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MSS - CV Exam 1 > Organization of the Thorax > Flashcards

Organization of the Thorax Flashcards

1
Q

most frequently broken bone in body?

A

clavicle

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2
Q

angle of louie?

A

sternal angle

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3
Q

what does sternal angle tell you?

A

articulation of 2nd costal cartilage

-2nd rib

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4
Q

xiphoid process

A

ossifies as we age

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5
Q

subcostal angle?

A

infrasternal angle

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6
Q

AML

A

anterior median line

intersection of median plane with anterior thoracic wall

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7
Q

MCL

A

mid-clavicular line

passes through midpoint of clavicle
parallel to AML

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8
Q

AAL

A

anterior axillary line

runs vertically along anterior axillary fold formed from inferolateral border of pectoralis major

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9
Q

MAL

A

mid-axillary line

runs from apex of axillary fossa, parallel to AAL

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10
Q

PAL

A

posterior axillary line

also parallel to AAL
drawn vertically along posterior axillary gold formed by latissimus dorsi and teres major muscles as they span from the back to the humerus

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11
Q

PML

A

posterior median line

vertical line along the tips of the spinous processes of the vertebrae

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12
Q

SL

A

scapular line

parallel to PML and intersects inferior angles of scapula

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13
Q

thorax

A

superior part of trunk lying between root of the neck and thoracic diaphragm

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14
Q

thoracic wall

A

osteocartilagenous components, muscles, fascia, skin

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15
Q

thoracic cavity

A

2 pulmonary cavities and central mediastinum

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16
Q

function of thorax

A

protect underlying viscera, respiration, muscle attachment

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17
Q

how many thoracic vertebrae?

A

12

have superior and inferior demifacets
-lower vertebrae gives its number

also have costal facets on transverse process
-articulate with rib tubercle

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18
Q

atypical thoracic vertebrae?

A

1, 10, 11, 12

have single facets for rib head

allows more rotation of rib**

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19
Q

how many and what types of ribs?

A

1-7 true
8-10 false
11-12 floating

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20
Q

true rib?

A

attached directly to sternum

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21
Q

false rib?

A

attach to costal cartilage and form costal margin

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22
Q

floating ribs

A

not attached to sternum

anteriorly end in muscle

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23
Q

anatomy of rib?

A

head - proximal end

neck - portion between head and tubercle

tubercle - junction of neck and body, articulate with transverse process of vertebrae

angle - anterolateral angulation of body just lateral to tubercle

shaft - mid and distal portion of rib, inferior portion has concave surface

costal groove - protection for intercostal vein, artery, nerve

costal cartilage - increased elasticity for thoracic wall

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24
Q

atypical ribs?

A

1, 2, 10, 11, 12

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25
Q

1st rib?

A

broad horizontal shaft with pronounced curvature
head has single facet - articulates TV1
shaft has grooves for subclavian artery and vein and scalene tubercle

-anterior and middle scalene muscle attachments

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26
Q

2nd rib?

A

serratus anterior tuberosity on superior surface

and posterior scalene muscle attachment

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27
Q

10th rib?

A

single articular facet on head for articulation with body of TV10

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28
Q

11th and 12th ribs?

A

single articular facet on head, absence of neck/tubercle

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29
Q

where do rib fractures occur most often?

A

near angle (weakest part of rib)

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30
Q

what ribs are more frequently broken?

A

middle ribs

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31
Q

flail chest?

A

multiple broken ribs in 2 or more places

-causes loose segment of thoracic wall which moves paradoxically with respiration

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32
Q

suprasternal notch?

A

anterior to TV2 TV3 intervertebral disc

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33
Q

clavicular notch?

A

for articulation with clavicle

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34
Q

lateral facets of manubrium?

A

for articulation with costal cartilage of ribs 1 and 2

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35
Q

manubriosternal joint?

A

between sternal body and manubrium

symphysis

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36
Q

xiphoid process?

A

variable in shape
cartilagenous, ossifies with age
lateral demi-facets, articulation with costal cartilage of 7th rib

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37
Q

xiphosternal joint

A

between sternal body and xiphoid

synchondrosis

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38
Q

transverse thoracic plane

A

sternal angle to disc between TV4 and TV5

-division between superior and inferior mediastinum

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39
Q

pectus excavatum?

A

anterior thoracic wall sunken in
-congenital anomaly

can cause respiratory and cardiac problems

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40
Q

pectus carinatum?

A

anterior thoracic wall protrusion
-congenital anomaly

can cause respiratory and cardiac problems

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41
Q

borders of superior thoracic aperture?

A

anterior - suprasternal notch of manubrium
lateral - 1st rib
posterior - TV1

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42
Q

extent of superior thoracic aperture?

A

extends obliquely from TV1 anteroinferiorly to manubrium

  • pleural space extends into the neck region
  • injury or surgery within this region may affect pleural cavity and lungs (pneumothorax)
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43
Q

borders of inferior thoracic aperture?

A

anterior - xiphosternal joint
lateral - costal margin
posterior - TV12 and ribs 11 and 12

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44
Q

extent of inferior thoracic aperture?

A

obliquely from TV12 anterosuperiorly to xiphosternal joint

  • pleural space extends inferiorly to lie posterior to the abdominal region
  • injury or surgery may affect pleural cavity and lungs (pneumothorax)
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45
Q

sternocostal joint?

A

articulation between costal cartilages and sternum

7 pairs

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46
Q

1st sternocostal joint?

A

synchondrosis - no movement

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47
Q

2-7 sternocostal joints?

A

synovial plane joints

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48
Q

support of sternocostal joint?

A

anterior and posterior radiate ligaments

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49
Q

costochondral joints?

A

articulation between rib and costal cartilage

most likely location of rib separation

synchondrosis - very little movement

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50
Q

interchondral joint?

A

articulation between costal cartilages of ribs 8-10 with costal cartilage above

51
Q

costovertebral joint?

A

articulation between head of rib with vertebral bodies, IV disc

synovial plane joint

52
Q

ribs 2-9?

A

articulate with adjacent vertebral bodies and IV discs

-intra-articular ligament extends from crest of head to IV disc limiting movement of this joint

53
Q

what supports joint capsule of costovertebral joint?

A

radiate ligament

54
Q

costotransverse joint?

A

articulation between rib tubercle and vertebral transverse process

synovial joint

not on rib 11 or 12**

55
Q

ligaments of costotransverse joint?

A

lateral, superior costotransverse ligaments

56
Q

attachments of external intercostal muscle?

A

origin:
inferior border of rib above (1-11)

insertion:
superior border of rib belw (2-12)

fiber direction - superoposterior >inferoanterior

57
Q

action of external intercostal muscle?

A

maintain intercostal space during respiration

-elevate ribs (inspiration)

58
Q

innervation of external intercostal muscle?

A

intercostal nerve

59
Q

attachments of internal internalcostal muscle?

A

origin:
superior border of rib below (2-12)

insertion:
inferior border of rib above (1-11)

fiber direction - inferoposterior > superoanterior

60
Q

action of internal intercostal muscle?

A

maintain intercostal space during respiration

-depress ribs (expiration)

61
Q

innervation of internal intercostal muscle?

A

intercostal nerves

62
Q

attachments of innermost intercostal?

A

origin:
superior border of rib below (2-12)

insertion:
inferior order of rib above (1-11)

63
Q

action of innermost intercostal?

A

maintain intercostal space during respiration

-depresses ribs (expiration)

64
Q

innervation of innermost intercostal?

A

intercostal nerves

65
Q

attachments of subcostal muscle?

A

origin:
superior border of rib near angle

insertion:
inferior border of rib 2 or 3 intercostal spaces higher

66
Q

action of subcostal muscle?

A

depress ribs (expiration)

67
Q

innervation of subcostal muscle?

A

intercostal nerves

68
Q

attachments of transverse thoracic muscle?

A

origin:
internal surface of inferior ternum

insertion:
inferior border of ribs 2-6

69
Q

action of transverse thoracic muscle?

A

depress ribs (expiration)

70
Q

innervation of transverse thoracic muscle?

A

intercostal nerves 2-6

71
Q

attachments of levator costarum muscle?

A

origin:
transverse proces of CV7-TV11

insertion:
superior border of ribs near tubercle

72
Q

action of levator costarum muscle?

A

assist with elevating ribs during forced inspiration

73
Q

innervation of levator costarum muscle?

A

ventral rami C8-T11

74
Q

attachments of serratus posterior superior?

A

origin:
nuchal ligament and spinous process of CV7-TV3

insertion:
ribs 2-5 superior border near angle

75
Q

action of serratus posteror superior?

A

assist in elevation of ribs during forced inspiration

76
Q

innervation of serratus posterior superior?

A

intercostal nerves 1-4

77
Q

attachments of serratus posterior inferior?

A

origin:
spinous process of TV11-LV2

insertion:
ribs 9-12, inferior border near angle

78
Q

action of serratus posterior inferior?

A

assist with forced inspiration

depress lower ribs to oppose superior movement of diaphragm

79
Q

innervation of serratus posterior inferior?

A

intercostal nerves 9-12

80
Q

external intercostal membrane?

A

continuation of external intercostal muscle anteriorly

81
Q

internal intercostal membrane?

A

continuation of internal intercostal muscle posteriorly

82
Q

innermost intercostals?

A

discontinuous sheet of muscle

transversus thoracis anteriorly
innermost intercostal laterally
subcostalis posteriorly

83
Q

neurovascular bundle course?

A

runs between 2nd and 3rd layers
-between internal intercostal and innermost intercostal muscles

VAN - superior-inferior
vein artery nerve

84
Q

endothoracic fascia?

A

connective tissue lining entire surface of internal thoracic wall and superior surface of diaphragm

thickens superiorly
simpsons fascia

85
Q

function of endothoracic fascia?

A

provides a cleavage plane between thoracic wall and pleura

-important for surgeries requiring access to thoracic cavity

86
Q

pump handle motion?

A

increase in AP diameter
-rotational movement at costotransverse joint causes elevation and depression of most distal portion of upper ribs

first rib is fixed***

87
Q

bucket handle motion?

A

increase in transverse diameter
-gliding movement at posterior (costovertebral and costotransverse) joints causes elevation and depression of lateral most portions of ribs

88
Q

what causes increase in vertical diameter of thoracic cavity?

A

contraction of diaphragm

89
Q

innervation of thoracic diaphragm?

A

phrenic nerve - C3,4,5

90
Q

action of thoracic diaphragm?

A

flattens during contraction to increase intrathoracic volume

91
Q

during deep expiration

A

diaphragm extends to 4th intercostal space

92
Q

during forced inspiration?

A

can move down 10cm

-about 2 vertebral bodies

93
Q

sternocleidomastoid?

A

inspiration

94
Q

scalene?

A

inspiration

95
Q

serratus anterior?

A

inspiration

96
Q

quadratus lumborum?

A

inspiration

97
Q

pectoralis major?

A

inspiration

98
Q

pectoralis minor?

A

inspiration

99
Q

anterolateral abdominal wall muscles?

A

expiration

100
Q

muscles of abdominal wall?

A

external intercostal > external abdominal oblique
internal intercostal > internal abdominal oblique
innermost intercostal > transversus abdominus

101
Q

where to put needle into thorax?

A

roll it over top of the rib

102
Q

intercostal nerve?

A

ventral ramus

103
Q

innervation of thoracic wall?

A

11 intercostal pairs
1 subcostal pair

travel in costal groove inferior margin of rib

104
Q

preganglionic sympathetic nerve cell processes?

A

via 14 pair white rami communicantes

105
Q

postganglionic sympathetic nerve cell processes?

A

31 pair of gray rami communicantes

106
Q

course of intercostal nerves?

A

first - within endothoracic fascia

near rib angle - pass between 2nd and 3rd muscle layers (internal and innermost intercostal muscles)

107
Q

lateral perforating branches?

A

given off near MAL

pierces lateral body wall
-divides to anterior and posterior cutaneous branches

108
Q

anterior perforating branches?

A

given off near lateral border of sternum

pierce anterior body wall
-divide into medial and lateral cutaneous branches

109
Q

ventral rami of T1?

A

divides into large superior trunk that goes to brachial plexus and small inferior trunk (1st intercostal nerve)

110
Q

intercostal nerve 1?

A

no cutaneous branches

-T1 dermatome not represented on thoracic wall

111
Q

lateral cutaneous branch of intercostal nerve 2

A

forms intercostobrachial cutaneous nerve, supplying skin and subQ of axilla and medial brachial area

112
Q

thoracoabdominal nerves

A

continuation of the intercostal and subcostal nerves

innervate skin and muscles of abdominal wall

113
Q

nipple dermatome?

A

in males T4

114
Q

xiphoid dermatome?

A

T6

115
Q

umbilicus dermatome?

A

T10 - key dermatome

116
Q

anterior intercostal arteries?

A

9 pairs

originate from internal thoracic artery (branch of subclavian)

descend along internal surface of anterior thoracic wall, lateral to sternum

117
Q

division of anterior intercostal artery?

A

near 6th or 7th intercostal cartilage, divide:

  • musculophrenic
  • epigastric arteries

directly provides anterior intercostal arteries 1-6

118
Q

musculophrenic artery?

A

follows costal arch and provides anterior intercostal arteries to lower intercostal spaces

119
Q

how many anterior intercostal arteries per intercostal space?

A

2

-anastomose with posterior intercostal arteries

120
Q

posterior intercostal arteries?

A

11 pairs (and 1 subcostal artery)

originate from thoracic aorta
-provides 3-11 and subcostal

originate from costocervical trunk (subclavian branch)
-provides supreme intercostal artery - 1st and 2nd intercostal spaces

121
Q

1-3 posterior intercostal veins?

A

unite to form superior intercostal vein

right - drain to azygous
left - drain to brachiocephalic

122
Q

anterior intercostal veins?

A

drain to internal thoracic veins

123
Q

posterior intercostal veins?

A

drain to azygous system

MSS - CV Exam 1 (14 decks)

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