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Clinical Anatomy > Module 4: Thoracic Wall and Mediastinum > Flashcards

Module 4: Thoracic Wall and Mediastinum Flashcards

1
Q

What are the boundaries of the thoracic cavity?

A

posterior: spine
anterior: sternum
inferior: diaphragm
superior: superior thoracic aperture

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2
Q

What are the contents of the thoracic cavity?

A

respiratory and cardiovascular organs

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3
Q

What are the compartments of the thoracic cavity?

A

pleural cavity: Right and Left

Mediastinum: superior and inferior (midline)

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4
Q

What are the components of the thoracic wall?

A

-skin
-subcutaneous tissue
-ribs
-intercostal muscles

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5
Q

What is the function of the thoracic wall?

A
  • protection
  • respiration
  • muscle attachment
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6
Q

What are the 3 different types of ribs?

A

True: 1st-7th
- direct cartilaginous attachment to sternum

False: 8th-10th
- indirect connection (come together to connect to sternum)

Floating: 11th and 12th
- do not attach to sternum

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7
Q

What is the general structure of a rib?

A

head
neck
costal tubercle
costal angle(posterior)
body/shaft

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8
Q

What are the 3 rib joints and their synovial classification?

A

costovertebral: head&raquo_space; vertebral body

costotranverse: costal tubercle&raquo_space; transverse process

sternocostal: sternum&raquo_space; costal cartilage

plane/gliding

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9
Q

What are the unique landmarks of the 1st rib?

A

scalene tubercle
groove for subclavian artery
groove for subclavian vein

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10
Q

What is the position of the anterior scalene muscle relative to the subclavian artery?

A

anterior to subclavian artery

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11
Q

What are the unique landmarks of the sternum?

A

manubrium
- jugular and clavicular notch/facet

body
- sternal angle (joint between manubrium and body)
- costal notches/facets

xiphoid process

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12
Q

Where does the 2nd rib attach to the sternum?

A

sternal angle

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13
Q

What are the muscles of the thoracic wall?

A

external intercostal
internal intercostal
innermost intercostal
tranversus thoracis
diaphragm

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14
Q

What are the OIAN for the external intercostal?

A

O: rib superior-lateral
I: rib inferior medial
A: elevation of ribs
N: intercostal nerve (segmental)

start from spine, do not reach sternum

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15
Q

What are the OIANs of the internal and innermost intercostal muscles?

A

O: rib superior-medial
I: rib inferior-lateral
A: depression of ribs
N: intercostal nerve (segmental)

start from sternum, do not reach spine

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16
Q

What are the OIANs of the tranversus thoracis muscle?

A

O: posterior sternum
I: costal cartilages
A: depress ribs
N: intercostal nerves (segmental)

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17
Q

What are the OIANs of the diaphragm?

A

O: xiphoid process, inner surface of lower ribs, costal cartilages, lumbar vertebrae via crura
I: central tendon
A: inspiration(negative pressure)
N: phrenic nerve c3-5 (R+L)

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18
Q

What are the actions of the sternum and ribs during expiration?

A

sternum: move downward and back

ribs: depress and move middle of shaft medially (bucket handle)

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19
Q

What are the actions of the ribs and sternum during inspiration?

A

sternum: moves upward and forward (pump handle)

ribs: elevate and move middle of shaft laterally

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20
Q

What is the naming convention of intercostal nerves?

A

T1-6: upper intercostal
T7-11: lower intercostal
T12: subcostal

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21
Q

What are the major landmarks of the innervation of the thoracic wall?

A

T4: nipple line

T6: skin over xiphoid

T10: umbilicus

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22
Q

What branches of arteries come off of the descending aorta?

A

bronchials
esophageal
posterior intercostals (3-11)
subcostal (12)

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23
Q

What arteries branch off th internal thoracic artery?

A

pericardiophrenic a.
anterior intercostals (1-6)
superior epigastric
musculophrenic

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24
Q

What artery do the anterior intercostal arteries (7-9) branch off of?

A

musculophrenic artery

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25
Q

What is the function of cisterna chyli?

A

forms below diaphragm and provides origin to thoracic duct

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26
Q

What is function of the thoracic duct?

A

drains nodes of the right and left lower extremities, pelvis, abdomen left thorax, left upper extremity, left head, and left neck

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27
Q

What is the function of the right lymphatic duct?

A

drain nodes of the right thorax, right upper extremity, and right head & neck

forms union of right jugular, right subclavian, and right bronchomediastinal trunks

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28
Q

What nodes drain into the right and left broncomediastinal trunks?

A

parasternal, visceral, and diaphragmatic nodes

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29
Q

What nodes are parietal?

A

parasternal
intercostal
posterior mediastinal
diaphragmatic

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30
Q

What is the function of parasternal lymph nodes?

A

drain breast, abdominal wall, pleura, and liver

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31
Q

What is the function of intercostal lymph nodes?

A

drain lateral and posterior thoracic wall

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32
Q

What is the function of posterior mediastinal lymph nodes?

A

drain pleura and esophagus

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33
Q

What is the function of diaphragmatic lymph nodes?

A

drain liver, pleura, and diaphragm

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34
Q

What are the 4 visceral lymph nodes?

A

pulmonary
bronchopulmonary
tracheobrocnial
paratracheal

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35
Q

What is the function of pulmonary lymph nodes?

A

drain lung

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36
Q

What is the function of bronchopulmonary lymph nodes?

A

drain bronchi

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37
Q

What is the function of tracheobronchial lymph nodes?

A

drain trachea & heart

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38
Q

What is the function of paratracheal lymph nodes?

A

drain tracheobronchial nodes

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39
Q

What are the 5 breast lymph nodes?

A

parasternal
inguinal
infraclavicular
axillary
apical axillary

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40
Q

What is the function of parasternal lymph?

A

drain medial breast bilaterally

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41
Q

What is the function of inguinal lymph?

A

may drain inferior breast

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42
Q

What is the function of infraclavicular lymph?

A

may drain superior breast

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43
Q

What is the function of axillary lymph?

A

predominant drainage of the breast

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44
Q

Where does the neurovascular structure of the intercostal muscles run?

A

between the inner and innermost intercostal muscles.

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45
Q

What is the orientation of intercostal neurovasculature?

A

vein
artery
nerve

46
Q

What are the external features of the right lung?

A
  • apex
  • 3 lobes (superior, middle, inferior)
  • horizontal fissure
  • oblique fissure
47
Q

What are the external features of the left lung?

A
  • apex
  • 2 lobes (superior and inferior)
  • oblique fissure
  • lingula
48
Q

What pattern of branching of the bronchial tree?

A

trachea > primary bronchi > secondary (lobar) bronchi > tertiary (segmental) bronchi

49
Q

What is the point of bifurcation of the trachea?

A

carina

50
Q

What is different about the right bronchus compared to the left bronchus?

A

more vertical and larger
(easier for objects to go down this bronchus)

51
Q

How many bronchopulmonary segments are there?

A

10 segments

52
Q

What structures comprise the root of the lung?

A
  • pulmonary artery
  • pulmonary vein
  • bronchi
53
Q

What pleural covering covers the root of the lung and what is its purpose?

A
  • pulmonary ligament
  • allows expansion of blood vessels
54
Q

What structure does the root of the lung pass through?

A

the hilum

55
Q

What is the difference between the structures in the root of the right lung and the root of the left lung?

A

Right: pulmonary artery is anterior to bronchus

Left: pulmonary artery is superior to bronchus

R.A.L.S.: Right lobe-anterior, Left lobe- superior

56
Q

What vessels supply the lungs?

A

bronchial branches from the descending aorta

57
Q

What are the two pleural coverings of the lungs?

A

parietal pleura (outer) and visceral pleura (inner)

58
Q

What are the regions of the parietal pleura?

A
  • cervical: neck
  • costal: largest
  • diaphragmatic: over diaphragm
  • mediastinal: medial
59
Q

What are the reflections of the parental pleura?

A

costodiaphragmatic

costovertebral

costomediastinal

60
Q

What are the recesses of the parietal pleura and their significance?

A
  • costodiaphragmatic = costal > diaphragmatic region
  • costomediastinal = costal > mediastinal region
  • site of fluid accumulation
61
Q

What is the significance of pulmonary collapse?

A
  • puncture of parietal pleura
  • air enters between pleura, descreasing surface tension causing clinging and collapsed lung
  • can be trauma from dry needling
  • pneumothorax
62
Q

What is the order of pericardium, superficial to deep?

A

fibrous pericardium > parietal pericardium > visceral pericardium (epicardium) > myocardium > endocardium

63
Q

What pericardium layers are part of the serous pericardium?

A

parietal pericardium and visceral pericardium (epicardium)

64
Q

What pericardium layers are part of the heart?

A

epicardium (visceral pericardium)

myocardium

endocardium: single layer of cells

65
Q

What are the surface features of the heart?

A
  1. R auricle
  2. R coronary sulcus
  3. L auricle
  4. anterior interventricular sulcus
  5. apex

Not pictured:
- L coronary sulcus
- posterior interventricular sulcus

66
Q

What are the internal features of the right atrium?

A
  • crista terminalis: smooth ridge
  • interatrial septum
  • fossa ovalis
  • pectinate muscle
  • opening of the:
  • coronary sinus
  • IVC and SVC
  • atrioventricular valve
67
Q

What are the internal features of the left atrium?

A
  • valve of foramen ovale
  • opening of the:
  • L atrioventricular valve
  • pulmonary veins
68
Q

What are the internal features of the left ventricle?

A
  • opening of the:
  • aortic valve
  • L atrioventricular valve
  • chordae tendinae
  • papillary muscle (2)
  • onterventricular septum
  • trabeculae carneae
69
Q

What are the internal features of the right ventricle?

A
  • opening of the:
    *pulmonary trunk
  • R atrioventricular valve
  • chordae tendineae
  • papillary muscle (3)
  • conus arteriosus
  • septomarginal trabecula (moderator band)
  • trabeculae carneae
70
Q

How many papillary muscles are in the R Ventricle?

A

3
- anterior
- posterior
- septal

71
Q

How many papillary muscles are in the L Ventricle?

A

2
- anterior
- posterior

72
Q

Which ventricle is thicker?

A

L ventricle because it shunts blood to entire body

73
Q

How many pulmonary veins are there?

A

4

74
Q

What is the difference between the Right and Left AV valves?

A

Right = tricuspid
Left = bicuspid (mitral)

75
Q

Which chamber of the heart does the pulmonary trunk connect to?

A

right ventricle

76
Q

What chamber of the heart does the aortic valve connect to?

A

left ventricle

77
Q

Where do the coronary arteries originate in the heart?

A

ascending aorta

78
Q

What is the role of the chordae tendineae and what do they attach to?

A
  • anchor valve flaps from allowing blood reflux from the R and L ventricles into the R and L atrium
  • papillary muscle
79
Q

How many secondary bronchi are in the L and R lung?

A

L: 2 = superior and inferior
R: 3 = superior, middle, & inferior

80
Q

What are the cardiac auscultation sites?

A

Aortic
- upper right, 2nd intercostal space
Pulmonary
- upper left, 2nd intercostal space
R AV valve
- medial right, 5th intercostal space
L AV valve
- lower left, 5th intercostal space

81
Q

What structures branch off the R coronary artery?

A
  • right marginal artery
  • posterior interventricular artery (anastomosis with anterior)
82
Q

What structures branch off the L coronary artery?

A
  • anterior interventricular artery
  • circumflex artery
  • L marginal artery
83
Q

Does the heart have collateral circulation supplying it?

A

no, the anastomoses are not great enough to do so

84
Q

Describe the blood flow through the heart including chambers and valves.

A

SVC + IVC > R Atrium > tricuspid valve > R ventricle > pulmonary valve > Pulmonary trunk/artery > lung > pulmonary veins > L atrium > bicuspid valve > L Ventricle > aortic valve > ascending aorta

85
Q

What is the conduction system of the heart?

A

Sinoatrial Node (RA) > atrioventricular node (R AV Valve) > atrioventricular bundle > L + R bundle branches

86
Q

What is the role of the moderator band?

A

gives right bundle branch rapid access to the lateral wall of the R ventricle

87
Q

What is referred pain during cardiac arrest?

A

pain receptors in the myocardium relay stimuli through visceral afferent axons that share somatic axons with the skin, the brain then interprets the pain coming from the skin

88
Q

What are the sites of referred pain?

A

L pectoral region
L shoulder
L Medial Upper Extremity to pinky

89
Q

What is the location of fossa ovalis and its previous function?

A
  • interatrial septum
  • fetal remnant of foremen ovale
  • connected right and left atrium for blood flow
90
Q

What is the location of the ligamentum arteriosum?

A
  • fetal remnant of ductus arteriosus
  • connected arch of aorta to pulmonary trunk
91
Q

What are the veins of the coronary sinus and their locations?

A
  • great cardiac: ant IV sulcus
  • oblique vein of left atrium: superior of coronary sinus
  • posterior vein of the left ventricle
  • middle cardiac: post IV sulcus
  • small cardiac: R coronary sulcus
92
Q

What is the role of white rami communicans?

A

T1-L2
- carry preganglionic sympathetic axons to the sympathetic chain and abdominal ganglia and sensory axons from the visceral spinal cord

93
Q

What is the role of gray rami communicans?

A

carry postganglionic sympathetic axons from the sympathetic chain to spinal nerves for distribution through the dorsal and ventral rami, and sensory axons from the viscera to the spinal cord

94
Q

What is the role of the phrenic nerve?

A

C3-5
- sensory and postganglionic sympathetic innervation to the pericardium and central tendon; motor and postganglionic sympathetic innervation to the diaphragm

95
Q

What is the role of the vagus nerve?

A

wandering
- carries preganglionic parasympathetic axons innervating thoracic and abdominal viscera to the level of the left colic flex and visceral sensory axons innervating the same

96
Q

What is the relation between rami communicans, sympathetic chain, and intercostal nerves?

A

ventral rami (intercostal nerves) > white rami > symp chain > grey rami > intercostal nerve

97
Q

What structures does the thoracic duct lie between?

A

Azygos vein and esophagus

Duck between 2 goose

98
Q

What structures does the thoracic duct lie between?

A

Azygos vein and esophagus

Duck between 2 goose

99
Q

What is the sequence of the great vessels of the heart?

A

Anterior to posterior:

Pulmonary trunk > Ascending aorta > sup vena cava

100
Q

What is the role of the septomarginal trabecula?

A

Moderator band; holds nervous cell tissue allows for jumping off the right bundle branch to the lateral side of the right ventricle

101
Q

What area of the heart does the great cardiac vein drain?

A

Drains blood from left side of heart, located in Ant IV Sulcus

102
Q

What is the role of the coronary sinus?

A

Veins empty here then to the right atrium

103
Q

What is the role of the middle cardiac vein and its location

A

Drains blood from posterior side of heart, located in Post IV Sulcus

104
Q

What part of the heart does the right coronary artery supply?

A
  • right atrium
  • most of right ventricle
  • part of left ventricle
  • part of IV septum
  • SA node
  • AV node
105
Q

What part of the heart does the left coronary artery supply?

A
  • left atrium
  • most of the left ventricle
  • part of the right ventricle
  • most of the IV Septum
  • SA node
  • AV node
106
Q

What is the reason for referred pain?

A

Phrenic nerve is C3-5, when heart pain occcurs, it shares sensory skin cells of C3-5 dermatome, making the left shoulder, left pectoralis, and left arm hurt

107
Q

What is the conducting system of the heart?

A

Action potential generated in SA node, right atrial walls to the AV node. potential goes through AV node to bundle branches to purkinje fibers to ventricular walls

108
Q

What is sympathetic innovation of the heart?

A

Sympathetic chain

109
Q

What is the parasympathetic innovation of the heart?

A

Valgus nerve

110
Q

What arteries anastomos in the heart?

A

Right coronary and circumflex of LC

Post IV Art and Ant IV Art

111
Q

What is the relation of the rami communicans to the sympathetic chain ganglia and intercostal nerves including the type of axon found within?

A

sympathetic pre-ganglionic branch leaves the lateral horn of the spinal cord > travels along ventral root through mixed spinal nerve > goes into white rami communican in the sympathetic chain ganglion > synapses with post-ganglionic branch axons > leaves through grey rami communicans > travels through ventral ramus to corresponding intercostal space for sympathetic innervation

Clinical Anatomy (12 decks)

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