CVR: Anatomy Flashcards
What are the three parts of the sternum?
Manubrium, sternal body, xiphoid process/xiphisternum.
Where does the manubrium articulate with the clavicle?
At the sternoclavicular joint, laterally to manubrium.
What is another term for the sternal angle, other than the angle of Louis?
Manubriosternal joint.
What does the manubrium articulate with?
Clavicles, first ribs, and the sternal body.
Where is the suprasternal (jugular) notch?
Superior border of the sternum.
With which ribs does the body of the sternum articulate, and what are these joints called?
Ribs 2-7 (the “true” ribs).
Sternocostal joints.
2nd rib articulates at the manubriosternal joint (sternal angle).
What is the costal margin?
The lowest part of the ribs anteriorly.
What is the term for where the ribs articulate with their costal cartilage?
Costochondral joints.
How are ribs 8-10 related?
Their costal cartilage unite and join the 7th costal cartilage
Why are ribs 11 & 12 different to the other ribs?
They are shorter, don’t have costal cartilage and don’t articulate with the sternum, they are “floating” ribs.
What is the name of the joint between ribs and thoracic vertebra and how does the rib articulate with the vertebra?
Costovertebral joints.
Tubercle of rib articulates with transverse process, head of rib articulates with vertebral body above and below.
What is the costal groove and what is its function?
Groove in the internal aspect of rib, protects the neurovascular bundle.
What forms the boundary of the superior thoracic aperture?
Manubrium, first ribs, and first thoracic vertebra.
What is a dermatome?
An area of skin innervated by a single spinal nerve.
Are the dermatomes of the thoracic wall in vertical strips or horizontal strips, and which spinal nerves innervate them?
Horizontal strips.
T1-T12
(same as the ribs! just all the thoracic vertebra).
In which dermatome is the umbillicus?
T10
In which dermatome are the nipples?
T4
Where is the axillary tail and what tissue is it part of?
The part of the breast tissue extending towards the anterior axilla.
In breast tissue, what is a lobule composed, and what does it lead to?
Glandular or secretory tissue.
Leading to ducts which converge on the nipple.
Which arteries supply the breast?
Axillary artery, and anterior intercostal arteries, which are branches of the subclavian artery.
What veins return blood from the breast?
Axillary and internal thoracic veins.
What nerves supply somatic nerves and sympathetic fibres to the breast?
Intercostal nerves.
Why are the axillary lymph nodes often involved in the spread of breast cancer?
Because they drain most of the lymph from the breast.
What are the five groups of lymph nodes in the axilla?
- Central
- Pectoral
- Humeral
- Subscapular
- Apical
Where do the axillary lymph nodes drain lymph from (5 places)?
- Breast
- Upper limb
- Chest wall
- Scapular region
- Abdominal wall
What is the most superficial (lies closest to surface) of the anterior thoracic wall? What bones does this muscle attach to?
Pectoralis major
Attaches to:
Proximal humerus, sternum, clavicle, ribs 1-6.
Where is the pectoralis minor muscle and what does it attach to?
Deep to pectoralis major (underneath it).
Attaches to:
Scapula and ribs 3-5.
Which superficial muscle sweeps around the lateral aspect of the thoracic cage and attaches to the scapula and ribs 1-8?
The serratus anterior muscle.
Which upper limb muscles act as accessory muscles in respiratory distress?
Pectoralis major, pectoralis minor, and serratus anterior muscles.
Sternocleidomastoid (neck muscle) is also used.
What structures would you find in the intercostal space?
Intercostal muscles (3 layers; external, internal, innermost).
Neurovascular bundle (artery, vein, nerve).
Which artery do the posterior intercostal arteries branch from, and which vein do they drain to?
Descending aorta in the posterior thorax.
Azygos system of veins.
Which artery do the anterior intercostal arteries branch from, and which vein do they drain to?
Internal thoracic artery (which branches from the subclavian artery).
Internal thoracic vein.
Are intercostal nerves somatic or autonomic (sympathetic or parasympathetic)?
Both, intercostal nerves are somatic and have motor & sensory fibres.
They also carry sympathetic autonomic fibres.
Are both the parietal and visceral pleura visible to the naked eye?
No, only the parietal pleura (the outermost pleura) is visible to the naked eye.
What produces pleural fluid?
The pleural cells.
Where is the cervical pleura?
Covering the apex of the lung.
What are the two potential spaces the lungs expand into during deep inspiration?
Costodiaphragmatic recess and the costomediastinal recess (“gutters” where different areas of the parietal pleura meet).
Is the visceral pleural innervated by somatic or autonomic sensory nerves?
Autonomic only.
Is the apex of the lungs the most superior aspect or most posterior?
Superior aspect of the lungs is the apex.
What is the lingula in the lungs?
Anterior extension of the superior lobe in the left lung which extends over the heart.
How many lobes does the right lung have and how are they divided?
Right lung has 3 lobes.
Superior and middle lobe separated by oblique fissure.
Middle and inferior lobe separated by horizontal fissure.
Which ribs mark the inferior border of the lungs (anteriorly, laterally, and posteriorly)? How is this different to the parietal pleura?
Anteriorly = 6th rib midclavicular
Laterally = 8th rib midaxillary
Posteriorly = 10th rib lateral to vertebral column.
Parietal pleura extends 2 ribs lower in each place.
At which ribs does the oblique fissure start and end?
Starts at 4th rib posteriorly.
Ends at 6th costal cartilage anteriorly.
Where is the horizontal fissure of the right lung if palpating the ribs?
Horizontal fissure starts at 4th costal cartilage anteriorly, ends where it intersects the oblique fissure.
What is the hilum of the lung?
Region on mediastinal surface where pulmonary artery, veins, and main bronchus enter and exit the lung.
In the hilum of which lung is the pulmonary artery superior to the main bronchus? Where is it positioned in the other lung?
Left lung.
In the hilum of the right lung, the pulmonary artery is anterior to the main bronchus.
Which are the most anterior and inferior structures in the hilum of the lung?
The pulmonary veins.
A foreign body entering the trachea is more likely to end up in the right or left main bronchus and why?
Right main bronchus.
Because the right main bronchus is shorter, wider, descends more vertically than left main bronchus.
Describe the bronchial tree.
Branching system of tubes.
Each main bronchus divides into lobar (secondary) bronchi, supply each lobe.
Lobar bronchi further divide into segmental bronchi, supply each bronchopulmonary segment.
Segmental bronchi then divide further into bronchioles which keep dividing until the very smallest which conduct air to/from the alveoli.
How many bronchopulmonary segments are there in each lung?
Right lung = 10
Left lung = 8-9
What is the difference between the structure of the bronchioles versus the trachea & bronchi?
Trachae & bronchi contain smooth muscle and cartilage.
Bronchioles only contain smooth muscle.
What arteries supply lung tissue and what main artery do they originate from?
Bronchial arteries originating from the descending aorta.
Parasympathetic or sympathetic fibres stimulate relaxation of bronchial smooth muscle (bronchodilation)?
Sympathetic.
What bones/cartilage does the diaphragm attach to?
Xiphoid process, costal margin, and lumbar vertebra.
Is the diaphragm made of smooth or skeletal muscle?
Skeletal.
Does the diaphragm contract and flatten during inspiration or expiration, and why?
Inspiration.
Increases intrathoracic volume, decreases pressure, air rushes in, lungs expand.
Does expiration always involve contraction of internal intercostal muscles?
No, at rest/normal quiet breathing, expiration is passive. Relaxation of diaphragm and recoil of lung tissue is enough.
In vigorous breathing, active expiration uses internal intercostal muscles.
Is a spontaneous pneumothorax due a tear in the visceral or parietal pleura?
Visceral - next to lung.
What is mesothelioma?
Malignancy of the pleura.
What 6 structures are in the posterior mediastinum?
Descending (thoracic) aorta.
Azygos veins
Oesophagus
Thoracic duct
Sympathetic trunk & splanchnic nerves
Posterior intercostal vessels & nerves
What do the following arterial vessels have in common?Posterior intercostal arteries, bronchial arteries, oesophageal, pericardial, and phrenic branches.
They all originate from the descending thoracic aorta.
At what vertebral level does the thoracic aorta pass through the diaphragm, and what is it called below this level?
T12 vertebrae
Below T12 it is called the abdominal aorta.
Where do the azygos veins drain from, and what vessel do they drain into?
The azygos veins drains blood from the posterior thoracic wall (posterior intercostal veins, oesophageal, and bronchial veins) and returns the blood into the superior vena cava.
Where is the azygos vein?
In the posterior mediastinum, on the right side of the vertebral column.
Where is the oesophagus?
In the posterior mediastinum, slightly to the right of, and posterior to, the aorta.
At what vertebral level does the oesophagus pass through the diaphragm and what is this called?
T10.
Called the oesophageal hiatus.
Where is the thoracic duct?
In the posterior mediastinum, between the oesophagus and the aorta.
What does lymph from the lower limbs, pelvis, and abdomen flow into before entering the thoracic duct, and where is this structure?
Cisterna chyli in the abdomen.
What structure in the lymph system returns most of the body’s lymph to the venous system?
The thoracic duct.
Where does the thoracic duct terminate and return lymph to the venous system?
At the junction between the left internal jugular vein and the left subclavian vein.
How does lymph drain from the right side of the head and neck, and the right upper limb into the venous system?
Lymph drains into lymphatic ducts which enter the venous system at the junction of the right internal jugular and right subclavian veins.
Where are the sympathetic trunks?
Posterior mediastinum on the posterior thoracic wall, either side of the vertebral columns and posterior to the parietal pleura. Running from the skull base to the coccyx.
