CVR 2

Question 1

intercostal spaces

Answer 1

spaces between ribs

Question 2

What do intercostal spaces contain

Answer 2

-3 layers of intercostal muscles and their associated membranes
-Intercostal (ir) neurovascular bundle comprised of ir nerve, ir vein, ir artery

Question 3

External intercostal

Answer 3

Most superficial
Its fibre are orientated antero-inferiorly
When contracted pulls ribs superiorly so most active during inspiration
The most anterior part of the intercostal muscle become membranous and form the external intercostal membrane

Question 4

Internal intercostal muscle

Answer 4

Lies deep to external intercostal
Its fibres are perpendicular to external ir, running in a postero-inferior direction
When it contracts it pulls the ribs inferiorly so it’s most active during expiration
The posterior part of the ir space is where the internal ir muscle becomes membranous and form the internal ir muscle membrane

Question 5

Innermost intercostal

Answer 5

Posterior part of ir space
Deep to internal ir muscle
Fibers orientated in the same direction as internal ir muscle

Question 6

endothoracic fascia

Answer 6

Lies deep to the innermost ir muscle but superficial to the parietal pleura

Question 7

Where does intercostal neurovascular bundle lie

Answer 7

Is in each ir space
It lies in the plane between the internal ir and the innermost ir
Supplies ir muscle, overlying skin and parietal pleura

Question 8

Where does the ir neurovascular bundle lie

Answer 8

In a shallow costal groove on the inferior deep border or the rib superior to the ir space
When the intercostal muscle needs to be pierced (placing a chest drain) the surgeons try to make the incision through the middle-lower part of the ir space to avoid the ir neurovascular bundle
Collateral branches run in the same tissue plane but lie on the inferior part of the ir space

Question 9

anterior and posterior ir arteries

Answer 9

They supply the ir spaces respectively
anterior ir ateries branches of internal thoracic artery (branch of subclavian artery)
posterior ir ateries branches from descending aorta tin the posterior thorax

Question 10

Where do anterior and posterior ir veins drain into

Answer 10

Anterior ir veins-internal thoracic vein
Posterior ir veins-azygos system of veins

Question 11

IR nerves

Answer 11

Somatic and contains motor and sensory fibres
Innervates intercostal muscles, skin of chest wall, parietal pleural
Cont sympathetic fibres

Question 12

Pleura

Answer 12

Covers lungs and structures passing in and out (main bronchi & pulmonary blood vessels)
Parietal pleura-lines inside of thorax
Visceral pleura-covers surface of lungs
Small pleural cavity between the 2

Question 13

why is the parietal pleura visible w naked eye but not visceral pleura

Answer 13

the 2 layers of pleura are continuous w each other

Question 14

Pleural Fluid

Answer 14

Small amount of fluid that pleural cells prod to fill the pleural cavity

Question 15

The parts of the parietal pleura are named according to the parts they lie adjacent to

Answer 15

Cervical-covers apex of the lungs
Thoracic- Lies adjacent to the ribs
Mediastinal -Lies adjacent to the heart
Diaphragmatic-Lies adjacent to the diaphragm

Question 16

Costomedial recess, costodiaphragmatic recess

Answer 16

costodisphragmatic recess-‘gutter’ of the periphery of the diaphragm where the costal and diaphragmatic pleura become continuous
costomedial recess- smaller junction where costal and mediastinal pleura meet
Potential spaces lung expands into during deep inspiration

Question 17

Why is the sensation of pain very different depending on whether the parietal or visceral pleura are hurt

Answer 17

They are innervated by different nerves
Parietal-ir nerves that innervate the overlying skin of the chest wall cont somatic sensory fibres that carry sensation to our consciousness, injuries to this pleura e.g. tearing by fractured rib usually v painful
Visceral-autonomic sensory nerves (visceral afferents), sensation from visceral afferents usually do not reach our conscious perception so not painful

Question 18

Where does the lungs sit

Answer 18

The most superior part of the lungs is the apex of the lungs that project into the root of the neck above the clavicle and the most inferior part is the base that sits on the diaphragm

Question 19

Lobes of the lungs

Answer 19

Right lung-3 lobes-superior, middle, inferior
Left lung-2 lobes-superior, inferior, anterior extension of superior lobe extends over the heart (lingula)

Question 20

fissures

Answer 20

oblique fissure-on left lung separates superior lobe from inferior lobe, on right love separates superior & middle lobes from inferior lobe
horizontal fissure-separates superior lobe from middle lobe on right lobe

Question 21

surfaces + borders of lungs

Answer 21

mediastinal s - s adjacent to heart
costal s - s adjacent to ribs
diaphragmatic s - inferior s of lung

anterior b - sharp & tapered
posterior b - thick and rounded
inferior b - tapered - sharp and tapered