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AP1 Block 4 > Head Neck Trunk slides 120 to 233 > Flashcards

Head Neck Trunk slides 120 to 233 Flashcards

1
Q

Structure of Individual Vertebrae

Parts of a typical vertebra include…

A

Parts of a typical vertebra include….

a body, a vertebral arch, and several processes

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2
Q

Look at slide 121 / 122 / 123 images to differentiate between the following:

Parts of a typical vertebra include a body, a vertebral arch, and several processes

Four types of vetebral processes shown

A

You’re doing swell

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3
Q

What are the four types of vetebral processes shown (seven total processes per vertebrae with four types)… (answer is on slide 122)

All four TYPES of these processes (seven total processes per vertebrae with four types) connect to the….

A

Transverse Process (2/ vertebrae)

Superior Articular Process (2 /vertebrae)

Inferior Articular Process (2 /vertebrae)

Spinous Process (1 / vertebrae)

These processes above connect to the pedicle

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4
Q

Imagine how the superior articular process and inferior articular process come together. What do we see in between these two processes and the vetebral body?

A

The intervetrebral foramen (slide 123)

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5
Q

A typical vertebrae has the following parts?

A

Body

Vetebral Arch

Vetebral foramen

Seven processes

Vetebral notches

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6
Q

The body of a typical vetebrae is used for:

A

weight bearing

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7
Q

The vetebral arch is made up of the:

A

pedicles and laminae

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8
Q

The vertebral foramen is where?

A

A large hole in superior view and look at image on slide 124

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9
Q

How many processes are in a typical vertebrae and of which type?

A

Seven processes

  • 2 transverse
  • 1 spinous
  • 4 articular
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10
Q

is all vertebral foramina together

A

Spinal canal

slide 125 image

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11
Q

are 2 vertebral notches together

A

Intervertebral foramina

slide 125 image

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12
Q

There are _ cervical vertebrae

A

7

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13
Q

There are 7 cervical vertebrae:

The first cervical vertebra is the ___. It supports the skull

The second cervical vertebra is the ___, which permits side-to-side rotation of the head

The third to sixth correspond to the ___ ____ of the typical cervical vertebrae

The seventh called the ___ ___ is somewhat different from vertebrae 3 through 6

A

There are 7 cervical vertebrae:

The first cervical vertebra is the atlas. It supports the skull

The second cervical vertebra is the axis, which permits side-to-side rotation of the head

The third to sixth correspond to the structural patterns of the typical cervical vertebrae

The seventh called the vertebra prominens is somewhat different from vertebrae 3 through 6

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14
Q

There are 7 cervical vertebrae:

The first cervical vertebra is the atlas. It…

The second cervical vertebra is the axis, which….

The third to sixth correspond to….

The seventh called the vertebra prominens is somewhat different from vertebrae 3 through 6

A

There are 7 cervical vertebrae:

The first cervical vertebra is the atlas. It supports the skull

The second cervical vertebra is the axis, which permits side-to-side rotation of the head

The third to sixth correspond to the structural patterns of the typical cervical vertebrae

The seventh called the vertebra prominens is somewhat different from vertebrae 3 through 6

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15
Q

Smaller bodies but larger spinal canal

Transverse processes: shorter, with transverse foramen for vertebral artery

Spinous processes of C2 to C6 often bifid (divided by a deep cleft or notch into two parts.)

1st and 2nd cervical vertebrae are unique - atlas & axis

A

Typical Cervical Vertebrae (C3-C6)

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16
Q

What is different about Typical Cervical Vertebrae (C3-C6) in relation to the vetebral bodies and spinal canal?

In regard

A

Smaller bodies but larger spinal canal

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17
Q

What is different about Typical Cervical Vertebrae (C3-C6) in regards to the transverse processes?

A

Transverse processes: shorter, with transverse foramen for vertebral artery

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18
Q

What is different about Cervical Vertebrae (C2-C6) in regards to the spinous processes?

A

Spinous processes of C2 to C6 often bifid (divided by a deep cleft or notch into two parts.)

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19
Q

The _____ transmit the vertebral arteries

A

transverse foramina

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20
Q

There are two craniovertebral joints:

A

Atlanto-occipital joint: between the atlas and occipital bone of the skull

Atlantoaxial joint: between the atlas and axis

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21
Q

Atlanto-occipital joint

Atlantoaxial joint

are the two what?

are they synovial?

What about their range of movement?

Articulations involve?

A

These are the two craniovertebral joints

Craniovertebral joints are synovial joints

They have a wider range of movement than the rest of the vertebral column

The articulations involve the occipital condyles, atlas, and axis

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22
Q

between the atlas and occipital bone of the skull

A

Atlanto-occipital joint:

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23
Q

between the atlas and axis

A

Atlantoaxial joint:

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24
Q

Craniovertebral joints are ____ joints

They have a _________than the rest of the vertebral column

The articulations involve the ______, _____, and ____

A

synovial

They have a wider range of movement than the rest of the vertebral column

The articulations involve the occipital condyles, atlas, and axis

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25
Q

ring of bone, has superior facets for occipital condyles

nodding movement at atlanto-occipital joint signifies “yes”

A

Atlas C1

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26
Q

Axis C2

__ or ___ process is body of atlas

pivotal movement at atlanto-axial joint signifies ____

A

dens or odontoid process is body of atlas

pivotal movement at atlanto-axial joint signifies “no”

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27
Q

Atlas C1

A

ring of bone, has superior facets for occipital condyles

nodding movement at atlanto-occipital joint signifies “yes”

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28
Q

dens or odontoid process is body of atlas

pivotal movement at atlanto-axial joint signifies “no”

A

Axis C2

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29
Q

Atlas C1

ring of bone, has superior facets for …

nodding movement at atlanto-occipital joint signifies ___

A

…occipital condyles

“yes”

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30
Q

The ________ is a strong band extending between right and left tubercles of C1 which holds the dens of C2 against the anterior arch of C1, forming the posterior wall of a socket for the dens

A

transverse ligament

slide 132 image

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31
Q

The transverse ligament is a strong band extending between right and left tubercles of ___ which holds the ____ of C2 against the anterior arch of ____, forming the posterior wall of a socket for the ____

(slide 132 image)

A

The transverse ligament is a strong band extending between right and left tubercles of C1 which holds the dens of C2 against the anterior arch of C1, forming the posterior wall of a socket for the dens

(slide 132 image)

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32
Q

The _____ is the strong superior continuation of the posterior longitudinal ligament across the central atlantoaxial joint through the foramen magnum to the central floor of the cranial cavity

(slide 133 image)

A

The tectorial membrane is the strong superior continuation of the posterior longitudinal ligament across the central atlantoaxial joint through the foramen magnum to the central floor of the cranial cavity

(slide 133 image)

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33
Q

The tectorial membrane is the strong superior continuation of the ____ _____ ligament across the ____ atlantoaxial joint through the foramen magnum to the ___ ____of the cranial cavity

(slide 133 image)

A

The tectorial membrane is the strong superior continuation of the posterior longitudinal ligament across the central atlantoaxial joint through the foramen magnum to the central floor of the cranial cavity

(slide 133 image)

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34
Q

is the colloquial name given to a fracture of both pedicles of vertebra C2 (axis)

A

Hangman’s fracture

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35
Q

Cause is forcible hyperextension of the head, commonly in falls, motor accidents, and sports activities in which the victim’s face or chin strike an unyielding object with the neck in extension, placing a large axial load onto the C2 vertebra

A

Hangman’s fracture

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36
Q

Cause of Hangman’s fracture

A

forcible hyperextension

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37
Q

Survival is relatively common since the fracture tends to expand the spinal canal at the C2 level, and it is not unusual for patients to walk in for treatment only to have the fracture discovered on X-rays

A

Hangman’s fracture

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38
Q

Hangman’s fracture on slide 135 for image of common MOA which is….

A

auto accident

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39
Q

Thoracic Vertebrae (T1-T12)

Articulate with the ____

Larger and stronger ____

Longer ___ and ___

Facets or demifacets on body for ___ __ ___

Facets on transverse processes (T1-T10) for ___ __ ___

A

Thoracic Vertebrae (T1-T12)

Articulate with the ribs

Larger and stronger bodies

Longer transverse and spinous processes

Facets or demifacets on body for head of rib

Facets on transverse processes (T1-T10) for tubercle of rib

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40
Q

Look at Facets and Demifacets on slide 137

A

YOU DID IT!

or you’re a turd

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41
Q

Rib Articulation:

Tubercle articulates with….

Head articulates with ___

A

….transverse process

vertebral bodies

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42
Q

Strongest and largest

Short thick spinous and transverse processes

A

Lumbar Vertebrae

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43
Q

Lumbar Vertebrae:

Strongest and largest

Short thick ___ and ____

A

Lumbar Vertebrae:

Strongest and largest

Short thick spinous and transverse processes

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44
Q

The sacrum is formed by the union of 5 sacral vertebrae, S1 – S5 (usually by age 30 years), and serves as a strong foundation for the….

A

pelvic girdle

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45
Q

Sacrum:

The auricular surface is the site of the synovial part of the…

A

sacroiliac joint.

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46
Q

The _____ is the continuation of the vertebral canal in the sacrum

A

sacral canal

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47
Q

It contains the nerve roots of the cauda equina

A

Sacrum

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48
Q

Sacrum:

Median sacral crest represents fused…

A

rudimentary spinous processes

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49
Q

Sacrum:

Medial (intermediate) crests represent fused…

A

articular processes (medial crests illustrated above, but not labeled)

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50
Q

Sacrum:

Lateral sacral crests are tips of transverse processes of…

A

fused sacral vertebrae

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51
Q

Spinous processes are not present on S_ and sometimes S_, resulting in formation of a _____ due to the absence of the spinous processes and associated laminae

A

Spinous processes are not present on S5 and sometimes S4, resulting in formation of a LARGE SACRAL HIATUS due to the absence of the spinous processes and associated laminae

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52
Q

The _____ represents the inferior articular process of S5 vertebra, and is a helpful guide to the location of the sacral hiatus

A

sacral cornu

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53
Q

The coccyx is formed by the fusion of….

The _____ are rudimentary articular processes

A

…4 coccygeal vertebrae, generally by age 30

coccygeal cornua

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54
Q

frequently used during labor

146

A

Caudal anesthesia (epidural block),

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55
Q

Caudal anesthesia (epidural block)

numbness in which nerves?

important landmarks

A

A local anesthetic agent injected into the sacral canal at the sacral hiatus, which

causes numbness in the regions innervated by the sacral and coccygeal nerves (approximately from the waist to the knees)

sacral and coccygeal cornu are important landmarks

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56
Q

Joints between vertebrae

We will distinguish two types of joints:

A

joints of the vertebral bodies (joints between vertebrae)

joints of the vertebral arches (joints between vertebral arches).

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57
Q

Intervertebral Discs

A

Between adjacent vertebrae absorbs vertical shock

Permit various movements of the vertebral column

Fibrocartilagenous ring with a pulpy center

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58
Q

Between adjacent vertebrae absorbs vertical shock

Permit various movements of the vertebral column

Fibrocartilagenous ring with a pulpy center

A

Intervertebral Discs

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59
Q

HNP - herniation of nucleus pulposus

_____ of the vertebral column pushes the nucleus pulposus ______ toward the thinnest part of the anulus fibrosus

A

Flexion

posteriorly

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60
Q

If degeneration of the HNP - herniation of nucleus pulposus

_______ ______ligament and wearing of the anulus have occurred, the nucleus pulposus may herniate into the vertebral canal and compress the spinal cord or the nerve roots of the cauda equina

A

posterior longitudinal

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61
Q

Compression by protruding disc

When an intervertebral disc protrudes, it may compress the nerve roots numbered one _____to the disc

but the IV disc forms the inferior part of the foramen and bulges out….

A

inferior

… below the exit of the nerve

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62
Q

Hyperflexion of the neck

A forcible hyperflexion of the cervical region may rupture the intervertebral disc….

The most commonly ruptured IV discs are those between _____ thereby compressing spinal nerve roots ____

IV disc protrusions result in pain in the….

A

….posteriorly without fracturing the vertebral body

C5 / C6 and C6 / C7,

C6 and C7, respectively

….neck, shoulder, arm, and hand

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63
Q

Severe hyperextension of the neck may stretch or tear the ___________

A

anterior longitudinal ligament

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64
Q

Rear-end automobile collision commonly results in such

A

hyperextension (whiplash) injury

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65
Q

Joints between vertebral arches

Zygapophyseal joints:

The joints of the _____ ____ are the zygapophysial joints (facet joints)

A

vertebral arches

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66
Q

Joints between vertebral arches

Zygapophyseal joints:

They are plane synovial joints (permit gliding) between the….

A

….superior and inferior articular processes of adjacent vertebrae

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67
Q

Accessory ligaments unite the laminae, transverse processes, and spinous processes, and help stabilize the joints

A

Zygapophysial joint

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68
Q

Injury and disease of zygapophysial joints:

Zygapophysial joints are close to the ______ through which the spinal nerves emerge from the vertebral canal

A

intervertebral foramina

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69
Q

Injury and disease of zygapophysial joints:

When the joints are injured or diseased from osteoarthritis, the ______ are often affected

This causes pain along the distribution patterns of the dermatomes and spasm in the muscles derived from the associated _____

A

spinal nerves

myotomes

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70
Q

means narrowing of one or more spinal foramina, commonly at C5/6 and C6/7 in the neck, and at L3/4, L4/5, and L5/S1 in the low back

A

Foraminal Stenosis

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71
Q

Foraminal Stenosis

Symptoms: associated with back or neck pain with ___ or _____.

In the lumbar region it may be associated with sciatic pain particularly after standing or walking for prolonged periods, due to….

A

sciatica or brachialgia

…..settlement in the spine decreasing the diameter of the foramen

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72
Q

Ligaments of the vertebral column

The _____ ligament is a strong, broad fibrous band that covers and connects anterior aspects of vertebral bodies and intervertebral discs

A

anterior longitudinal ligament

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73
Q

It extends from the atlas to the sacrum

The ligament maintains stability of the joints between vertebral bodies, and helps prevent hyperextension of the vertebral column

A

anterior longitudinal ligament

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74
Q

anterior longitudinal ligament extends from?

A

anterior longitudinal ligament extends from the atlas to the sacrum

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75
Q

The _____ ligament runs within the vertebral canal along the posterior aspect of the vertebral bodies

A

Posterior longitudinal ligament

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76
Q

It is narrower and weaker than the anterior longitudinal ligament

It helps prevent hyperflexion of the vertebral column and herniation or posterior protrusion of the discs

A

Posterior longitudinal ligament

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77
Q

helps prevent hyperflexion of the verebral column?

A

Posterior longitudinal ligament

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78
Q

The _____ are broad, yellow elastic fibrous tissue that join laminae of adjacent vertebral arches

A

Ligamenta flava (flavum)

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79
Q

They prevent separation of the vertebral lamina, arrest abrupt flexion of the vertebral column, and help prevent injury to the intervertebral discs

A

Ligamenta flava (flavum)

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80
Q

The ______ ligament joins tips of spinous processes from C7 to the sacrum

A

supraspinous

81
Q

The _____ _____ is a thickening of the supraspinous ligament in the neck, extending from C7 to the occipital protuberance

A

ligamentum nuchae

82
Q

Vasculature of the vertebral column

In general, a ______ is related around each vertebra, and supplies it

A

segmental artery

83
Q

Spinal arteries enter the IV foramina and divide, then are distributed to….

A

…. dorsal and ventral roots of spinal nerves and their coverings

84
Q

Venous drainage of the vertebral column

Spinal veins form _____ along the vertebral column both inside and outside the vertebral canal:

which two?

A

venous plexuses

Anterior vertebral venous plexus, both internal and external

Posterior vertebral venous plexus, both internal and external

85
Q

Venous drainage of the vertebral column:

Anterior vertebral venous plexus, both ___ and ____

Posterior vertebral venous plexus, both ___ and ____

A

internal and external

internal and external

86
Q

Venous drainage of the vertebral column

_____ veins are large and tortuous, and are in the substance of the vertebral bodies

A

Basivertebral

87
Q

Venous drainage of the vertebral column

_____ veins accompany the spinal nerves through the IV foramina and receive blood from the spinal cord and vertebral plexuses

A

Intervertebral

88
Q

The vertebral venous plexus is a _____ system.

As such, it is clinically significant because it can…

For example?

A

valveless

….transmit cancer metastases to distant locations that do not lie in the normal venous pathway.

For example: to the brain, but not to the lungs.

89
Q

Skeleton of the Rib Cage and Pectoral Girdle

Rib cage:

Externally visible features of the thoracic wall?

A

The serratus anterior, costal margin, and pectoralis major are easily distinguished

90
Q

Bony thorax

Formed by ?

A

Thoracic portion of the vertebral column

12 pairs of ribs with their costal cartilages

Sternum

91
Q

Bony thorax

Openings:

____, which is bounded by the first pair of ribs and the sternum

_____, which is larger, and closed by the diaphragm

A

Superior thoracic aperture

Inferior thoracic aperture

92
Q

Attributes of selected ribs:

Ribs 1 – 7

Have costal cartilage, and attach directly to the sternum

A

Vertebrosternal ribs

93
Q

Attributes of selected ribs:

Has the sharpest curvature of all the ribs

Articulates with the manubrium at a point below the clavicle

94
Q

Attributes of selected ribs:

Sternal costal articulations are direct to the body of the sternum

Referred to as “true ribs” (as are ribs 1 and 2)

A

Ribs 3 – 7

95
Q

Attributes of selected ribs

Ribs 8 – 10

Do not have a direct articulation with the sternum

Indirectly articulate with the sternum by joining the costal cartilage of rib 7

Costal arch is the arrangement of costal cartilages that provide for the indirect articulation of ribs 8, 9, and 10

Are termed “false ribs”

A

Vertebrochondral ribs

96
Q

Vertebrochondral ribs are termed what?

A

false ribs

97
Q

Do not have a direct articulation with the sternum

A

Vertebrochondral ribs

98
Q

Indirectly articulate with the sternum by joining the costal cartilage of rib 7

A

Vertebrochondral ribs

99
Q

Costal arch is the arrangement of costal cartilages that provide for the indirect articulation of ribs 8, 9, and 10

Are termed “false ribs”

A

Vertebrochondral ribs

100
Q

Have no anterior articulation with the sternum

Are called floating ribs (due to the lack of anterior articulation with the sternum)

Are also false ribs

A

Ribs 11 and 12

101
Q

floating ribs

A

Ribs 11 and 12

102
Q

The head has either one articulating facet which articulates with the ________________, or two articulating facets which articulate with ___________________

A

facet of the body of the corresponding vertebra

the demifacets of the bodies of adjacent vertebrae, as well as the intervertebral disc

103
Q

The ______ has a site of articulation of the rib with the transverse process of posterior vertebrae of the same number

104
Q

The ____ attaches the head of the rib to the body (shaft) of the rib

105
Q

The _______ is the site of costochondral articulation of the rib to its cartilage

A

sternal extremity

106
Q

The ______ begins near the tubercle on the body of the rib and provides some protection for the intercostal nerve and vessels

A

costal groove

107
Q

The ______ is an abrupt change in the curvature of the shaft of the rib

A

costal angle

108
Q

The sternum is a flat, elongated bone in the middle of the anterior portion of the thoracic cage

Average length is _____ in adults

Composed of 3 parts?

A

5 to 6 inches

Manubrium
Body
Xiphoid process

109
Q

lies between the clavicles, and is the most superior landmark on the sternum

A

Jugular notch (suprasternal notch)

110
Q

is the point of articulation of the sternal extremity of the clavicle with the manubrium

A

Sternoclavicular notch

111
Q
  • At the junction of the manubrium and body of the sternum

- Is the location of the cartilaginous articulation of the second pair of ribs

A

Sternal angle

112
Q

Articulations

Costovertebral, Sternocostal images on slide 188 and 189

A

slide 188 and 189… do it!

113
Q

Each rib articulates posteriorly with the body and ________- of a thoracic vertebra

A

transverse process

114
Q

The posterior articulation of each rib is _____ in position to the anterior articulation

115
Q

The head of a typical rib (2-8) articulates with the ___ ___ ___ of the thoracic vertebra of the same number, and the costal tubercle articulates with the…..

A

superior costal facet

….transverse process of the vertebra of the same number

116
Q

Articulations

Xiphisternal, Interchondral, Costochondral

Look at slide 191

A

slide 191… Your country needs you!!!

117
Q

Articulation between xiphoid process and the body of the sternum

A

Xiphisternal joint

118
Q

Synchondrosis

A

Xiphisternal joint

119
Q

Progressively fuses as one ages, becoming a synostosis in older persons

A

Xiphisternal joint

120
Q

Articulation between costal cartilages of . . .
6th – 7th ribs
7th – 8th ribs
8th – 9th ribs

Synovial joints (they are synovial plane joints)

A

Interchondral joint

121
Q

Articulation of lateral end of costal cartilage with sternal end of rib

Cartilaginous joint

A

Costochondral joint

122
Q

is an inflammation of the junctions where the upper ribs join with the cartilage that holds them to the sternum

A

Costochondritis

123
Q

The condition causes localized chest pain that can be reproduced by pushing on the cartilage in the front of the ribcage

A

Costochondritis

124
Q

Costochondritis is a relatively harmless condition and usually goes away without treatment. The cause is usually unknown… T or F?

A

True my good Watson

125
Q

Superficial group of muscles that produce and control limb movements

Intermediate group of muscles that are involved in respiration

A

Extrinsic back muscles

126
Q

True back muscles (i.e. intrinsic back muscles)

Specifically act on the vertebral column, producing its movements and maintaining posture

A

Intrinsic back muscles

127
Q

Superficial back muscles

The group comprises?

A 
Trapezius  
Levator scapulae  
Rhomboideus 
----Minor 
-----Major 
Latissimus dorsi

These muscles are discussed as part of upper limb coverage

128
Q

These muscles are discussed as part of upper limb coverage

A

Superficial back muscles

129
Q

The serratus posterior group comprises superficial respiratory muscles

A

Intermediate back muscles

130
Q

The serratus posterior superior lies….

A

deep to the rhomboids, running underneath the shoulder blades

131
Q

Intermediate back muscles

Serratus posterior inferior is deep to the

A

latissimus dorsi

132
Q

Intermediate back muscles

Both serratus muscles are innervated by

A

intercostal nerves

133
Q

Respiratory muscle
Deep to rhomboideus muscles

Elevates rib cage – important in inspiration

Innervated by spinal intercostal nerves

A

Serratus posterior superior (posterior superior serratus)

134
Q

Serratus posterior superior AKA

A

(posterior superior serratus)

135
Q

Respiratory muscle

Deep to latissimus dorsi

Depresses lower four ribs – important in forceful expiration

Innervated by spinal intercostal nerves

A

Serratus posterior inferior (posterior inferior serratus)

136
Q

Serratus posterior inferior AKA

A

(posterior inferior serratus)

137
Q

Intrinsic muscle groups

A

Erector spinae

Transversospinal (transversospinalis group of muscles)

138
Q

Muscles that Move the Vertebrae

A

Quite complex due to overlap

Erector spinae fibers run longitudinally

Smaller, deeper muscles

139
Q

Muscles that Move the Vertebrae:

run longitudinally
3 groupings

Spinalis (medial)

Longissimus (intermediate)

Iliocostalis (lateral)

A

Erector spinae fibers

140
Q

Muscles that Move the Vertebrae:

Smaller, deeper muscles

A

transversospinalis group: semispinalis, multifidis and rotatores

run from transverse process to dorsal spine of vertebrae above and help rotate vertebrae

141
Q

Erector spinae group of muscles

LOOK AT SLIDE 202

A

LOOK AT SLIDE 202… GREAT VISUAL OF THE AFOREMENTIONED FLASH CARDS

142
Q

Names of the transversospinalis group of muscles from deepest to most superficial:

Mnemonic:
Rotate
My
Spine

A

rotatores muscles
multifidus muscles
semispinalis muscles

143
Q

Transversospinalis group of muscles is deep to erector spinae. They are innervated by

IMAGE ON SLIDE 203

A

dorsal rami of spinal nerves.

144
Q

Transversospinal actions

A

Stabilization of individual vertebrae

Rotation

Extension

Lateral bending

145
Q

Innervation of intrinsic back muscles by….

A

…posterior (dorsal) primary rami

146
Q

These imaginary lines facilitate anatomical descriptions, identification of thoracic areas, and the location of lesions

LOOK AT SLIDE 206 for these lines

A

LOOK AT SLIDE 206 for these lines

Description to follow

147
Q

line runs vertically along the anterior axillary fold, which is formed by the border of the pectoralis major as it spans from the thorax to the humerus

A

Anterior axillary

148
Q

line runs from the apex (deepest part) of the axilla, parallel to the anterior axillary line

A

Midaxillary

149
Q

line is parallel to the anterior axillary line, vertically along the posterior axillary fold formed by the latissimus dorsi and teres major muscles as they span from the back to the humerus

A

Posterior axillary

150
Q

(midvertebral, midspinal) line is a vertical line described by the tips of the spinous processes of the vertebrae

A

Posterior median

151
Q

are parallel to the posterior median line and cross the inferior angles of the scapulae

A

Scapular lines

152
Q

Groups of muscles in the thoracic wall:

A

Thoracoappendicular muscles

Muscles of the thorax that assist in breathing

153
Q

Anterior thoracic muscles or axial muscles that produce and control limb movements

Generally considered to be upper limb muscles

A

Thoracoappendicular muscles

154
Q

Groups of muscles in the thoracic wall:

Muscles of the thorax that assist in breathing

Alter the size of the thoracic cavity so breathing can occur

Comprise????

A

Diaphragm*

Scalenes*

Some thoracoappendicular muscles*

Intercostal muscles

155
Q

Thoracoappendicular
muscles

These are upper limb muscles that attach to the thoracic cage
Comprise ????

A

Anteriorly…

  • —Pectoralis major
  • —Pectoralis minor
  • —Subclavius
  • —Serratus anterior

Posteriorly: latissimus dorsi

These muscles are discussed as part of upper limb coverage

156
Q

These muscles are discussed as part of upper limb coverage

A

Thoracoappendicular muscles

157
Q

Groups of muscles in the thoracic wall:

These are upper limb muscles that attach to the thoracic cage
Comprise

A

Anteriorly…

  • —Pectoralis major
  • —Pectoralis minor
  • —Subclavius
  • —Serratus anterior

Posteriorly: latissimus dorsi

158
Q

Intercostal muscles

Occupy the intercostal spaces

Comprise three layers…. which three layers?

A

Outermost layer – external intercostal

Middle layer – internal intercostal

Innermost layer - comprised of the following:
Transversus thoracis (anteriorly)
Subcostal muscles
Innermost intercostal muscles (posteriolaterally)

159
Q

Intercostal muscles are ALL innervated by

A

segmental intercostal nerves

160
Q

Outermost layer (once pectoralis has been reflected)

A

External intercostal muscles

161
Q

External intercostal muscles

Travels obliquely (from lateral to medial) downward from the ____ border of one rib to the _____ border of the rib below

A

inferior

superior

162
Q

Elevates the rib cage (muscle of inspiration)

A

External intercostal muscles

163
Q

Originate from the superior border of a rib

Insert on the inferior border of the rib above

A

Internal intercostal muscles

164
Q

Internal intercostal muscles

Origination?

Insertion?

A

Originate from the superior border of a rib

Insert on the inferior border of the rib above

165
Q

Fibers are oriented at right angles to the external intercostal muscle (angle up and in)

Depress the rib cage, which is important in forced expiration

A

Internal intercostal muscles

166
Q

Internal intercostal muscles

Fibers are oriented at…

A

….right angles to the external intercostal muscle (angle up and in)

167
Q

Originate from the sternum

Insert on cartilages of ribs 2 - 6

Depress the ribs

A

Transverse thoracic muscles

168
Q

Transverse thoracic muscles

Origination?

Insertion?

Action?

A

Originate from the sternum

Insert on cartilages of ribs 2 - 6

Depress the ribs

169
Q

Innermost layer of ribs have two types of muscles

A

Subcostal muscles

Innermost intercostal muscles

170
Q

Subcostal muscles bridge two intercostal spaces, and probably elevate the ribs, making them muscles of inspiration

Innermost intercostal muscles bridge an intercostal space, and are probably muscles of expiration

A

Innermost layer

171
Q

Nerves of the thoracic wall

The 12 pairs of thoracic spinal nerves supply the thoracic wall.

The general distribution in the thoracic wall reflects the structure of the thoracic cage in that the nerves—intercostal nerves—run in the…

A

intercostal spaces parallel to the ribs

172
Q

Upon leaving the intervertebral foramina the spinal nerves divide into….

A

anterior and posterior primary rami.

173
Q

of nerves T1 –T11 form the intercostal nerves.

A

The anterior rami

174
Q

pass posteriorly to supply the joints, muscles, and skin of the back in the thoracic region

A

The posterior rami

175
Q

Cutaneous innervation to the thoracic wall:

Are generally supplied by dorsal roots of spinal nerves C5 and T1 – T6

C5 and T1 also supply the upper limb

Which part of thorax?

A

Dermatomes of the anterior thorax

176
Q

Dermatomes of the anterior thorax

Are generally supplied by dorsal roots of spinal nerves…

__ and ___ also supply the upper limb

A

….C5 and T1 – T6

C5 and T1

177
Q

Dermatome landmarks for the thorax and abdomen

jugular (suprasternal) notch and clavicles (actually, the clavicles generally coincide with the boundary between C4 and C5)

Which dermatome?

178
Q

Dermatome landmarks for the thorax and abdomen

just inferior to jugular notch, and down anterior portion of arm

Which dermatome?

179
Q

Dermatome landmarks for the thorax and abdomen

nipples

Which dermatome?

180
Q

Dermatome landmarks for the thorax and abdomen

xiphoid process

Which dermatome?

181
Q

Dermatome landmarks for the thorax and abdomen

umbilicus

Which dermatome?

182
Q

Dermatome landmarks for the thorax and abdomen

umbilicus

Which dermatome?

183
Q

is the most superior dermatome of the back that does not supply the upper limb.

A

T1

Just count sequentially up or down from there.

184
Q

The general pattern of vascular distribution in the thoracic wall reflects the structure of the thoracic cage in that the arteries—intercostal arteries—run in the intercostal spaces parallel to the ribs

A

Arteries of the thoracic wall

185
Q

Intercostal arteries:

Arise from the aorta

Travel toward the anterior thorax, giving off a lateral cutaneous branch

A

Posterior intercostal arteries

186
Q

Intercostal arteries:

Is a branch of the subclavian artery

Gives rise to the anterior intercostal artery, which anastamoses with the posterior intercostal arteries from the aorta (just discussed)

Gives rise to perforating cutaneous branches that supply the skin in that area

A

Internal thoracic artery

187
Q

Internal thoracic artery

Gives rise to the ?

Which anastamoses with?

Also gives rise to this which supply the skin?

A

Gives rise to the anterior intercostal artery, which anastamoses with the posterior intercostal arteries from the aorta (just discussed)

Gives rise to perforating cutaneous branches that supply the skin in that area

188
Q

Veins of the thoracic wall

Intercostal veins accompany the intercostal arteries (and nerves)

They lie ____ in the costal grooves

Each side has . .

which two veins anastamose?

A

most superior

….Eleven posterior intercostal veins
Eleven anterior intercostal veins

Anterior and posterior intercostal veins anastamose

189
Q

Veins of the thoracic wall:

The _______ are tributaries of the internal thoracic veins (the internal thoracic veins accompany the internal thoracic arteries)

A

anterior intercostal veins

190
Q

Veins of the thoracic wall:

Most posterior intercostal veins end in the…

A

azygos / hemiazygos venous system

images on slide 229 and 230

191
Q

azygos / hemiazygos venous system

A

Where MOST posterior intercostal veins end

images on slide 229 and 230

192
Q

Most superficial lymphatic vessels superior to the umbilicus drain to the

A

axillary lymph nodes

slide 231

193
Q

Some lymphatic vessels drain medially and deeply to the

A

parasternal and anterior diaphragmatic lymph nodes

slide 231

194
Q

Superficial lymph nodes inferior to the umbilicus drain to the

A

superficial inguinal lymph nodes

slide 231

195
Q

space between adjacent ribs

A

intercostal space

196
Q

the location of muscles, nerves, and vessels of the thoracic wall

A

intercostal space

197
Q

The word VAN describes the sequence of…

A

vein, artery, nerve for structures in the intercostal space (dissected, above showing posterior part of intercostal space)

slide 232

198
Q

Intercostal nerve block:

Local anesthesia of an intercostal space is produced by injecting a local anesthetic agent around the intercostal nerves, infiltrating the anesthetic around the…

A

…intercostal nerve trunk and its collateral branches

199
Q

Intercostal nerve block:

Considerable overlap occurs because any particular area of skin usually receives innervation from two adjacent dermatomes, therefore…

A

complete loss of sensation usually does not occur unless two or more intercostal nerves are anesthetized

AP1 Block 4 (5 decks)

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