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CV & R - Week 1 > Intro To The Thorax > Flashcards

Intro To The Thorax Flashcards

1
Q

What is the thorax?

A
  • found between neck and abdomen

- consists of thoracic cavity, its contents and the wall that surrounds it

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2
Q

What is contained with the thoracic cavity?

A
  • heart
  • lungs
  • oesophagus
  • part of trachea
  • major blood vessels
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3
Q

What bones make up the thoracic wall?

A
  • sternum
  • thoracic vertebrae
  • ribs
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4
Q

Other than bones, what makes up the thoracic wall?

A
  • costal cartilage of ribs
  • intercostal muscles
  • arteries, veins and nerves that supply it
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5
Q

What are the three segments of the sternum?

A
  • manubrium
  • body
  • xiphoid process
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6
Q

What are true ribs?

A
  • ribs that are attached directly to the sternum via their costal cartilage
  • ribs 1-7
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7
Q

What are false ribs?

A
  • ribs with indirect attachment to the sternum
  • their costal cartilage connects to the cartilage of of the rib above
  • ribs 8-10
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8
Q

What are free/floating ribs?

A
  • these do not attach to the sternum at all, even indirectly
  • they end in posterior abdominal musculature
  • usually 11th and 12th ribs, sometimes the 10th
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9
Q

Which ribs are typical and what are their components?

A
  • ribs 3-9
  • head
  • crest of head
  • neck
  • tubercle
  • body
  • costal angle
  • costal groove
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10
Q

Which ribs are atypical?

A
  • 1, 2 and 10-12
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11
Q

Why is the first rib atypical?

A
  • single facet on its head for articulation with T1 only
  • two transversesly directed grooves cross superior surfacae for the subclavian vessels
  • these grooves are separated by a scalene tubercle and ridge
  • anterior scalene muscle is attached to scalene tubercle
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12
Q

Why is the second rib atypical?

A
  • rough area on the upper surface called the tuberosity for serratus anterior
  • part of serratus anterior attaches here
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13
Q

Why are ribs 10-12 atypical?

A
  • 10-12 have one facet on their heads and so articulate with only one vertebra
  • ribs 11 and 12 are short and have no neck or tubercle
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14
Q

Describe the head of typical ribs.

A
  • wedge shaped
  • 2 facets, one for corresponding vertebra and one for vertebra above it
  • facets separated by crest of the head
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15
Q

Describe the neck of typical ribs.

A
  • connects the head of the rib with the body at the level of the tubercle
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16
Q

Describe the tubercle of typical ribs.

A
  • located at the junction of the neck and body
  • smooth articular part articulates with corresponding transverse process of the vertebra
  • rough nonarticular part provides attachment for costotransverse ligament
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17
Q

Describe the body of typical ribs.

A
  • thin, flat and curved
  • curved most markedly at costal angle where ribs turns anterolaterally
  • concave internal surface has a costal groove paralleling the inferior border of the rib which provides some protection for intercostal nerves and vessels.
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18
Q

Other than where the ribs turn anterolaterally, what else does the costal angle demarcate?

A

The lateral limit of attachment of the deep back muscles to the ribs

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19
Q

What is the purpose of costal cartilage?

A
  • to prolong the ribs anteriorly

- contribute to elasticity of thoracic wall providing a flexible attachment for their anterior tips

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20
Q

What is the costal margin?

A

Formed by ribs 8, 9 and 10’s costal cartilage attaching the cartilage above it.

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21
Q

What are the typical features of vertebrae?

A
  • body
  • vertebral arch
  • spinous process
  • transverse processes
  • articular processes
  • pedicles
  • lamina
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22
Q

What are the characteristic features of thoracic vertebrae?

A
  • bilateral costal facets/demifacets on the vertebral bodies for articulation with the head of the ribs
  • costal facets on the transverse processes for articulation with the tubercles of the ribs (excluding inferior 2/3 thoracic vertebrae)
  • long, inferiorly slaning spinous processes
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23
Q

What bony landmark can be used to identify the level of the 2nd rib?

A

The sternal angle

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24
Q

List the functions of the thoracic wall.

A
  • protects the contents of the thoracic cavity
  • provides the mechanics for breathing
  • provides for attachment of neck, back, upper limb and abdominal musculature
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25
Q

What are the apertures of the thoracic wall?

A
  • superior thoracic aperture

- inferior thoracic aperture

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26
Q

What passes through the superior thoracic aperture?

A
  • structures to and from the neck and upper limbs
  • trachea
  • oesophagus
  • nerves and vessels that supply and drain the head, neck and upper limbs
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27
Q

What is the relevance of the inferior thoracic aperture?

A

Provides a rim to which the diaphragm is attached. Structures which need to pass between the thorac and the abdomen traverse openings in the diaphragm.

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28
Q

List some diaphragmatic apertures and the structures which pass through them.

A
  • the caval opening for the inferior vena cava and terminal branches of right phrenic nerve
  • the oesophageal hiatus for the oesophagus, right and left vagus nerves and oesophageal branches of gastric artery/vein
  • the aortic hiatus for the aorta, thoracic duct and azygous vein
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29
Q

At which vertebral level would the caval opening be found?

A

T8

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30
Q

At which vertebral level would the oesophageal hiatus be found?

A

T10

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31
Q

At which vertebral level would the aortic hiatus be found?

A

T12

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32
Q

List the joints found in thoracic wall.

A
  • intervertebral
  • costovertebral (joints of head of ribs and costotransverse)
  • costochondral
  • interchondral
  • sternocostal
  • sternoclavicular
  • manubriosternal
  • xiphisternal
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33
Q

Describe the intervertebral joints of T1 - T12.

A

Type: symphysis (secondary cartilaginous)
Articulation: adjacent vertebral bodies bound together by IV disc
Ligaments: anterior and posterior longitudinal
Comments: movement mostly limited to small degress of rotation

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34
Q

Describe the costovertebral joints, both for joints of head of ribs and costotransverse.

A

Type: synovial plane joints
Articulation: head of each rib with superior demifacet of corresponding vertebra and inferior demi facet of superior vertebra and joinging IV disc; tubercle of the rib with transverse process of corresponding vertebra
Ligaments: radiate and intra-articular ligaments of head of rib; lateral and superior costotransverse
Comments: heads of ribs 1, 11 and 12 articulate only with vertebal body of same number; ribs 11 and 12 do not articulate with transverse process of vertebra of same number.

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35
Q

Describe the costochondral joints.

A

Type: primary/hyaline cartilaginous
Articulation: lateral end of costal cartilage with sternal end of rib
Ligaments: cartilage and bone bound together by periosteum
Comments: no movement normally occurs at this joint

36
Q

Describe the interchondral joints.

A

Type: synovial plane joint
Articulation: between costal cartilages of 6 and 7, 7 and 8, 8 and 9 (ribs)
Ligaments: interchondral ligaments
Comments: articulation between costal cartilages of ribs 9 and 10 is fibrous

37
Q

Describe the sternocostal joints.

A

Type: 1st = primary cartilaginous joint; 2nd - 7th = synovial plane joints
Articulations: 1st costal cartilage with manubrium of sternum; 2nd - 7th costal cartilages with body of sternum.
Ligaments: anterior and posterior radiate sternocostal, intra-articular
Comments: articular cavities are often absent, fibrocartilage covers articular surfaces

38
Q

Describe the sternoclavicular joints.

A

Type: saddle type of synovial joint
Articulation: sternal end of clavicle with manubrium of sternum and first costal cartilage
Ligaments: anterior and posterior sternoclavicular, costoclavicular
Comments: this joint is divided into 2 compartments by an articular disc

39
Q

Describe the manubriosternal joint.

A

Type: secondary cartilaginous
Articulation: between manubrium and body of sternum
Comments: this joint will often fuse and become synostoses in older people

40
Q

Describe the xiphisternal joint.

A

Type: primary cartilaginous
Articulation: between xiphoid process and body of sternum
Comments: this joint often fuses and becomes synostoses in older people

41
Q

Describe the diaphragm.

A

Attachments: L1 - L3 vertebrae, inferior 6 costal cartilages and adjacent ribs, xiphoid process
Innervation: phrenic nerve (C3-C5_

42
Q

List the muscles of the thoracic wall.

A
  • serratus posterior superior
  • serratus posterior inferior
  • levator costarum
  • intercostal muscles
  • transverse thoracis
43
Q

Describe serratus posterior superior.

A

Superior attachment: nuchal ligament, spinous processes of C7-T3
Interior attachment: superior borders of ribs 2-4
Innervation: 2nd - 5th intercostal nerves
Main action: proprioception, elevate ribs

44
Q

Describe serratus posterior inferior.

A

Superior attachment: spinous processes of T11-L2
Interior attachment: inferior borders of ribs 8 - 12 near their angles
Innervation: anterior rami to T9-T12 spinal nerves
Main action: proprioception, depress ribs

45
Q

Describe levator costarum.

A

Superior attachment: transverse processes of C7-T11
Interior attachment: subjacent ribs between tubercle and anlge
Innervation: posterior primary rami of C8 - T11 nerves
Main action: elevate ribs

46
Q

Describe the intercostal muscles.

A

Superior attachment: inferior border of the ribs
Interior attachement: superior border of rib below
Innervation: intercostal nerve

47
Q

What is the main action of the external intercostal muscles?

A
  • to elevate the ribs during forced inspiration
48
Q

What is the main action of the internal and innermost intercostal muscles?

A
  • interosseous part depresses the ribs during forced respiration
  • interchondral part evelates ribs during forced respiration
49
Q

In which direction do the muscle fibres of the external intercostal muscles run?

A

Anteroinferiorly

50
Q

In which direction do the muscles fibres of the internal intercostal muscles run?

A

Posteroinferiorly

51
Q

Describe the subcostal muscle.

A

Superior attachment: internal surface of lower ribs near their angles
Interior attachment: superior borders of 2nd or 3rd ribs below
Innervation: intercostal nerve
Main action: probably act similarly to internal intercostal muscles

52
Q

Describe transversus thoracis.

A

Superior attachment: posterior surface of lower sternum
Interior attachment: internal surface of costal cartilages 2-6
Innervation: intercostal nerve
Main action: weakly depress ribs, possibly proprioception

53
Q

What is the significance of the ribs sloping inferiorly in relation to elevation of the ribs?

A

Increases the anterioposterior and lateral dimensions of the thorax

54
Q

What is contained in the intercostal neurovascular bundle?

A

(Superior to inferior)

  • intercostal vein
  • intercostal artery
  • intercostal nerve
  • a collateral branch also exists inferiorly
55
Q

Which anterior rami form the intercostal nerves?

A

T1 - T11

56
Q

Which anterior rami forms the subcostal nerve?

A

T12

57
Q

Briefly describe the intercostal arteries.

A
  • posterior and anterior anastomose (good back up system)
  • posterior intercostal arteries originate from aorta
  • anterior intercostal arteries originate from internal thoracic artery or its branches
58
Q

Describe the internal thoracic artery.

A
  • originates from the subclavian artery
  • bifurcates into musculophrenic and superior epigastric arteries
  • if there is a stricture of the proximal aorta the internal thoracic arteries and anterior intercostal arteries can expand to maintain a blood supply
59
Q

List the three compartments of the thoracic cavity.

A
  • left and right pleural cavites

- mediastinum

60
Q

List the layers of the pericardium.

A

(From innermost to outermost)

  • visceral layer serous pericardium
  • parietal layer serous pericardium
  • fibrous pericardium
61
Q

What are the 2 pleural layers of the pleural cavities?

A

(Innermost to outermost)

  • visceral pleura
  • parietal pleura
62
Q

Where is the pericardial cavity found?

A

Between the visceral and parietal layers of serous pericardium.

63
Q

Where are the pleural cavities found?

A

Between the visceral and parietal pleura.

64
Q

What is the importance of the thin layer of fluid in the pericardial and pleural cavities?

A

It provides lubrication. This is important as the heart and lungs are constantly expanding and contracting.

65
Q

What is a serous membrane composed of?

A

Mesothelium = a layer of simple squamous epithelial cells supported by connective tissue.

66
Q

The parietal pleura can be subdivided according to the part of the body that it comes in contact with. List the subdivisions.

A
  • mediastinal
  • cervical
  • costal
  • diaphragmatic
67
Q

Where are the visceral and parietal pleura continuous with each other?

A

At the hilum of the lungs.

68
Q

What are the pleural recesses?

A

Potential spaces that the lungs can move into during inspiration.

69
Q

What is the clinical important of the pleural recesses?

A

They provide a location where fluid can accumulate.

70
Q

What are the two pleural recesses present in each pleural cavity?

A
  • costodiaphragmatic

- costomediastinal

71
Q

What is thoracentesis?

A

A procedure to remove fluid or air from around the lungs. A needle is inserted through the chest wall into the pleural space.

72
Q

Describe a thoracentesis procedure.

A
  • the patient sits upright
  • hypodermic needle inserted into 9th intercostal space in the midaxillary line during expiration
  • needle should be angled upward
  • needle inserted superior to rib, high enough to avoid damage to collateral vessels
  • the needle passed through the intercostal muscles and costal parietal pleura into the pleura cavity
  • fluid/air/blood/pus removed
73
Q

What are the surface landmarks of the thorax?

A
  • jugular/suprasternal notch
  • sternal angle
  • anterior median line
  • midclavicular lines
  • axillary fossa
  • anterior axillary line
  • midaxillary line
  • posterior axillary line
74
Q

Describe the sternocleidomastoid muscle.

A

Origin: sternal head - anterior surface of manubrium sterni; clavicular head - upper surface of medial third of the clavicle.
Insertion: lateral surface of mastoid process of temporal bone and adjacent part of superior nuchal line.
Innervation: Spinal accessory nerve (CN XI), proprioception from cervical plexus.
Main action: one muscle - head tipped to shoulder on same side and rotated to look at opposite side, two muscles - head moves forwards. May be involved in forced expiration.

75
Q

Where does the lateral thoracic artery originate from and what does it supply?

A

Origin: first part of axillary artery and runs across first intercostal space to uppe thoracic wall.
Supplies: upper thoracic wall.

76
Q

Where does the internal thoracic artery originate from and what does it supply?

A

Origin: the inferior surface of the first part of the subclavian artery opposite the thyrocervical trunk.
Supplies: intercostal spaces, breast, transversus thoracis, anterior mediastinum.

77
Q

What structures drain into the internal thoracic veins and where does it then drain to?

A

It drains to the braciocephalic veins after receiving deoxygenated blood from the 8-10th intercostal muscles, transversus thoracis and sternal region.

78
Q

Where does the long thoracic nerve originate from and what does it innervate?

A

Origin: ventral rami of C5, C6 and C7
Innervates: serratus anterior

79
Q

Describe pectoralis major.

A

ORIGIN: clavicular head - anterior surface of medial half of calvicle; sternocostal head - anterior surface of sternum, superior six costal cartilages and aponeurosis of external oblique muscles.
INSERTION: lateral lip of intertubercular sulcus of humerus.
INNERVATION: lateral and medial pectoral nerves.
MOVEMENTS: adducts and medially rotates humerus, draws scapula anteriorly and inferiorly. Acting alone, clavicular head flexes humerus and sternocostal head extends it from flexed position.

80
Q

Describe pectoralis minor.

A

ORIGIN: 3rd - 5th ribs near their costal cartilages.
INSERTION: medial border and superior surface of coracoid process of scapula.
INNERVATION: medial pectoral nerve
ACTION: depresses shoulder, pulls scapula forward, raises ribs in inspiration when scapula is fixed.

81
Q

Describe serratus anterior.

A

ORIGIN: exteral surface of lateral parts of ribs 1 - 8
INSERTION: anterior surface of medial border of scapula.
INNERVATION: long thoracic nerve
ACTION: protracts scapula and holds it against thoracic wall, rotates scapula.

82
Q

List the scalene muscles.

A
  • scalenus anterior
  • scalenus medius
  • scalenus posterior
83
Q

Which muscles do the brachial plexus and axillary artery pass between?

A

Scalenus anterior and scalenus medius.

84
Q

Which muscles does the subclavian vein pass between?

A

Scalenus anterior and sternocleidomastoid.

85
Q

What surgical procedure uses the internal thoracic artery?

A

Coronary artery bypass grafts

86
Q

At what vertebral level is the sternal angle?

A

At level of T4 and T5 IVD posteriorly

87
Q

What structures are transected by a horizontal section through the sternal angle?

A
  • RATPLANT*
  • 2nd Rib
  • Aortic arch
  • bifurcation of Trachea
  • Bifurcation of pulmonary trunk
  • left recurrent laryngeal/ligamentum arteriosum
  • Azygous vein
  • nerves - cardiac plexus
  • thoracic duct

CV & R - Week 1 (10 decks)

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