Chapter 3 (Trunk) Flashcards
___corresponds to the upper part of the trunk and is located between the neck and the abdomen. The ___ is the prominent superficial structure in the anterior aspect. The bones of the ___ include the ___ in the back, the ___ in the side, and the ___ in the front.
- thorax
- breasts
- 12 thoracic vertebrae, ribs in the side, and sternum in the front
The ribs articulate with the ___ and the ___ and form the ____, which surrounds the ____ cavity and contains the ___ and ____, as well as the structures in the ____.
- verterbae and sternum
- thoracic cage
- thoracic
- heart and lungs
- mediastinum
the thoracic cage has an ___ and ___ opening, referred to as the ____ and ___.
- upper and lower
- thoracic inlet and outlet
extends from the body of the T1 vertebra posteriorly, first rib laterally and slopes downward and provides space for some thoracic structures, such as the lungs and pleura
thoracic inlet
injuries to the lower part of the neck may be accompanied by damage to the ___ and/or ___
- pleura
- lungs
between the T12 posteriorly, ribs 11 and 12 laterally, and costal margin anteriorly.Junction of the costal cartilage of ribs 7-10 creates costal margin and the infrasternal angle
thoracic outlet
refers to the lateral edge of the costal margin on each side
infrasternal angle
junction of the costal cartilage of ribs 7-10 create the ___
costal margin
Ribs 11 and 12 are ___ ribs, with ___ connection to the sternum
- floating
- no
There are ___ pairs of ribs in total in the body. The anterior part of the rib is ______ and is known as the _____. Ribs 1-7 are directly connected to the sternum and therefore are known as the ____ ribs. The five lower ribs are known as the ____, which are either indirectly connected to the sternum through the _____, or not at all connected to the sternum are ribs ___. These latter ribs are known as the ____ and lie in the abdominal wall.
- 12
- cartilaginous (hylaine)
- costal cartilage
- true ribs
- false ribs
- costal cartilage of rib 7
- 11 and 12
- floating ribs
- abdominal wall
Ribs: following parts are distinguished in the ribs-the ___, ___, body, and ____. There is a ___ in the body of the ribs posteriorly, known as the ____. The head and tubercle have ____ to articulate with ____. The ___ usually articulates with the bodies of the 2 adjacent vertebrae and the _____ between them, while the tubercle articulates with the transverse process of the ____. As previously described, these articulations are referred to as ____ and ____, respectively, and various interconnecting ligaments support the capsule. The head of the 1st, 11th, and 12th ribs articulate only with their ____; these are the only ribs that do not have a ______ near their lower surface, through which the ______ run.
- head, neck, tubercle
- bend
- costal angle
- articular surfaces
- vertebrae
- head
- interverterbral discs
- thoracic vertebrae
- costovertebral, costotranverse
- own vertebrae
- costal sulcus (groove)
- intercostal vessels and nerve
Some ribs have important features among them, the following landmarks can be distinguished on the ____, the ___ on its superior surface, as well as ____-one for ___ and lower ____ and one for the passage of the ____. Although the initial ossification of the ribs takes place between the __ and __ month of gestation, their anterior part remains ___. This costal cartilage will ossify with ___ and may cause restrictions in the mobility of the thoracic cage.
- first rib
- scalene tubercle
- two grooves
- subclavian artery
- brachial plexus
- subclavian vein
- 2nd and 4th
- unossified
- age
Ribs may ____ in crushing injuries and blows to the ____ cage, and a rare fracture of the ___ may injure the ___, as well as the ____.
- fracture
- thoracic cage
- first rib
- subclavian vessels
- brachial plexus
problems with cervical rib: a cervical rib is one of the causes of the _____ syndrome. It is due to a remnant or or development of a costal process on the ____, which may lead to compression of the ___ leading to ____. ____ may also lead to ___ compression, which can cause muscle weakness and pain in the upper limb. A mass may be palpable in the ____.
- thoracic outlet
- C7 vertebrae
- subclavian artery
- ischemic pain
- thoracic outlet syndrome
- lower brachial plexus
- lower neck
The ____ is a flat bone located anteriorly in the midline of the chest, consisting of an upper part, the ___; a lower part, the ___; and the ___, located in the middle. The body of the ___ is about 8-9 cm long, and is slightly longer and thinner in ____.
- sternum
- manubrium
- xiphoid process
- sternum
- males
There is an angle between the ____ and the body of the sternum-the ____-which is at the level of the ___. The junction is referred to as the ____, and may unit (___) after age 40.
- manubrium
- sternal angle
- T4 vertebra
- manubriosternal joint
- synostosis
Important features of the manubrium include the ____ on its superior border, the ___ for articulation with the clavicle, and the ____ for articulation with the 1st and 2nd ribs. There are also several ___ on the lateral borders of the sternal body, for continuous ___articulations with the other ribs. These articulations are supported by various ____.
- jugular (supra sternal) notch
- clavicular notch
- costal notch
- costal notches
- cartilaginous
- sternocostal ligaments
The ____ of the sternal body in the midline can be used for ___ and ___ needle biopsy for bone marrow transplants or cytologic analysis. The lower part by be associated with ___ and ___, and its is dangerous to puncture this area. The ossification of the sternum begins in the cartilage during _____, during which several ossification centers appear and will unite later in life. The ____ may ossify during the middle age. ___ is a cut through the bone, a procedure done to access the heart in coronary bypass or open heart surgery
- upper third
- puncture and bone marrow
- congenital fissures or foramen
- months three to six gestation
- xiphoid process
- median sternotomy
The thoracic cage moves with ____ by widening the ___ during ___, then returning to normal size during ____. These movements are facilitated by several factors, including the mobility in the ___, movement at the ____ joint, elevation of the sternum by ___ and ____, elasticity of the ____, increased ___ of the thoracic curvature in the vertebral column, and function of the ____.
- respiration
- thorax
- inspiration
- expiration
- costovertebral joints
- manubriosternal joint
- sternocleidomastoid and scalene muscles
- costal cartilages
- kyphosis
- respiratory muscles
_____ and muscles of the __ and ___ are involved in the movement of the thoracic cage
- intercostal muscles
- neck
- abdomen
Are usually three ____ muscles in the neck and upper parts of the thorax, assisting the respiration and movement of the thoracic cage by ___ the upper ribs
- scalene
- elevating
Scalene muscles originate from the ____ of the cervical vertebrae and attach to the ___. The ____ muscle attaches to the ___ tubercle of the first rib, the ___ nerve runs downward on the muscle, and the subclavian vein runs anterior to the insertion point of the muscle in the first rib. The ____ scalene muscle inserts on the first rib behind the insertion point of the ___ scalene and reaches the ___ rib. An opening called the scalene ___ is therefore formed between these two scalene muscles, through which the subclavian artery and brachial plexus pass. Finally, the __ scalene muscle connects to the ___ and/or __ rib. The scalene muscles can also tilt the ____ column, and are innervated by the ___ and the ___.
- transverse process
- upper ribs
- anterior scalene
- anterior scalene
- phrenic
- middle
- anterior
- gap
- posterior
- second and third
- cervical vertebral
- brachial plexus and cervical plexus
The ___ muscles are related to the ribs. Some of these muscles are found between the ribs, including the ___, ___, and the ____ muscles. The ___ and ___ muscles also connect to the ribs. By elevating or depressing the ribs, the ___ muscles are involved in respiration, but their function is complex. They are innervated by ___ nerves.
- intercostal
- external, internal, innermost intercostal
- subcostal and transverse thoraces
- intercostal
- intercostal
External intercostal muscles are the ___ layer of muscles, originating from the lower border of the ___ and running ___. They connect to the upper border of the lower ___, and are extended from the ___ tubercle of the vertebrae in the back between two ___, to the front to the ___ cartilage. From here, muscle continues as the external intercostal membrane toward the ___. The muscles function during forced ___.
- outermost
- ribs
- obliquely
- rib
- costal
- ribs
- costal
- sternum
- inspiration
Internal intercostal muscles are found ___ than the external muscles between two __, and run more ___ compared to the external intercostal fibers. They extend posteriorly from the angle of the ___ toward the __ in the front, and continue backward as the internal intercostal membrane toward the ___. These muscles function both as ___ and ___ muscles.
- deeper
- ribs
- vertically
- rib
- sternum
- vertebrae
- expiratory
- inspiratory
the innermost intercostal muscles run in the same direction as the ____ and are indeed part of the ___, but are positioned __ and may be missing in some areas. The intercostal ___, ___, and ___ are found between the innermost intercostal muscles and the ___ muscles.
- internal intercostal fibers
- internal intercostal fibers
- deeper
- artery, vein, and nerve
- internal intercostal
Subcostalis muscles are actually the fibers of the ____ muscles that extend over several segments. These are found close to the ___ angles and function similarly to the ___.
- internal
- intercostal
- costal
- internal intercostal
The transverses thoraces muscle originates from the internal surface of the ____ and extends to the ___. These are also ___ muscles.
- xiphoid process
- ribs
- expiratory
Muscles on the outside of the chest wall: These muscles belong to the ___, the ___, and the ___. They include the ___ and ___ and ___, which are discussed with the upper ___ muscles. The ___ and the external and internal abdominal ___ muscles are discussed in the abdominal region. Among the muscles of the back related to the thorax, the ___, ___, and others were discussed among muscles of the back.
- upper limb
- abdominal wall
- back
- pectoralis major and minor
- serratus anterior
- limb
- rectus abdominis
- oblique
- latissumus dori
- trapezius
Which muscles elevate the thoracic cage?In addition to the ___, the ____, ___, and the ___ and __ also elevate the ribs.
- scalene muscles
- sternocleidomastoid
- intercostal muscles
- pectoralis major and minor
The _____, along with its paired accompanying veins, runs vertically downward on the posterior aspect of the anterior thoracis muscle.
internal thoracic (mammary) artery
Internal thoracic (mammary) artery originates from the ____ artery on each side. The artery sends transverse branches- the ____ arteries- that run in the intercostal spaces and, together with the ______ branches, supply the thoracic wall, including the skin of that region, as well as the back.
- subclavian artery
- anterior intercostal arteries
- posterior intercostal
The internal thoracic artery gives off a branch, the _____, in the 6th intercostal space, and continues downward as the ____ in the rectus sheath between the abdominal muscles. The ___ provides the blood supply for intercostal spaces seven, eight, and nine anteriorly on each side.
- musculophrenic artery
- superior epigastric artery
- musculophrenic artery
The superior epigastric artery continues downward as the ____ in the lower abdominal wall and joins the ____.
- inferior epigastric artery
- external iliac artery
In condition such as _____, a narrowing in the arch of the aorta may compromise the blood supply to the thoracic, abdominal, and lower limb structures. Therefore, internal thoracic artery and its branches, including the intercostal arteries, may be dilated and supply blood to the thorax, abdomen, and especially the lower limbs
-coarctation of the aorta
The ___ originate from the thoracic aorta and run in intercostal spaces three through eleven, and the subcostal artery is also a branch of the thoracic aorta
-posterior intercostal arteries
In the thoracic wall, the posterior and anterior intercostal veins are finally drained by the ___ and ___ veins into the ___. The first intercostal veins are drained by the ____ directly, while the second and third posterior intercostal veins unite to form the ____ vein, which drains into the ___ on the right side, and into the left ____ vein on the left side.
- azygos
- hemiazygos
- superior vena cava
- brachiocephalic veins
- superior intercostal
- azygos
- brachiocephalic
Intercostal nerves one through ___ run within the ___ in the intercostal spaces, and the subcostal nerve branches off the ___ nerve. Intercostal nerves are the ____ of the spinal nerves and contain motor, sensory, and autonomic fibers. The ___ innervate the intercostal and abdominal muscles as well as the subcostalis and transversus thoracic, while the ___ innervate various dermatomes. The ___ are the postganglionic fibers that originate from the sympathetic chain and reach the intercostal nerves through the grey communication ramus. The ____ fibers originate from the spinal cords intermediate grey column, run a short distance into the intercostal nerves and arrive at the white communicating ramus, reaching the sympathetic ganglia in the thoracic cavity into the abdomen and synapse in preverterbal ganglia.
- eleven
- costal groove
- T12
- primary ventral rami
- motor fibers
- sensory fibers
- myelinated preganglionic
- preganglionic
Some conditions for which we may need to access the intercostal spaces? The intercostal nerves can be anesthetized during painful conditions such as fractures of the ___ or ___. The procedure is termed intercostal nerve block and the needle is inserted close to the ___ border of the __ in order to reach the nerves. However, since the ___ and __ pass beneath the ___, extreme care should be taken not to sever them. Another method of accessing the intercostal space is tube ___ and ___, to drain pathologic air/gas or fluid from the pleural cavity. The approach is usually close to the ___ border of the ___ to avoid injury to the intercostal nerve and vessels. All layers from the __ down to the ___ are punctured in this intervention.
- ribs
- shingles
- lower
- rib
- intercostal nerve and vesseks
- thoracostomy
- thoracocentesis
- upper
- rib
- skin
- parietal pleura
Anterior regions of the Trunk, including the thorax
axillary region, deltoid region, infraclavicular region, and clavipectoral region
Skin innervation of the thorax is derived mainly from the ___ nerves from ____. They cover the area at the level of the clavicle down to the level of the ____. The anterior and lateral cutaneous branches of the intercostal nerves innervate the ___ and ___ of the thorax, while the skin of the back, about 2 inches from the midline is innervated by the ___. The boundary between the anterior and posterior branches of the spinal nerves is the ___ in the back. The ___ artery, a branch of the ancillary artery supplies the lateral side, and, medially the perforating branches of the ___ artery, as well as other ___ arteries, all help supply blood to the skin. The veins follow similar naming conventions and drain into regional veins. The ____ plexus around the nipple drains into the anterior intercostal, thoracoepigastric and lateral thoracic veins. Lymphatics of the region are drained by the superficial and deep lymph nodes, and a major portion of the lymphatics here is drained by the ___ lymph nodes. These may be removed if invaded by a metastatic ____
- ventral rami of the thoracic spinal
- T2-T6
- xiphoid process
- front and sides
- dorsal rami of the thoracic nerve
- scapular line
- lateral thoracic
- internal thoracic
- intercostal
- areolar venous
- axillary
- breast cancer
The ___ in females is the main structure in the anterior region of the thoracic wall. It is a ___ structure that consists of mainly fat and ___ tissues that are supported by ___ tissues. It varies in size, shape and function in different people, depending on age and gender. In males, the breast is a rudimentary structure in spite of showing some changes in puberty. In females, the breast can produce ___ for sustenance of their offspring. The breast in females extends vertically from the ___ to ___ ribs and transversely from the ___ to the mid axillary line. Prominent features seen in the surface of the breast include the ___ and the ___. __ is the presence of more than one nipple on a breast.
- breast
- cutaneous
- glandular
- fibrous
- milk
- second to sixth
- sternum
- nipple
- areola
- polythelia
The nipple consists of ____ tissue and ___ muscle covered by a keratinizing stratified squamous epithelium. Milk conducting ducts open into the ___, which is surrounded by the ___, a round area of pigmented skin containing ___ glands giving it a nodular appearance. These glands ___ during pregnancy and their oils secretion helps the suppleness of the nipple during ___. The color of the nipple at puberty and of the areola during pregnancy, may ___ due to increased ___ production and pigmentation. The areola gradually lightens in color after delivery.
- connective
- smooth
- nipple
- areola
- enlarge
- lactation
- darken
- melanin
The breast is situated in the anterior wall of the ___ in the superficial fascia covering of the ___ and the ___ muscles. It extends into the ___, and downward onto the sheath covering the ___ abdominis. The breast is separated from the pectoralis muscles by the deep fascia and a gap called the____ is located between the breast and deep fascia, which allows some degree of breast movement. The internal structures of the breast are supported by bands of ___ tissue, the ___ ligaments of Cooper, which extend from the ___ to the skin to the deep fascia. The __ in the breast determines its size and contour, while the ___ tissue produces the milk. The ____ glands are exocrine in type and are, in fact, enlarged and modified swear glands. In humans, they are complex tubuloalveolar glands that develop as a down-growth of the epidermis along the milk line. Accessory or ___ breasts are known as polymastia.
- chest
- pectoralis major
- serratus anterior
- axillary
- rectus
- retro mammary space
- fibrous
- suspension
- dermis
- fat
- glandular
- mammary
- supernumerary
The alveoli are lined by a milk secreting ____, and are surrounded by the myo epithelial cells that can contract upon ___ secretion. This contraction leads to the ____ into the lumen of the alveoli. The alveoli join to produce ___. There are about ___ milk-secreting lobules in the human breast, each of which is drained by a ____ duct and opens into the ___. The ducts have dilated portion called the ____ where the mile accumulates. The action of a baby sucking the nipple leads to ___ activation and secretion of ___ for release of the milk in a let down process. Milk production is under the anterior ____ secretion.
- cuboidal epithelium
- oxytocin
- excretion of milk
- lobules
- 15-20
- lactiferous
- nipple
- lactiferous
- sinus
- neurohormonal
- oxytocin
- pituitary prolactin
Under influence of ___ during puberty, the ___ undergo branching and there is an increase in ___ deposition, which leads to ___ enlargement. During pregnancy, true ___ grow when estrogen and progesterone levels increase. Breast involution takes places after ___. When there is a decrease in ___ and growth promoting factors and a cessation of the baby suckling, all alveoli and secretory ducts collapse and undergo ___ and ___.
- estrogen
- lactiferous ducts
- fat
- breast
- secretory lobules
- lactation
- prolactin
- apoptosis and autophagy
Innervation of the breast: ____ innervate the skin, vessels, and smooth muscles of the breast. Dermatomes of the nipple is approximately at ___.
- intercostal nerves T4-T6
- T4
Blood supply: ____, ___ artery and ___ arteries.
- Internal thoracic, axillary
- intercostal
Venous drainage: ___ from the breast is drained to the corresponding veins, which are finally drained by the ___ and ___ veins.
- blood
- axillary
- azygos
Lymphatic drainage: ___ lymph nodes receive the lymphatics of the upper limb and the wall of the trunk as low as the ___. About __ % of the breast lymphatics from the lateral quadrants are drained by ___ nodes. There is a plexus of vessels within the breast under the areola, called the ___, into which the lymphatics of other parts of the breast received. The plexus, in turn, drains into the ___ nodes. There are also some direct pathways from the breast to the ___ nodes, around the ___ or into the __ and not necessarily through the plexus of Sappay.
- axillary
- umbilicus
- 75
- axillary
- subareolar plexus of Sappay
- axillary
- axillary
- clavicle
- neck
The axillary lymph nodes are organized into 5 major groups ___. The ___ drains major lymphatics of the upper limb. The ___, at the lateral border of the pectoralis minor and major muscles, drain most of the mammary gland. The ___ drains the posterior part of the shoulder, while the ___ drains above groups. The ___ and other groups drain their lymphatics into the ___ group, and some lymphatics of the breast are drained into the ___ group. The ___ group drains to the subclavian lymphatic trunk into the right lymphatic duct in the right side, which then drains into larger veins at the ___ angle. The lymphatics of the left side finally drain the ___ duct. The remaining lymphatics from the medial quadrants of the breast drain by the ___ nodes or other side vessels, and the inferior quadrant lymphatics may reach the ___ lymph node.
- pectoral, lateral, apical, subscapular, central.
- lateral group
- pectoral/anterior group
- subscapular/posterior group
- central group
- central
- apical
- central
- apical
- venous
- thoracic
- parasternal
- abdominal
Breast cancer may metastasize to the ___ lymph nodes, and removal of the __nodes may be necessary. Invasion of the __ ligaments by a tumor may cause dimpling of the skin, similar to the appearance of an orange peel. There may be an injury to the ___ nerve during radical mastectomy.
- axillary
- lymph
- suspensory
- long thoracic
Can a male have an enlarged breast? Yes, males can also develop an abnormally large breast; this condition is called ____. It may develop during the ___ stage due to the effect of the mothers hormones; it can arise during ___; or it may develop in older people. It may appear as a small lump just under the ___. During growth, this mass can be tender.
- gynecomastia
- neonatal
- adolescence
- areola
Gynecomastia is usually ___ to the normal hormonal imbalances between testosterone and estrogen, in favor of ___. This commonly occurs during ___. Gynecomastia may be due to persistent ___ gynecomastia, ___, no detectable abnormality, ___, ___, or the result of testicular and suprarenal cancers. It may be one of the features of male hypogonadism, known as ___. These males have one or more ____.
- secondary
- estrogen
- puberty
- pubertal
- drugs
- cirrhosis
- malnutrition
- Klinefelters syndrome
- extra X chromosome
The ____ is one of the transitional regions between the thorax and the upper limbs, located in the upper chest.
-infraclavicular region
The skin of the infraclavicular region is innervated by the ____. Beneath the skin, the ___ is attached to the superficial fascia, covering the pectoralis major and deltoid muscles. The ___ then continues upward through the neck to attach to the inferior border of the mandible and the skin close to the angle of the mouth
- suprascapular nerves of the cervical plexus
- platysma
The ___ innervated the platysma
-facial nerve
The ___ overlying the pectoralis major muscle is found under the platysma, and the pectoralis minor is deeper than the major in the ___ region. The _____ nerves accompanied by the pectoral vessels and lymphatics can also be found in the infraclavicular region. The ___ muscle is located deep in this region as well, originating from the first rib and connecting to the sulcus for the ___ muscle on the lower surface of the clavicle. It pulls the clavicle toward the sternum and is innervated by the ___.
- pectoral fascia
- infraclavicular
- medial and lateral pectoral
- subclavius
- subclavius
- nerve to the subclavius
Main structure in the region are the ___ artery and the cords of the ___ plexus, as well as the ___ vein situated medial to the artery. These structures continue inferolaterally,
- axillary
- brachial
- axillary
The ___ region is transitional region between the trunk and the upper limb. The main structures in this region are the distal part of the brachial plexus including the cords and their terminal nerves, the ___ artery, vein and lymph nodes.
-axillary
The axillary is a pyramid region whose boundaries include the ___ and __ muscles located anteriorly, the ___ located posteriorly, the ___, together with the ___ and short head of the ____, laterally and the thoracic wall with the ___ located medially. Several lymph nodes, which drain the ___ of the upper limb as well as the ___, are arranged in 5 grips that are also found in this region
-pectoralis major and minor
-lattisimus dorsi
-humerus
-coracobrachialis
-biceps brachii
-serratus anterior
lymphatics
-breast
In the infraclavicular region, the ___ lies superolaterally to the axillary vessels and cephalic to the chest wall. The ___ lies deep to the skin, ___ and clavipectoral fascia, which splits to enclose the pectoralis minor muscle. The ultrasound-guided infraclavicular nerve block include anesthesia for the surgery of the ___, ___ and ___ and post surgical too, also including reimplantation.
- brachial plexus
- plexus
- pectoralis major
- arm, forearm, and hand
The axillary is a pyramid region whose boundaries include the ___ and __ muscles located anteriorly, the ___ located posteriorly, the ___, together with the ___ and short head of the ____, laterally and the thoracic wall with the ___ located medially. Several lymph nodes, which drain the ___ of the upper limb as well as the ___, are arranged in 5 grips that are also found in this region
-pectoralis major and minor
-lattisimus dorsi
-humerus
-coracobrachialis
-biceps brachii
-serratus anterior
lymphatics
-breast
In the infraclavicular region, the ___ lies superolaterally to the axillary vessels and cephalic to the chest wall. The ___ lies deep to the skin, ___ and clavipectoral fascia, which splits to enclose the pectoralis minor muscle. The ultrasound-guided infraclavicular nerve block include anesthesia for the surgery of the ___, ___ and ___ and post surgical too, also including reimplantation.
- brachial plexus
- plexus
- pectoralis major
- arm, forearm, and hand
The middle part of the thorax between the two lungs is called the ___, which can be divided into superior and inferior sections by a plane passing though the angle of the ___ to the inferior border of the __. The superior section contains great vessels around the __, including the __ of the __ and its three branches, the ___, ___, and the ___; part of the __, ___ and ___; and ___ and smaller vessels, as well as the ___ duct. The inferior section can be subdivided into three parts in an anteroposterior direction. The anterior mediastinum contains mainly the __, __ and __.
- mediastinum
- sternum
- T4 vertebra
- heart
- arch
- azygos vein
- superior vena cava
- r/l brachiocephalic vein
- thymus, trachea, and esophagus and phrenic nerves
- thoracic
- thymus
- fat
- lymph nodes
The thymus consists of ___, and the tissue is populated with the ___ migrating from bone marrow. The thymus weighs about 10g birth and 20-40 g puberty. With age, it ___ and is replaced by adipose tissue, though it still functions and is a site of ___ differentiation. Pathology of the anterior mediastinum includes ___, as well as thymomas due to ___.
- epitheliocytes
- T stem cells
- decreases in size
- T cell differentiation
- lymphomas
- myasthenia gravis
The middle mediastinum contains the ___ and the ___, covered by ___ as well as the great vessels, including the ascending aorta, the autonomic and phrenic nerves. The posterior mediastinum, which lays behind the __ ligament from the T5-T12 vertebrae, contains the ___, ___, ___ and __; the ___ system; and the ___ nerves.
- heart and coronary vessels
- pericardium
- pulmonary
- esophagus, vagus nerves, thoracic aorta, and thoracic duct; azygos venous, sympathetic
The lungs are covered by a saclike, ___ membrane called the pleura, a ___ that produces a small quantity of serous fluid. The ___ of the pleura is very close to and actually adheres to the ___, the __ and the ___, and lines one half of the cavity. It is continuous with the __ which is closely adhered to the surface of the ___ and even into the __ of the lungs. Different parts of the parietal layer take different names: the ___ is the area where the parietal layer covers the ribs and costal cartilages, whereas the apex of the lungs is covered by the ___, which is reinforced by the suprapleural membrane. Close to the lateral borders of the heart, the parietal leura is called the ____, while the part covering the diaphragm is known as the ___. At the __ of the lungs, where the bronchi and pulmonary vessels enter or leave the lungs, the mediastinal pleura becomes continuous with the ____.
- double-layered
- serous membrane
- outer (parietal) layer
- thoracic wall
- diaphragm
- pericardium
- inner (visceral) layer
- fissures
- costal pleura
- cervical pleura
- mediastinal pleura
- diaphragmatic pleura
- hilum
- visceral pleura
Inferior to the hilum, the duplicature of the pleura is called the ___. The posterior mediastium is situated posterior to the ___
-pulmonary ligament
The ___ is from the sternoclavicular joints on both sides, which extend anteriorly in the middle of the sternum down to the xiphoid process slightly on the right side, and laterally to the right by reaching rib 8 around the midclavicular line, to rib 10 laterally, and to rib 12 posteriorly. On the left side, it follows the border of the ___, reaching the costal cartilage of the fourth rib, down to the sixth costal cartilage and follows a path similiar to the right side when extended laterally and posteriorly.
- reflection of the pleura
- mediastinum
The pleural cavity is the space between the __ and __ pleurae that is filled with a small amount of ___: the pleural fluid serves for lubrication and other purposes. The pleural cavity becomes wider close to the ___ or ___, creating the costodiaphragmatic and costomediastinal recesses.
- parietal
- visceral
- serous
- diaphragm
- medastinum
Innervation, blood supply, and lymphatic drainage of the pleura: ___ nerves, including the ___ and the ___, innervate the parietal layer. The pain of ___ is due to the ___ innervation of the parietal layer, causing a sharp local pain as well as referred pain in the thoracic wall, or even to the root of the neck. The parietal pleura is supplied by the __ and __ arteries, and venous drainage is accomplished via the corresponding __. The lymphatic pass to the nodes of the internal aspect of the ___ wall.
- local somatic
- intercostal and phrenic nerve
- phrenic nerve
- intercostal and internal thoracic
- veins
- thoracic
The ___ nerves innervated the visceral pleura, which is insensitive to pain caused by ___. The vessels of the lungs supply the blood to the ___ layer, and its lymphatic drainage follows that of the lungs to the nodes in the ___ of the lungs.
- sensory autonomic
- inflammation
- visceral
- hilum
Significance of intrapleural press: the pressure of the ___ is very important for the expansion of the thorax and the lungs. The pressure can be measured with a balloon catheter placed in the ___. In a breathing cycle, the intrapleural pressure is ___ at rest, due to the opposing forces of the lungs trying to ___ and the chest wall trying to ___. During ___, the intrapleural pressure drops even further because of an increase in both volume and elastic recoil strength of the lungs. During normal ___, the intrapleural pressure returns to the value at rest, and the cycle repeats.
- pleural cavity
- esophagus
- negative
- collapse
- expand
- inspiration
- expiration
What happens if the intrapleural pressure is disturbed. Conditions that disturb the intrapleural pressure may interfere with ___. The most important of these include ____, a condition in which air gets into the pleural cavity due to injury, such as a gunshot wound or puncture by a sharp object such as a knife wound, trauma with fractures of the ribs, inadvertent damage to the pleura during surgery of the kidney from a posterior approach, thoracocentesis, catheterization of the subclavian vein, mechanical ventilation or brachial plexus or sympathetic nerve block. Another possible cause of ___ is ___, which may lead to the rupture of the visceral pleura, thereby allowing air from the lungs into the pleural cavity. ___ pressure leads to the collapse of the lung and interferes with respiration, which can be fatal if not corrected in time.
- respiration
- pneuomothorax
- pneumothorax
- pulmonary disease
- positive intrapleural
