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CV I > Organization of thorax > Flashcards

Organization of thorax Flashcards

1
Q

Superior and inferior borders of thorax

A

root of neck and thoracic diaphragm

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2
Q

what makes up the thorax. generally

A

osteocartilaginous components, muscles, fascia, skin and thoracic cavity(pulmonary and mediastinum)

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3
Q

function of thorax

A

protection of underlying viscera, respiration and muscle attachment

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4
Q

Which ribs have a full facet for rib

A

1,10,11,12

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5
Q

Which ribs are true ribs

A

1-7

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6
Q

which ribs are “false ribs”

A

8-10

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7
Q

which ribs are “floating ribs

A

11-12

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8
Q

what does the head of the rib articulate with

A

adjacent vertebral body

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9
Q

what does the tubercle on the rib articulate with

A

the transverse process

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10
Q

what runs in costal groove

A

intercostal vein artery and nerve

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11
Q

what provides the increased elasticity for thoracic wall

A

costal cartilage

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12
Q

What is unique anatomically of first rib

A

broad, horizontal shaft with pronounced curvature
head has a single facet for articulation TV1
shaft has groove to subclavian a and vein, scalene tubercle

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13
Q

where is the transverse thoracic plane

A

sternal angle to disk between L4 and L5

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14
Q

what is unique anatomically of second rib

A

serratus anterior tuberosity on superior surface

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15
Q

what is unique anatomically of 10th rib

A

single articular facet on head for articulation with body of TV10

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16
Q

what is unique anatomically of 11th and 12th ribs

A

single articular facet on head, absence of neck/tubercle

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17
Q

where do rib fractures occur most often

A

near the angle, middle ribs

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18
Q

what is a flail chest

A

multiple ribs broken in 2 or more places.

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19
Q

what disk is the suprasternal(jugular notch) in front of

A

TV2/TV3

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20
Q

what ribs articulate with manubrium

A

1 and 2

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21
Q

what ribs articulate with sternum

A

2-7

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22
Q

what do the lateral demi facets of the xiphoid process articulate with

A

costal cartilage of 7th rib

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23
Q

what does the sternal angle demarcate

A

articulation of 2nd rib

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24
Q

What is pectus excavatum

A

anterior thoracic wall is sunken in and carinatum protrusion- congenital anomalies from malformation of sternum and ribs

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25
Q

what are the boundaries of the superior thoracic aperture

A

anterior- jugular notch
lateral- 1st rib
posterior- 1st thoracic vertebra

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26
Q

injury or surgery within the superior thoracic aperture may have what consequence

A

pneuomothorax because the pleural space extends superiorly into neck region

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27
Q

what are the boundaries of the inferior thoracic aperture

A

anterior- xiphisternal joint
lateral- costal margin
posterior- 12th thoracic vertebra and 11th and 12th rib

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28
Q

injury or surgery within the inferior thoracic aperture may have what consequence

A

pnuemothorax because plueral space extends inferiorly to inferior aperture

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29
Q

what is radiate ligament

A

vertebral body to the head

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30
Q

superior costotransverse ligaments

A

rib to transverse process on vertebra above

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31
Q

lateral costotransverse ligaments

A

between transverse process and rib of same level

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32
Q

how many pairs are there of articulations of costal cartilages and sternum

A

7

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33
Q

describe joint of 1st sternocostal joint

A

synchondrosis, no movement

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34
Q

what types of joints are sternocostal 2-7

A

synovial plane

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35
Q

describe the articulation between the rib and costal cartilage

A

synchondrosis, very little movement

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36
Q

what are the interchonral articulations and where are they found

A

8th-10th

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

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37
Q

what ligaments support joint capsule of ribs

A

anterior and posterior radiate ligaments

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38
Q

what are the three layers of mm in the thoracic cavity

A

external intercostals, internal intercostals and innermost intercostals

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39
Q

which way to the external intercostal m fibers go

A

infero-medially

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40
Q

which way to the internal intercostal m fibers go

A

inferio-laterally

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41
Q

what make sup the innermost intercostals

A

discontinuous sheet of muscle.

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42
Q

3 components that make up innermost intercostals

A 
transverse thoracis (anteriorly)
innermost intercostal (laterally)
subcostalis (posteriorly)
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43
Q

where does the neurovascular bundle run between ribs

A

between the internal intercostal and innermost intercostal mm

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44
Q

what is the endothoracic fascia

A

CT lining entire surface of internal thoracic wall and superior surface of diaphragm
also adheres to parietal pleura

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45
Q

Why is the endothoracic fascia important for surgeries requiring access to thoracic cavity

A

cleavage plane between thoracic wall and pleura

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46
Q

which joint of thoracic cavity allows for elevation and depression of the most distal portio of ribs (anterior)

A

costotransverse joint

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47
Q

what is the importance of 1st rib in respiration

A

fixed joint, so moves entire sternum thus moving all the ribs

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48
Q

Describe what allows for the increase in transverse diameter of thoracic wall

A

gliding of costovertebral and costotransverse joints

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49
Q

what allows for considerable increase in anterior posterior cavity during respiration

A

the inferior slope of the distal portions of ribs

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50
Q

What allows the increase in vertical diameter during respiration

A

diphragm inn by phrenic C3 C4 C5

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51
Q

During expiration the superior portion of diaphragm extends to what intercostal space

A

4th intercostal space

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52
Q

What are the thoracic wall mm involved in inspiration

A

serratus posterior superior and inferior
leavator costorum
external intercostal mm

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53
Q

what are the thoracic mm involved in expiration

A

internal intercostal mm

transverse thoracic mm

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54
Q

what other mm are involved in forced inspiration

A 
sternocleidomastoid
scalene mm
serratus anterior
pectoralis minor and major
quadratus lumborum
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55
Q

mm involved during forced expiration

A

anterolateral abdominal wall mm

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56
Q

what innervates thoracic wall

A

intercostal 11 pair and subcostal 1 pair

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57
Q

what type of information do the intercostal nn and subcostal n contain

A

preganglionic sympathetic nerve cell processes from spinal cord to sympathetic chain via 14 pair white rami communicantes
postganglionic sypathetic nerve cell proccesses via 31 pair gray rami communicantes

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58
Q

Where do the intercostal nn course

A

within endothoracic fascia

near rib angle, nerves pass between 2nd and 3rd m layers

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59
Q

What are the other branches of intercostal nn besides the rami communicantes

A

muscular branches, collateral branch, lateral perforating cutaneous branch
anterior perforating cutaneous branch

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60
Q

Where is the collateral branch of intercostal nn

A

near angle of rib, course superior border of rib

61
Q

Describe the ventral ramus of T1

A

larger superior trunk which goes to brachial plexus and small inferior trunk– 1st intercostal n (no cutaneous to thoracic wall)

62
Q

describe the lateral cutaneous branch of intercostal nerve 2 and soemtimes 3

A

intercostobrachial cutaneous n supplying skin and subcu tissue of axilla and medial brachial area

63
Q

Describe the intercostal nn 7-11 and subcostal

A

continue anterolaterally as thoracoabdominal nn because inn abdominal wall as well

64
Q

problem at TV10

A

look for problem at 10th thoracic n

65
Q

describe dermatome for nipple level in males

A

T4

66
Q

what dermatome is the xiphoid

A

T6

67
Q

what is the dermatome for umbilicus

A

T10

68
Q

How many anterior intercostal aa are there

A

9 pair

69
Q

Where do the anterior intercostal aa originate from

A

the internal thoracic artery

70
Q

what does the internal thoracic a branch from

A

the subclavian a

71
Q

what are the terminal branches of the internal thoracic a

A

musculophrenic and superior epigastric aa

72
Q

Where does the musculophrenic a course

A

follow costal arch and provides anterior intercostal aa to spaces below 6th

73
Q

how many anteiror intercostal aa supply each space

A

2 usually

74
Q

how many posterior intercostal aa are there

A

11 pair and 1 subcostal pair

75
Q

where do the posterior intercostal aa arise from

A

thoracic, descending aorta 3-11 and subcostal a

costocervical trunk provides highest intercostal a to posterior 1st and 2nd spaces

76
Q

What posterior intercostal vv join to form superior intercostal v

A

1-3

77
Q

where do the rest of the posteiror intercostal vv drain into

A

azygos system

78
Q

where do the anterior intercostal vv drain into

A

internal thoracic vv

79
Q

what order do you find the structures of the neurovascular bundle of intercostal space

A

Vein superior
artery middle
nerve inferior

80
Q

Where do the superficial structures of thoracic cavity drain lymphatics

A

axillary lymph nodes

81
Q

what drains into the parasternal nodes

A

anteiror thoracic wall, superior portion of abdominal wall, superior surface of liver and medial portions of mammary gland

82
Q

where do the parasternal nodes drain into

A

bronchomediastinal trunk

83
Q

Where are the intercostal nodes found

A

near heads and necks of ribs

84
Q

what drains into intercostal nodes

A

posterolateral thoracic wall

85
Q

what do the intercostal nodes drain

A

thoracic duct of right lymphatic duct 1-6 spaces

7-11 spread to abdomen and enter cisterna chyli directly

86
Q

What are the groups of diphragmatic nodes

A

anterior lateral and posterior

87
Q

what diaphragmatic nodes drain to parasternal

A

anterior and lateral

88
Q

where do the posterior diphragmatic nodes drain to

A

posterior mediastinal nodes

89
Q

Where would you place a chest tub in the intercostal space to avoid the bundle

A

superior border- be careful for collateral branches

90
Q

where is the pressure greatest in arterial supply of thorax. anteriorly or posterior

A

posterior because aorta supplies it

91
Q

What are the three compartments of the thoracic cavity

A

2 lateral pulmonary cavities and a central mediastinum

92
Q

boundaries of mediastinum

A 
superior- superior thoracic aperture
lateral- mediastinal parietal pleura
inferior- diaphragm
anterior- sternum and costal cartilages
posterior- bodies of thoracic vertebra
93
Q

what are the divisions of the mediastinum

A

superior and inferior.

anterior middle and posterior

94
Q

what part of azygous system forms hemiazygous

A

lower third on left side. from junction of ascending lumbar and subcostal v, also drains 11,10,9 and crosses midline

95
Q

what forms middle third azygous system

A

accessory hemiazygous v, spaces 5,6,7,8 (left) crosses midline

96
Q

where to the top left intercostal spaces drain venous blood 1-4

A

directly into subclavian v

97
Q

what are the boundaries of the superior mediastinum

A

superior- superior thoracic aperture
inferior- transverse plane
anterior- manubrium
posterior- anterior surface of vertebral bodes of TV1-TV4

98
Q

where does the azygous v drain into

A

superior vena cava

99
Q

are there valves in azygous system

A

no

100
Q

what does the azygous system provide collaterally

A

connection between superior and inferior vena cava

101
Q

what are the major structures in the superior mediastinum

A

thymus, brachiocephalic vv, superior vena cava, aortic arch and branches, trachea, esophagus, thoracic duct, sympathetic trunk, phrenic n, vagus n

102
Q

where is the thymus found

A

posterior to manubrium

103
Q

what is the primary lymphatic organ in infants

A

thymus

104
Q

what supplies thymus arteriorly

A

internal thoracic and inferior thyroid vessels

105
Q

what innervates the thymus

A

vagus and sympathetic trunk

106
Q

what forms the brachiocephalic vv

A

subclavian and internal jugular vv

107
Q

which brachiocephalic v is longer and why?

A

left traversely across superior mediastinum

108
Q

what forms the superior vena cava

A

union of left and right brachiocephalic vv

109
Q

at what level does the superior vena cava enter right atrium

A

third costal cartilage

110
Q

Where does the aortic arch being (what segment level)

A

TV4 TV5 intervertebral space

111
Q

where does the aorta arch

A

posteriorly to left over root of left lung

112
Q

what are the 3 main branches of aortic arch

A

brachiocephalic trunk, left common carotid a and left subclavian a

113
Q

where is the ligamentum arteriosum

A

passes from origin of left pulmonary a to arch of aorta

114
Q

What levels are in phrenic and what does it inn

A

C3-5 motor inn to thoracic diaphragm

sensory to diaphragm, mediastinal pleura and pericardium

115
Q

where does the phrenic n descend in relation to lungs

A

anterior to root of lungs

116
Q

where does the vagus n descend in relation to lungs

A

posterior to root of lungs

117
Q

what type of info does vagus carry

A

preganglionic PARAsympathetic to thoracic autonomic plexuses

118
Q

what does the left vagus give off in the superior medistinum

A

left recurrent laryngeal

119
Q

where does the left recurrent laryngeal travel

A

under arch of aorta just lateral to the ligamentum arteriosum, then superior

120
Q

when the vagus nn approach esophagus in posterior mediastinum what do they become

A

left- anterior vagal trunk

right- posterior vagal rtunk

121
Q

what n is compressed with hoarseness of voice

A

the recurrent laryngeal

122
Q

what can impinge recurrent laryngeal

A

aoritic aneurysm, esophageal cancer, enlargement of mediastinal lymph nodes

123
Q

What is the division of the anterior and posterior mediastinum

A

the pericardium

124
Q

At what segmental level does the esophagus originate

A

CV6 as continuation of pharynx

125
Q

in relation to trachea where does esophagus travel

A

left

126
Q

where does the esophagus exit the thorax

A

through esophageal hiatus of diaphragm at TV10

127
Q

Where is the cervical constriction

A

CV6 pharyngoesophageal

128
Q

where is the thoracic constriction

A

TV4/5 broncho-aortic

129
Q

where is the diaphragmatic constriction

A

TV10

130
Q

what inn the esophagus autonomically

A

the esophageal autonomic plexus- SANS and PANS

131
Q

where do the SANS of esophageal plexus come from

A

preganglionic nerve cell bodies at T2-T6

post ganglionic nerve cell bodies in sympathetic chain

132
Q

How can esophageal pain and pain from MI present similarly

A

esophageal nn travel with cardiopulmonary splanchnic nn

133
Q

what is the funciont of SANs on esophagus

A

vasoconstriction, and decreased gland secretion

134
Q

Where are the postganglionic cell bodies of the PANs of esophagus

A

in its wall

135
Q

what is the function of PANS on esophagus

A

vasodilation, increased gland secretion and increased peristalsis

136
Q

Where does the descending aorta go in relation to midline

A

left

137
Q

where does the descending aorta exit thorax

A

TV12 through aortic hiatus in thoracic diaphragm

138
Q

What are the branches of the descending aorta

A 
posterior intercostal 9 pari and subcostal aa
bronchial a(2L, 1R)
esophageal aa 3-5 unpaired
pericardial and mediastinal aa
superior phrenic aa (1 pair)
139
Q

what percent of body does thoracic duct drain lymph

A

75%

140
Q

where does the thoracic duct being

A

LV2 level from cisterna chyli

141
Q

where does thoracic duct ascend in relation to esophagus

A

posterior

142
Q

What branches come off ascending aorta

A

the coronary aa

143
Q

At TV5 where does the thoracic duct traverse

A

across midline to left of esophagus and posterior to left common carotid a

144
Q

Where are the postganglionic sympathetic nerve cell bodies found in abdomen

A

sympathetic chain ganglia

145
Q

what is the smooth m in the trachea

A

trachealis

146
Q

What nn supply the preaortic abdominal autonomic plexuses

A

thoracic splanchnic nn

147
Q

what type of info is int thoracic splanchnic nn

A

preganglionic sympathetic nerve cell processes

148
Q

3 parts of thoracic splanchnic nn and give cord levels in each

A

greater T5-T9
lesser T10-T11
least T12

CV I (7 decks)

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