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Anatomy > Exam 3 Thorax > Flashcards

Exam 3 Thorax Flashcards

0
Q

Boundaries of the thorax

A

anterior: sternum, costal cartilage
posterior: 12 thoracic vertebrae, posterior part of 12 ribs, intercostal muscles

laterally: ribs, intercostal muscles
superior: first rib
inferior: diaphragm

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1
Q

level of the plane passing through sternal angle

A

T4-5 disc

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2
Q

superior thoracic aperture

A
  • bordered by 1st rib

- opening for structures that enter/leave thoracic cavity that run to head, neck, UE

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3
Q

inferior thoracic aperture

A
  • covered by diaphragm

- holes for structures entering the abdomen from the thorax

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4
Q

manubrium

A
  • upper part of sternum
  • clavicular notch: medial end of clavicle
  • costal notch: costal cartilage of 1st rib
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5
Q

sternal angle

A
  • between manubrium and superior body of sternum
  • same level as disc T4-5
  • costal notch for cartilage of 2nd rib
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6
Q

body of sternum

A

-costal notches for cartilage of ribs 3-6

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7
Q

xiphisternal joint

A
  • between inferior body of sternum and xiphoid process

- costal notch for cartilage of rib 7

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8
Q

True ribs

A
  • ribs 1-7

- attach directly to sternum

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9
Q

false ribs

A
  • ribs 8-12 (lower 5)
  • costal cartilage of ribs 8,9,10 attach to rib above
  • floating ribs = ribs 11, 12 (no costal cartilage, do not attach to sternum)
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10
Q

Ribs 3-10

A
  • anterior costal notch (costal cartilage)
  • head: interarticular crest (disc), two demifacets (superior/inferior vertebrae)
  • rib 10 only has one facet, no interarticular crest
  • neck: between costal tubercle and head
  • body: costal tubercle to anterior costal notch
    - rounded superiorly, sharp inferiorly
  • angle: sharp curvature beyond tubercle
    • external surface: rough for iliocostalis attachment
    • internal surface: COSTAL GROOVE (intercostal nerves, vessels)
  • costal tubercle: attaches to TP
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11
Q

1st rib

A
  • very short/curved
  • head: one articular facet for T1
  • scalene tubercle: superior surface, attachment for anterior scalene
  • groove for subclavian v: medial to scalene tubercle
  • groove for subclavian A: lateral to scalene tubercle
  • inferior trunk of brachial plexus: passes posterior to scalene tubercle
  • subclavian A,V, inferior trunk cross SUPERIOR THORACIC APERTURE to reach 1st rib*
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12
Q

Thoracic outlet syndrome

A
  • tight scalene ant/med elevate 1st rib–>compress subclavian A,V, inferior trunk
  • weakness in hypothenar, interosseous muscles
  • tingling in ulnar side of hand
  • pain in anterior chest, shoulder
  • diminished pulse in involved limb
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13
Q

2nd rib

A
  • longer, more rounded, less curved than 1st rib
  • one articular facet for T2 vertebra
  • scalene posterior: attached to tuberosity on superior surface, mid body
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14
Q

Ribs 11, 12

A
  • shorter, less curved than other ribs
  • one articular surface for vertebrae T11, 12
  • no prominent costal tubercle
  • ends covered in hyaline cartilage, no costal notch
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15
Q

Extrinsic muscles of thorax (attach to rib cage and other structures)

A
  1. iliocostalis
  2. longissimus
  3. pec major
  4. pec minor
  5. serratus anterior
  6. subclavius
  7. external oblique
  8. internal oblique
  9. transverse abdominis
  10. rectus abdominis
  11. levator costarum
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16
Q

scalenus anterior

A 
nerve: C5-8
O:ant tubercle of TP C3-6
I: scalene tubercle, ridge of 1st rib
-attaches anterior to subclavian A.
A: elevate 1st rib, cervical flex (bilateral), rotation to opposite side (unilateral)
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17
Q

scalenus medius

A

N: C3-8
O: posterior tubercle of TP (C2), C3-7
I: superior 1st rib (posterior to groove for subclavian A)
-attaches posterior to subclavian A.
A: elevate 1st rib, cervical flex (bilateral), rotation to opposite side

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18
Q

Scalenus posterior

A

N: (C5),(C6),7,8
O:posterior tubercle of TP C4-6
I: outer posterior border of 2nd rib
A: elevate 2nd rib, cerv flex (bilateral), lateral flex (unilateral)

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19
Q

Intrinsic muscles of the thorax (attach only to rib cage)

A
  1. serratus posterior superior
  2. serratus posterior inferior
  3. external intercostals
  4. internal intercostals
  5. transversus thoracic
  6. innermost intercostal
  7. subcostal
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20
Q

external intercostals

A

N: intercostal nerve of that intercostal space
O: inferior body of rib above
-from costal tubercle to costal cartilage
-from cartilage junction to sternum (replaced by external intercostal membrane
I: superior body and costal cartilage of rib below
A: elevates rib below to expand A/P diameter of thorax during normal/forced inspiration; stabilizes bony thorax

21
Q

internal intercostals

A

N: intercostal nerve of that intercostal space
O: inferior body of rib above
-from angle of rib to sternum (along costal groove)
-at angle of rib, muscle is replaced by internal intercostal membrane
I: superior body of rib below
-from angle of rib to sternum
-at angle of rib posteriorly, muscle replaced by internal intercostal membrane
-inferior attachment lies internal to external intercostal muscle
A: depresses rib above to reduce thoracic volume during forced expiration; may be active in forced inspiration; stabilizes bony thorax

22
Q

transversus thoracis

A

N: intercostal nerve of that intercostal space
O: inferior body of sternum, xiphoid process; internal surface of costal cartilages 2-6
I: 4 to 5 slips of muscle attaching to inner surface of costal cartilages 2-6
A:depresses ribs during expiration

23
Q

innermost intercostal

A

N: intercostal nerve of that intercostal space
O: internal surface of rib above (from angle of rib to costal cartilage)
I: internal surface of rib below (from angle of rib to costal cartilage)
A:depression of rib above–>decrease size of thoracic cavity during forced expiration; may be active in forced inspiration; stabilizes bony thorax

24
Q

subcostal muscle

A

N: intercostal nerve of intercostal space
O: inner surface of angle of rib above
I: inner surface of angle of rib below or second rib below
A: elevate ribs–>inspiration

25
Q

costovertebral joints

A

Head of rib w/ costal facets of vertebral bodies

  • ribs 3-9 articulate w/ two vertebral bodies
  • ribs 1 & 2 articulate w/ one vertebra each
  • ribs 10-12 articulate w/ one vertebra each

Cover intervertebral disc
Synovial

26
Q

ligaments of costovertebral joints

A
  1. radiate ligaments

2. intra-articular ligaments

27
Q

costotransverse joint

A
  • Tubercle of rib w/ TP

- synovial joint

28
Q

ligaments of costotransverse joint

A
  1. superior costotransverse lig
    - superior neck of rib below to inferior aspect TP above
  2. lateral costotransverse lig
    - tip of TP to adjacent costal tubercle
  3. inferior costotransverse lig
    - between posterior aspect of neck of rib –>anterior surface of TP
    - between costovertebral/costotransverse joints
29
Q

serratus posterior inferior

A

N: intercostal N of intercostal space (T9-11)
O: SP of T11-L2 or L3
I: lateral inferior margin of ribs 9-12
A: depresses lower ribs during ventilation; stabilizes costovertebral joints of ribs 9-12
*Intrinsic thoracic muscle

30
Q

serratus posterior superior

A

N: intercostal N of intercostal space (T2-T4)
O:caudal part of ligamentum nuchae; SP C7-T3
I: ribs 2-4 or 5
A: elevates ribs during ventilation, stabilizes upper costovertebral joints of ribs 2-4

31
Q

levator costarum

A

*extrinsic thoracic muscle
N:dorsal ramus of thoracic spinal nerve (intercostal) crossed by muscle
O: TP C7-T11
I: angle of rib below
-longus (skip one rib)
-brevi (attach to rib directly below)
A: ELEVATES RIBS (inspiration); thoracic extension (both sides), lateral flex (same side); thoracic rotation (opposite side)

32
Q

intrinsic thoracic muscles that perform expiration (3)

A
  1. internal intercostals
  2. innermost intercostals
  3. transversus thoracic
33
Q

intrinsic thoracic muscles that perform inspiration (3)

A
  1. external intercostals
  2. subcostal
  3. levator costarum EXTRINSIC THORACIC MUSCLE
34
Q

muscles of inspiration (6)

A
  1. SCM
  2. scalenes
  3. external intercostals
  4. diaphragm
  5. subcostalis
  6. levator costarum
35
Q

muscles of expiration (5)

A
  1. internal intercostals
  2. innermost intercostals
  3. transverse thoracis
  4. rectus abdominis
  5. transverse abdominis
36
Q

location of intercostal N., A., V. relative to rib muscles

A
  • subcostal groove

- between innermost/internal intercostals

37
Q

intercostal N

A
  • ventral rami T1-11
  • runs w/ A. & V. along each rib
  • motor to intercostal muscles
  • sensory to skin of thoracic region
  • Lateral Cutaneous N (lies external to external intercostals)
    • sensory to skin
    • divides into Ant/Post branches
  • Intercostal N terminates near sternum as Anterior Cutaneous N
    • Ant Cutaneous N divides into med/lat branches
38
Q

Intercostal A branches from?

Intercostal V drains to?

A

Thoracic Aorta –> intercostal Arteries

intercostal V –>Azygos V (runs along anterior right side of vertebral column

39
Q

Diaphragm innervation and action

A

Phrenic N (C3,4,5)–>keeps diaphragm ALIVE
O:
-sternal:xiphoid process
-costal: internal surface of lower six ribs, costal cartilages
-vertebral: upper 2-3 lumbar vertebrae (muscular crus, med/lat arcuate lig on each side); arcuate lig = extensions of T/L fascia
I:central tendon
A:
-lowers central tendon
-increases volume of thoracic cavity during inspiration
-decreases pressure on lungs–>allows inward movement of air

40
Q

subcostal nerve

A

intercostal nerve of ventral ramus T12 (emerges below 12th rib)

41
Q

anterior/posterior thoracic cavity expansion

A

true ribs (1-7)

42
Q

medial/lateral thoracic cavity expansion

A

false ribs (8-12)

43
Q

superior/inferior thoracic cavity expansion

A

diaphragm

44
Q

4 openings of the diaphragm

A
  1. vena caval foramen (Between T8/9)
    - inferior vena cava
  2. esophageal hiatus (T10 vertebra)
    - esophagus
    - R/L vagal trunks
  3. aortic hiatus (sides: R/L crus, ant: median arcuate lig, post: T12)
    - aorta
    - azygos V.
    - thoracic duct
  4. psoas gap (@ level of aortic hiatus, lateral to crura)
    - psoas major, ilioinguinal N, genitofemoral N, sympathetic chain
45
Q

costotransverse lig strained/torn during pregnancy

A

superior costotransverse lig

46
Q

Anterior intercostal A.

A
  • supplies anterior intercostal region
  • Highest Thoracic A (1st part of Axillary A)–>1st,2nd intercostal space
  • Internal Thoracic A (lateral edge of sternum, deep to transverse thoracis)–>2nd through 6th intercostal spaces
  • Musculophrenic A (branch of Internal Thoracic)–> 7th-9th intercostal space & diaphragm

*Do not supply 10th/11th intercostal spaces

47
Q

superior epigastric A

A
  • branches off Internal Thoracic A @ 6th-7th intercostal space
  • supplies diaphragm, upper rectus abdominals
48
Q

posterior intercostal A

A
  • supply 10th-11th intercostal spaces (no anterior intercostal A)
  • Subclavian A–>costocervical trunk–>supreme intercostal A –> posterior intercostal A to 1st/2nd intercostal spaces
  • Thoracic Aorta–>posterior intercostal A from 3rd-11th intercostal spaces
49
Q

Anterior Intercostal V

A
  • accompany corresponding arteries

- drain into musculophrenic V. & Internal Thoracic V.

50
Q

posterior intercostal V

A
  • Right: drain into azygos V.
  • Left: drain into hemiazygos V., accessory hemiazygos V
  • upper thorax: Hemiazygos V & Accessory Hemiazygos V drain into Azygos V
  • Azygos V –> superior vena cava
51
Q

Hiatal Hernia

A
  • part of stomach slips through esophageal hiatus

- indigestion when supine–>need to be placed in inclined position

Anatomy (10 decks)

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