterior surface of the _____

A

connected by median arcuate ligament which crosses over the anterior surface of the aorta

131
Q

the medial arcuate ligaments is the thickened _______ covering the anterior surface of the _______

A

the thickened upper margin of the fascia covering the psoas major muscle

132
Q

the lateral arcuate ligaments is the thickened _______ covering the anterior surface of the _______

A

the thickened upper margin of the fascia covering the quadratus lumborum muscle

133
Q

the median arcuate ligament connects the ____ borders of the 2 _____. This ligament crosses over the anterior surface of the _____ at level of T_

A

the median arcuate ligament connects the medial borders of the 2 crura. it crosses over the anterior surface of the aorta at level of T12

134
Q

the diaphragm inserts into ____ this lies at which point

A

a central tendon which is shaped like3 leaves, a trifle. The central tendon lies at the xiphsternal junction

135
Q

the nerve supply to diaphragm

A

motor: the roots of C3, C4, C5 form the left and right phrenic nerves. 3, 4, 5- keep the diaphragm alive!
sensory: the parietal pleura and peritoneum covering the central surfaces of the diaphragm are from the phrenic nerve

the periphery of the diaphragm is from the lower six intercostal nerves

136
Q

diaphragmatic openings: the caval opening, where located when houses?

A

the caval opening is at the level of T8, it allows passing of the IVC and right phrenic nerve

137
Q

diaphragmatic openings: the esophageal opening, where located when houses?

A

opening at T10

allows passage of: esophagus, vagus nerve, esophageal branches of the left gastric vessels and lymph vessels

138
Q

diaphragmatic openings: the aortic opening, where located when houses?

A

level of T12,

transmits:
aorta,
thoracic duct,
azygos vein

139
Q

diaphragmatic openings: other than the major openings, the diaphragm allows what to pierce?

A
  • splanchnic nerves
  • superior epigastric vessels
  • left phrenic nerve
140
Q

diaphragm action/function

A

pulls down its central tendon and increases the vertical diameter of the thorax

141
Q

the diaphragm is a muscle of inspiration, abdominal straining, weight lifting, and thoracoabdominal pump

A

inspiration: decrease pressure in lungs, air rushes in as atmospheric pressure is higher

abdominal straining: micturition (urination), defecation (pooping), parturition( giving birth)

weight lifting (can strengthen)

thoracoabdominal pump: caval lymphatic force increases by increasing intra-abdominal pressure

142
Q

clinical significances of diaphragm

A

hiccup- involuntary spasmodic contraction of the diaphragm

paralysis of the diaphragm- lost of control of one or both sides of the diaphragm, shortness of breath

penetrating injury to diaphragm- any penetrating wound below level of nipples should be suspected of causing damage to the diaphragm

diaphragmatic hernia- may occur in middle age person due to weak musculature, abdominal organs can creep in thoracic cavity

Anatomy (12 decks)

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