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Gross Anatomy > Lecture 6: Thorax > Flashcards

Lecture 6: Thorax Flashcards

1
Q

Surface anatomy points (4)

A
  1. Midclavicular line: Passes just medial to the nipple
  2. Mid-axillary line: descends from midpoint of Avila
  3. Nipple: dome of respiratory diaphragm at T4 level
  4. Xipoid Process: at level of T10
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2
Q

Midclavicular Line

Surface Anatomy

A

Passes just medial to nipple

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3
Q

Mid-axillary line

surface anatomy

A

descends from midpoint to avila

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4
Q

Nipple

surface anatomy

A

dome of respiratory diaphragm at T4 level

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5
Q

Xiphoid precess

surface anatomy

A

at level T10

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6
Q

Bones of Thoracic Wall (2)

A
  1. Sternum
    A. Manubrium
    B. Body
    C. Xiphoid Process
  2. Ribs- 12 pairs
    A. True 1-7
    B. False 8-12
    C. Floating 11-12
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7
Q

Muscles of Thoracic Wall

movement
(3) muscles

A
  1. Anterior Thoracic Wall muscles that act on upper limb

A. Pec. major
B. Pec. Minor
C. Serratus Anterior

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8
Q

Types of Joints in Thoracic Wall (4)

A
  1. Sternoclavicular: saddle-type synovial
  2. Sternocostal: primary cartilagenous/synchondroses
  3. Costcohondral: Primary cartilaginous
  4. Intechondral: Synovial plane

See slide 7-9

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9
Q

Nerves of Thoracic Wall (3)

A
  1. intercostal nerves
  2. 12th spinal nerve
  3. Neurovascular bundle
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10
Q

Intercostal Nerves

A

anterior rami of first 11 thoracic spinal nerves

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11
Q

12th spinal nerve

A

gives rise to subcostal nerve

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12
Q

Neruvascular bundle (NAV)

A

lives inferior to each rib

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13
Q

Female Breast (2)

A
  1. mammary tissue composed of compound tubuloacinar glands
    - organized into 15-20 lobes, separated by fibrous connective tissue (suspensory of ligaments of cooper)
  2. Tail of spence (axillary tail)- extension of mammary tissue superolatterally toward axilla
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14
Q

Suspensory ligaments of cooper

A

fibrous connective tissue separating tubuloacinar glands in female breast

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15
Q

Tail of spence

A

“axillary tail”

extension of mammary tissue superolatterally toward the axilla

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16
Q

Female Breast Lymphatics (3)

A
  1. lymph is drained from breast tissues
  2. 75% of lymphatic drainage is to the axillary nodes
  3. Remainder lymph drains to infraclavicular, pectoral, or parasternal nodes
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17
Q

Breast cancer clinical pearl

A

~ 50% breast cancer develops in upper, outer, quadrant of the breast

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18
Q

Sings Female Breast Cancer

A
  1. Nipple Retraction
  2. Skin Edema
  3. Skin dimpling
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19
Q

Nipple Retraction/Breast Cancer

A

Carcinomatous involvement of mammary ducts may cause duct shortening and retraction or inversion of nipple

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20
Q

Skin Edema

A

Involvement and obstruction of SQ lymphatic by tumor result in lymphatic dilation and lymph accumulation in the skin

Reluctant edema created orange peel appearance owing to prominence of skin gland orifices

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21
Q

Skin Dimpling

A

Dimpling of skin over a carcinoma is caused by involvement and retraction of suspensory cooper’s ligaments

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22
Q

Lungs (2)

A
  1. lie in pleural cavityA. Visceral Pleura: lines the lung
    B. Parietal Pleura: Line’s the cavity/thoracic wall
  2. Lobes
    A. R=3 lobes
    B. L=2 lobes and lingual
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23
Q

Visceral Pleura of Lung

A

lines the lung

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24
Q

Parietal Pleura

A

line’s cavity/thoracic wall

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25
Q

Lobes of Lung (2)

A
  1. Right=3 lobes

2. Left= 2 lobes + lingula

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26
Q

External Lung Features (9)

A
  1. Lobes
  2. Horizontal Fissure
  3. Oblique Fissure
  4. Impressions
  5. Hilum
  6. Lungula
  7. Cardiac notch
  8. Pulmonary Ligament
  9. Bronchopulmonary Segment
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27
Q

Lobes: external features

A
  1. Three Lobes R lung: Superior, Middle, Inferior

2. Two Lobes L: Superior/inferior

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28
Q

Horizontal Fissure of lung

A

external features of lung

Only in R lun, extends along line of 4th rib

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29
Q

Oblique fissure of lung

A

External features of lung

On both lungs, extends from T2-T3 vertebra spine to 6th costal cartilage anteriorly

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30
Q

Impressions

A

External features of lung

made by adjacent structures in fixed lungs

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31
Q

Hilum

A

External features of lung

Points at which structures (bronchus, vessels, nerves, lymphatics) enter or leave lungs

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32
Q

Lingula

A

external feature of lung

tongue-shaped feature of left lung

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33
Q

Cardiac Notch

A

Indentation for the heart, in left lung

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34
Q

Pulmonary Ligament

A

Double layer of parietal pleura, hanging from the hilum that marks reflection of visceral pleura to parietal pleura

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35
Q

Bronchopulmonary Segment

A

10 functional segments in each lung supplied by a segmental bronchus and a segmental artery from the pulmonary artery

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36
Q

Trachea (4)

A
  1. single airway that extends midline from circoid cartilage to its bifurcation at sternal angle of louis
  2. T4/T5
  3. Trachea lies anterior to the esophagus and its supported by cartilaginous rings
  4. Trachea bifurcates into right and left main stem bronchi
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37
Q

Features of Trachea

A
  1. 5 inched long and 1 inch in diameter

2. inferiorly anterior to esophagus and posterior to aortic arch

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38
Q

Cartilaginous rings

A
  1. 16-20 C shaped rings
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39
Q

Bronchus

A

Divides into R and L main primary bronchi at level of sternal angle of Louis

40
Q

Right Bronchus

A
  1. Shorter, Wider, and more vertical than L Bronchus

2. aspirated foreign objects more likely to pass into R bronchus

41
Q

Carina

A

internal, keel-like cartilage at bifurcation of trachea

42
Q

Secondary Bronchi

A

supply lobes of each lung

  • 3 R
  • 2L
43
Q

Tertiary Bronchi

A

Supply bronchopulmonary segments

-10 for each lung

44
Q

Lung muscles: inspiration (2)

A
  1. diaphragm moves down and intercostal muscles increase diameter of thoracic wall, decreasing intrapleural pressure
  2. accessory muscles may assist in very deep inspiration
45
Q

Lung muscles: exhalation movements (4)

A
  1. elastic recoil of lungs
  2. reaction diaphragm
  3. relaxation thoracic cage
  4. muscles expels air
46
Q

Phrenic Nerve (3)

purppose
roots

A
  1. innervates diaphragm
  2. C3, C4, C5 roots
  3. Keeps diaphragm alive
47
Q

Vagus Nerve (3)

A
  1. Paraympathetic bronchoconstrictor fibers contract smooth muscle
  2. vasodilator pulmonary muscles
  3. initiate secretion of alveolar glands
48
Q

Blood/Lymph (2)

  1. supply
  2. return
A
  1. lung parenchyma is supplied by small bronchial arteries
    - arise from proximal portion of descending thoracic aorta
  2. blood returns to heart via pulmonary via pulmonary, but some collect into small bronchial veins
    - -> azygos system of veins
49
Q

Lymphatic Drainage

4 steps

A

Pulmonary (intrapulmonary) -> bronchopulmonary (hilar) nodes -> tracheobronchial nodes

50
Q

Landmarks

Pericordial Areas of Auscultation (4)

A
  1. Aortic Area
  2. Pulmonic Area
  3. Tricuspid area
  4. Mitral Area
51
Q

Heart Anatomy Components (3)

A
  1. Chordae Tenidinae
  2. Papillary muscles
  3. pectinate muscles
52
Q

Chordae Tendinae

A

fibrous cords that connect papillary muscles to valve leaflets

53
Q

Papillary muscles

A

superoposteriar, inferior, and septal projections of myocardium extending into ventricular cavity

54
Q

Pectinate muscles

A

ridges myocardium inside auricle (pouchlike appendage of atrium)

55
Q

Heart Vavles

A
  1. tricuspid/R AV
  2. pulmonary/ semilunar
  3. mitral/ bicuspid
  4. aortic/ semilunar
56
Q

Tricuspid (3)

Location/characteristics

A
  1. A/V valve
  2. between R atrium and R ventricle
  3. 3 cusps
57
Q

Pulmonary valve

location/characteristics

A
  1. Semiluar valve
  2. between R ventricle and pulmonary trunk
  3. 3 semilunar cusps (leaflets)
58
Q

Mitral

location/characteristics

A
  1. bicuspid
  2. between L atria and L ventricle
  3. 2 cusps
59
Q

Aortic

Location and characteristics

A
  1. Semilunar
  2. between L ventricle and Aorta
  3. 3 semi-lunar cusps
60
Q

Conduction system components (3)

A
  1. SA node
  2. AV node
  3. Bundle of His
  4. Purkinje Fibers
61
Q

SA node/Sinuatrial (2)

A
  1. pacemaker

2. superior end of crista terminals near opening of SVC (sup. vena. cava)

62
Q

AV node/Atrioventricular (2)

A
  1. receives from SA node and conveys to bundle of HIS

2. located between opening of coronary sinus and origin of septal cusp of tricuspid valve

63
Q

Bundle of his

A

inferior to AV node, splits interventricularly to form L and R bundle branches

64
Q

Purkinje Fibers

A

ramification of bundle branches in ventricles of heart’s conduction system

65
Q

Cardiac Cycle

A
  1. heart’s conduction system moderated the cardiac cycle
    - coordinated systole (contraction)
    - and diastole (relaxation) or atria and ventricle

slide 44 for full cycle

66
Q

systole

A

contraction

67
Q

Diastole

A

relaxation

68
Q

Nerves of Heart

Parasympathetic
Functions (3)?

A
  1. Parasympathetic fibers from CN X (vagus) determine

A. HR
B. force of contraction
C. vasodilates coronary resistance vessels

69
Q

Nerves of Heart

Sympathetic
functions (3)
A
  1. fibers from T1-T4/T5

A. HR
B. force contraction
C. minimally vasoconstrictor coronary resistance vessles

70
Q

Cardiac Tamponade

causes?

complication?

tx?

A
  1. can results from fluid accumulation or bleeding in pericardial sac
  2. bleeding can be caused by ruptured aortic aneurysm, ruptured myocardial infarct or a penetrating unjury (most common)
  3. compromises heart and decreased venous return and cardiac output
  4. fluid can be removed by a pericardial tap
71
Q

Myocardial infarction (2)

cause?

A
  1. major cause of death
  2. caused by
    - coronary artery artherclerosis and thrombosis
    - ->precipitate local ischemia and necrosis in myocardial area
    - —> necrosis occurs approximately 20-30 minutes after coronary artery occlusion
  3. MI begins in the subendocardium because this region is the most poorly perfused part of the ventricular wall
72
Q

Vavlular heart disease

2 types of complications
most common valve

A
  1. Most commonly, *mitral and aortic valves

A. Stenosis (narrowing)
B. insufficiency (comprised valve function, leads to regurgitation)

73
Q

Repair tetralogy of fallot (2)

A
  1. surgical repair done on cardiopulmonary bypass to close the VSD (ventricular septal defect) and provide unobstructed flow into the pulmonary trunk
  2. stenotic pulmonary outflow tract is widened by inserting a patch into the wall (pericardial) thus increasing the volume the subpulmonic stenosis and/or the pulmonary artery stenosis
74
Q

Medistinum (2)

division?

A
  1. “Middle Space”
    - middle of thoracic cavity
  2. Superior and inferior divisons
    - horizontal line from sternal angle of Louis to intervertebral disc between T4-T5
75
Q

Superior Divison Medistinum Components(8)

A
  1. thymus
  2. superior vena cava
  3. brachiocephalic veins
  4. aortic arch and 3 branches
  5. trachea
  6. phrenic and vagus nerves
  7. thoracic duct
  8. lymphatics
76
Q

Inferior media stinum divisions (3)

A
  1. anterior
  2. middle
  3. posterior
77
Q

Inferior Mediastiunum: Anterior portion (3)

location(2)
contents (1)

A
  1. Posterior to the body of the sternum
  2. anterior to pericardium
  3. contains fat
78
Q

Inferior Mediastinum: Middle portion (2)

A
  1. Contains pericardium

2. contains heart

79
Q

Inferior Mediastinum: Posterior position

(9) components
- location (2)
- contents (6)

A
  1. posterior to heart
  2. anterior to bodies of T5-T12
  3. esophagus and its nerve plexus
  4. thoracic aorta
  5. azygos system of veins
  6. sympathetic trunks and thoracic spinal nerves
  7. lympatics
  8. thoracic duct
80
Q

Tetralogy of Fallot

A

usually results from maldevelopment of the ventricular septum

-normally divides the truncus anteriosus into the pulmonary trunk and aorta

81
Q

Tetralogy of Fallot defects (4)

A
  1. Pulmonary Stenosis or narrowing of the R ventricular outflow tract
  2. Overriding (transposed) aorta
  3. R ventricular hypertrophy
  4. Ventricular petal defect (VSD)
82
Q

Aortic Stenosis (3)

complications? (2)
cause? (3)

A
  1. Leads to left ventricular overload and hypertrophy
  2. calcific stenosis
  3. congenital bicuspid valve
  4. caused by RHD
83
Q

Aortic Regurgitation

6 causes

A
  1. caused by congenitally malformed leaflets
  2. RHD
  3. IE (infective endocartitis= infection of cardiac valves)
  4. ankylosing spondylitis
  5. Marfan’s syndrome
  6. Aortic root dilation
84
Q

Mitral Stenosis

complication?
cause?

A

Leads to left atrial dilation

usually caused by RHD

85
Q

Mitral Regurgitation

5 causes

A
  1. caused by abnormalities of valve leaflets
  2. rupture of papillary muscle or cordae tendinaea
  3. Papillary muscles fibrosis
  4. infective endocarditit
  5. left ventricular enlargement
86
Q

Frequency of Areas affected by MI

A
  1. LAD (left anterior descending artery)- 40-50%
  2. Right coronary 30-40%
  3. Left circumflex 15-20%
87
Q

Signs snd Sx of Cardiac tamponade (4)

A
  1. patient in variable degrees of shock or in extremis
  2. decreased arterial and pulse pressures often exist but not pathognomic
  3. Neck veins distended
  4. Venous pressure elevated
88
Q

Blood flow (14)

A
  1. Superior/inferior Vena Cava
  2. R atrium
  3. tricuspid valve
  4. R ventricle
  5. Pulmonary valve
  6. Pulmonary artery
  7. lungs
  8. Pulmonary vein
  9. L atria
  10. Mitral valve
  11. L ventricle
  12. Aortic valve
  13. Aorta
  14. systemic circulation
89
Q

Aortic heart sounds

location
sound

A

upper R sternal border

-aortic stenosis

90
Q

Pulmonary heart sounds

location
sound (4)

A

Upper L sternal border, below L clavicle

  1. second heart sounds
  2. pulmonary valve murmurs
  3. VSD (ventricular septal defect) murmur
  4. continuous murmur of patient ducts seteriosus (PDA)
91
Q

Tricuspid heart sounds

location
sound

A

Left 4th intercostal space
or sternal border 5th rib

tricuspid and aortic regurgitation

92
Q

Mitral heart sounds

location

sound (3)

A

L 5th intercostal space in midclavicular line
apex

  1. 1st heart sound
  2. murmurs of mitral or aortic valves,
  3. 3rd and 4th heart sounds
93
Q

COPD (3)

A

Chronic Obstructive Pulmonary Disease

  1. broad classification of lung diseases including
    A. Chronic Bronchitis
    B. Asthma
    C. Emphysema
  2. smoking major rx
94
Q

Emphysema

4 characteristics

A
  1. permanent enlargement of air spaces at and distal to the respiratory bronchioles
  2. destruction to bronchiole walls by chromic inflammation
  3. Lung compliance increases because elastic’s recoil of the lung decreases
  4. airways collapse during expiration
95
Q

Lung cancer types

A
  1. Squamous cell/ bronchiogenic 20%

2. Adenocarcinoma 37%

96
Q

Pancoast syndrome

A

Atypical lung tumor ay spread to involve sympathetic trunk, and affect lower portion of brachial plexis

can lead to horner’s syndrome

97
Q

Horner’s syndrome

A
  1. mitosis: constricted pupil
  2. Ptosis: drooping of upper eyelid
  3. Anhidrosis: lack of sweating
  4. Flushing: SQ vasodilation
  5. pain/parasthesia in neck, shoulder, limb
    - complete or incomplete paralysis of limb and head

*due to lung carcinoma that has spread to brachiocephalic trunk

Gross Anatomy (14 decks)

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