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Gross III > Part I. Thorax > Flashcards

Part I. Thorax Flashcards

1
Q

Types of Ribs

A

True, false, floating

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2
Q

True ribs:

A

Vertebrosternal ribs 1-7

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3
Q

False ribs:

A

Vertebrochondral ribs 8-10

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4
Q

Floating ribs:

A

Vertebral ribs 11-12

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5
Q

Typical ribs:

A

Ribs 3-9

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6
Q

Atypical ribs

A

1, 2, 10-12

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7
Q

What are features of typical ribs?

A
  • head with 2 facets + a crest
  • neck
  • tubercle
  • body (angle and groove)
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8
Q

Why do typical facets have 2 facets?

A

Because demifacets

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9
Q

What does the rough part of a typical rib’s tubercle attach to?

A

Lateral coststransverse ligament

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10
Q

What are features of atypical ribs?

A

Only 1 facet (Rib 1, 10-12)

Note: Rib 2 has 2 facets

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11
Q

Which atypical rib has 2 facets?

A

Rib 2

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12
Q

Describe atypical rib 1:

A
  • broadest
  • shortest
  • most curved
  • synarthrosis (like sutures of skull)
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13
Q

Where are the grooves on rib 1 and what are they for?

A
  • superior grooves for subclavian a + v
  • scalene tubercle for ant. Scalene m.
  • ridge posterior to groove for subclavian a. for middle scalene muscle attachment
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14
Q

What kind of joint is Rib 1 NOT?

A

Synovial

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15
Q

Describe atypical rib 2:

A
  • more typical body
  • 2 facet heads
  • tuberosity for m
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16
Q

What does rib 2 articulate with?

A

T1 and T2

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17
Q

What is rib 2’s tuberosity for?

A

Serratus anterior Muscle attachment

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18
Q

Describe Ribs 10-12

A

Only 1 facet (so it articulates with only 1 vertebra)

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19
Q

Describe ribs 11-12

A

Short, no necks or tubercles because they do not articulate with TPs

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20
Q

What level is the manubrium?

A

T3-T4

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21
Q

What landmarks are on the manubrium?

A

Jugular notch
Sternoclavicular joints at clavicular notch
Sternocostal ‘synchondrosis’ of rib 1
Manubriosternal joint (rib 2 articulation)

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22
Q

What vertebral level is the sternal body?

A

T5-T9

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23
Q

Describe the features of sternal body

A

Costal notches = rib 3-7 articulations (and 1/2 of rib 2)

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24
Q

What contains hematopoietic bone marrow throughout life?

A

Sternal body

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25
Q

The sternal body is made up of ___ sternebrae bones and they fuse by ages _____

A

4; 14-25 yo

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26
Q

What vertebral level is the xiphoid process?

A

T10

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27
Q

Describe the xiphoid process

A

Cartilaginous (ossified over age 40)

Xiphisternal joint

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28
Q

What is the superior thoracic aperature?

A

The opening at the top of the thorax

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29
Q

Boundaries of thoracic apertures:

A

T1 vertebra
1st ribs
1st costal cartilages
Manubrium

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30
Q

What passes through superior thoracic aperture?

A

Trachea
Esophagus
Major nerves and blood vessels pass through

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31
Q

Another name for superior thoracic aperture?

A

Anatomical thoracic inlet

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32
Q

Another name for inferior thoracic aperture?

A

Anatomical thoracic outlet

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33
Q

Boundaries of inferior thoracic aperture?

A

T12 vertebra
11th and 12th ribs
Costal arch 7-10
Xiphisternal joint

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34
Q

What passes through the inferior thoracic aperture?

A

Esophagus (at level of T10)
IVC (at level of T8)
Aorta (at level of T12)

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35
Q

What attaches to inferior thoracic aperture?

A

Diaphragm

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36
Q

Joints of thoracic wall:

A

Costovertebral joints
Costochondral joints
Sternocostal joints

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37
Q

Muscles of respiration:

A 
Scalenes
SCM
Serratus anterior
Pectoral is major; minor
Iliocostalis lumborum
Quadratus lumborum
Serratus posterior superior and inferior
Lavator costarum
Transversus thoracic
Subclavius
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38
Q

Passive expiration results from:

A

Muscle relaxation and elastic recoil in lungs

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39
Q

Active expiration assisted by:

A

Abdominal wall muscle contraction

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40
Q

The female breast is usually located at what rib level(s)?

A

2-6

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41
Q

The nipple is an opening for:

A

15-20 lactiferous ducts

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42
Q

Where is the axillary process?

A

Breast tissue that extends along inferolateral margin of pec major and into the axilla

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43
Q

What is the space between breast and deep pectoral fascia called and what does it do?

A

Retromammary space; allows movement

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44
Q

What are the ligaments called that span from mammary gland to overlying dermis for support?

A

Suspensions ligaments

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45
Q

The suspensory ligaments do what?

A

Support the shape of the breast and the lobes of the mammary gland (lactating)

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46
Q

What part of the female breast contain numerous sebaceous glands?

A

Areola

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47
Q

The areola secrets oily protective substance to do what:

A

Lubricate nipple and areola

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48
Q

The __________ is the dilated region in each lactiferous duct.

A

Lactiferous sinus

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49
Q

What does the lactiferous sinus do?

A

Milk accumulates here during nursing

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50
Q

Milk is produced in the

A

Alveoli (acini) of the mammary gland

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51
Q

Where are the secretory acini located?

A

Lobules of mammary gland

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52
Q

Why does female breast enlarge at puberty?

A

Fat deposition

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53
Q

Why does female breast enlarge during pregnancy?

A

Gland hypertrophy and hyperplasia and fat deposition

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54
Q

Why does female breast enlarge during menstrual cycle?

A

Gland hypertrophy (preparatory… as though she’s expecting the sperm to hit the jackpot)

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55
Q

What are the 3 arteries that supply the breast?

A

Medial Mammary Artery (from Anterior Intercostal A (From Internal Thoracic A))

Lateral Thoracic Artery and Thoracoacromial Trunk (from Axillary A)

Posterior Intercostal A (from Thoracic Aorta)

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56
Q

What is the primary vein and secondary that drains the breast?

A

Axillary Vein via Lateral Thoracic V

Some: Internal Thoracic V via Medial Mammary V

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57
Q

Where does the lymph from nipple, areola and gland lobules drain?

A

Subareolar Lymphatic Plexus

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58
Q

Most lymph from female breast drains to:

A

Axillary lymph nodes through Anterior (Pectoral) Nodes

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59
Q

Medial quadrants in the breast drain lymph to:

A

Parasternal nodes or opposite breast

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60
Q

Lower quadrants in the breast drain lymph to

A

Inferior phrenic (abdominal) nodes

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61
Q

What are 2 individual lateral compartments containing lungs and pleurae?

A

Pulmonary cavities

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62
Q

What is the 1 central compartment containing all thoracic structures except lungs?

A

Mediastinum

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63
Q

What does the mediastinum do?

A

Completely separates pulmonary cavities from each other

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64
Q

What is double layered serous mesothelial sac surrounding and investing the lungs?

A

Pleura

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65
Q

What is simple squamous epithelium completely investing the lungs (including fissures)

A

Visceral pleura

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66
Q

Can visceral pleura be dissected from lungs?

A

No

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67
Q

What is simple squamous epithelium lining inner surface of each pulmonary cavity?

A

Parietal pleura

68
Q

Can parietal pleura be dissected from peripheral structures?

69
Q

What is the potential space between visceral pleura and parietal pleura?

A

Pleural cavity

70
Q

What kind of pleura lines the internal surface of thoracic wall (ribs, intercostal spaces)?

A

Costal pleura

71
Q

What separates costal pleura from peripheral structures?

A

Endothoracic fascia

72
Q

What does endothoracic fascia do?

A

Provides surgical access without penetrating pleural cavity

73
Q

What pleura covers lateral aspects of mediastinum?

A

Mediastinal pleura

74
Q

What is the double layer of mediastinal pleura extending inferior from root of lung. This structure allows lung root structures to slide up/down during respiration.

A

Pulmonary ligament

75
Q

What pleura covers superior surface of thoracic diaphragm on either side of mediastinum?

A

Diaphragmatic pleura

76
Q

What pleura lines the cup-shaped dome over the apex of each lung?

A

Cervical pleura

77
Q

Cervical pleura is reinforced by a membrane called:

A

Suprapleural membrane, a fibrous extension of endothoracic fascia

78
Q

What is it called when parietal pleura transitions from one part to another? Ie. From diaphragmatic parietal pleura to costal parietal pleura

A

Pleural reflections

79
Q

What is it called when two parietal pleura layers contact each other?

A

Pleural recess

80
Q

Where is the sternal line of pleural reflection? (Describe location)

A

Anterior transition of costal pleura and mediastinal pleura

81
Q

Where does the sternal line of pleural reflection happen on the right side?

A

Midline from sternal angle to 6th costal cartilage

82
Q

Where does the sternal line of pleural reflection happen on the left side?

A

Midline to 4th costal cartilage lateral the 6th costal cartilage (because of heart)

83
Q

Describe the location of costal line of pleural reflection

A

Peripheral transition of costal pleura and diaphragmatic pleura

84
Q

Where does the costal line of pleural reflection happen on the right side?

A

Follows costal margin

85
Q

Where does the costal line of pleural reflection happen on the left side?

A

Starts at midclavicular line (because of heart) and then follows costal margin

86
Q

What is the right border of the heart?

A

Right atrium

87
Q

What is the left border of the heart?

A

Left ventricle

88
Q

What is the inferior border of the heart?

A

Right ventricle

89
Q

What is the superior border of the heart?

A

Left and right atriums

90
Q

What is the flow of the blood in the heart starting from the inferior vena cava or superior vena cava?

A

Right atrium through [tricuspid valve] —> right ventricle through [pulmonary semilunar valve] —> L/R pulmonary branch and arteries —> LUNGS —> L/R pulmonary veins —> left atrium through [bicuspid valve] —> left ventricle through [aortic semilunar valve] —> aorta —> arteries —> capillaries —> veins —> back to the inferior/superior vena cava

91
Q

What type of joint is the manubriosternal joint?

92
Q

The manubriosternal joint creates what anatomical landmark?

A

sternal angle

93
Q

What type of joint is the xiphisternal joint?

94
Q

The xiphisternal joint is a landmark for what four anatomies?

A
  • inferior border of central thoracic cavity
  • infrasternal (subcostal) angle
  • inferior border of the heart
  • superior border of the liver
95
Q

For a typical rib (3-9), the inferior articular facet of the rib articulates with which which demifacet (superior or inferior) of which vertebral body (superior, inferior or same)?

A

superior, same

96
Q

The crest on the head of the rib articulates with what structure? via what ligament?

A

articulates with the IVD via the intra-articular ligament

97
Q

What type of joint is the costovertebral joint?

98
Q

What type of joint is the costotransverse joint?

99
Q

What ligament attaches rib tubercle to transverse process at the same vertebral level?

A

lateral costotransverse ligament

100
Q

What ligament attaches rib neck to the transverse process one vertebral level above?

A

superior costotransverse ligament

101
Q

Which ribs articulate with only one vertebral body?

A

1, 10, 11, 12

102
Q

What type of joint is the costochondral joint?

A

synchondroses

103
Q

What type of joint is the sternocostal joint?

A

synovial at rib 2-7 and synchondrosis at rib 1

104
Q

What ligaments support the sternocostal joints?

A

anterior and posterior radiate sternocostal ligaments

105
Q

The external intercostal muscle starts at ______ and end at _____.

A

rib tubercle: costochondral joint

106
Q

What fills in the space from where the external intercostal muscles end (costochondral joint) to the sternum externally?

A

external intercostal membrane

107
Q

What is the fiber direction of the external intercostal muscle?

A

anterior and inferior (fingers in pockets)

108
Q

What is the action of the external intercostal muscle?

A

elevate ribs

109
Q

The internal intercostal muscle starts at ______ and end at _____.

A

sternum: rib angle

110
Q

What fills in the space from where the internal intercostal muscles end (rib angle) to the transverse process internally?

A

internal intercostal membrane

111
Q

What is the fiber direction of the internal intercostal muscle?

A

inferior and posterior (fingers under shirt)

112
Q

What is the action of the internal intercostal muscle?

A

depress ribs

113
Q

What is the path of the 3rd-11th intercostal nerve, artery vein and in what order (from superior to inferior) are they usually traveling?

A

medially they travel between internal intercostal membrane and parietal pleura.
laterally they travel between the internal and innermost intercostal muscles.
usually in V.A.N. order

114
Q

What is the fiber direction of the innermost intercostal muscle?

A

inferior and posterior (same as internal intercostal and subcostal)

115
Q

What is the action of the innermost intercostal muscle?

A

depress ribs (same as internal intercostal and subcostal)

116
Q

What is the fiber direction of the subcostal muscle?

A

inferior and posterior (same as internal and innermost intercostal)

117
Q

What is the action of the subcostal muscle?

A

depress ribs (same as internal and innermost intercostal)

118
Q

The transversus thoracis muscle spans from the _______ to ______?

A

inferior sternum: 2-6 costal cartilage

119
Q

What is the action of the transversus thoracis muscle?

A

depress ribs

120
Q

The action of all of the muscles of the thoracic wall is ______ except which muscle? What is the action of the exception?

A

depress ribs, except external intercostal muscles which elevated the ribs

121
Q

Which muscle of the thoracic wall may also function in proprioception?

A

transversus thoracis

122
Q

There are how many intercostal nerves and what are they formed by?

A

11 pairs formed by VPR of T1-T11

123
Q

Which intercostal nerves are considered typical and who?

A

3-6, because they run in the costal groove

124
Q

Which intercostal nerves are atypical and why?

A

1,2 because they do not run in the costal groove

7-11 because they run out of rib cage anteriorly and become thoracoabdominal nerves when they go into the abdomen

125
Q

The VPRs of T12 form what nerve?

126
Q

Which dermatome is located at the umbilicus?

127
Q

Which dermatome is located at the nipple?

128
Q

What are the branches of the intercostal nerves and what do they supply?

A
  • collateral branches supply muscles and pleura
  • lateral and anterior cutaneous branches supply skin
  • muscular branches
  • rami communicates
129
Q

The lateral cutaneous branch of the 2nd intercostal nerve gets a special name because it is part of the brachial plexus. What is the special name?

A

intercostobrachial nerve

130
Q

White communicating rami tend to be located _____ to the gray rami.

131
Q

White rami contain what kind fo fibers?

A

presynaptic sympathetic

132
Q

Gray rami contain what kind fo fibers?

A

postsynaptic sympathetic

133
Q

Communicating rami connect what two structures?

A

intercostal (spinal) nerves and sympathetic ganglion

134
Q

What nerves supply the costal and peripheral diaphragmatic pleura?

A

intercostal nerves

135
Q

What nerves supply the central diaphragmatic and mediastinal pleura?

A

phrenic nerves

136
Q

How is the visceral pleura innervated?

A

visceral afferents only (no somatic innervation) which may cause referred pain

137
Q

What is the pulmonary root?

A

hilum of the lung where vessels enter and exit the organ and are enclosed in pleura

138
Q

What are the contents of the pulmonary root?

A 
pulmonary artery
main bronchi
pulmonary vein
lymph vessels 
bronchial arteries and veins
nerves of the ANS
139
Q

What is the Carina and at what vertebral level is it located?

A

it is the internal ridge at bifurcation of the trachea. Located at around T5 and is area of sensitive cough reflex

140
Q

Which main bronchus is shorter, wider, more vertical and forms 3 secondary bronchi?

A

the right bronchus

right lung has 3 lobes to match the 3 right secondary bronchi

141
Q

Which main bronchus passes inferior to aorta, anterior to the esophagus and forms 3 secondary bronchi

A

the left bronchus

left lung has 2 lobes to match the 2 right secondary bronchi

142
Q

How many bronchopulmonary segments does each lung have?

143
Q

What separates each bronchopulmonary segment?

A

connect tissue seams with pulmonary veins running through (allows for surgical resection of individual segments.

144
Q

Each bronchopulmonary segment is supplied by ______ and ______.

A

segmental (tertiary) bronchi and tertiary pulmonary arteries, they branch and travel together to each segment

145
Q

Pulmonary arteries carry what kind of blood to the lung from which part of the heart?

A

deoxygenated blood from the right ventricle to the lung

146
Q

The pulmonary trunk branches into how many pulmonary arteries?

A

2, right and left

147
Q

Where in the pulmonary root is the pulmonary artery typically located?

A

superiorly (ABV)

148
Q

Pulmonary veins carry what kind of blood from the lung to which part of the heart?

A

oxygenated blood to the left atrium

149
Q

How many pulmonary arteries are there?

A

4, 2 right and 2 left

150
Q

Where in the pulmonary root are the pulmonary veins typically located?

A

inferior and anterior (ABV)

151
Q

What supplies blood to the lungs and visceral pleura? Where do they originate and how do they travel in the lungs?

A

bronchial arteries which originate from the aorta (occasionally from posterior intercostal a.) and travel with bronchi until anastomosing at respiratory bronchiole

152
Q

Where does the right bronchial vein drain to?

153
Q

Where does the left bronchial vein drain to?

A

hemiazygos v.

154
Q

About what percentage of the blood is drained from the lung via the bronchial arteries? What drains the rest?

A

13%, the remained returns via pulmonary vein due to anastomoses

155
Q

What is the order of SUPERFICIAL lymphatic drainage from the lungs?

A

superficial (sub pleural) lymphatic plexus (under pleura) -> bronchopulmonary (hilar) lymph nodes -> tracheobronchial nodes ->bronchomediastinal trunks -> then into the venous systems via the thoracic duct if on the left or right lymphatic duct

156
Q

What is the order of DEEP lymphatic drainage from the lungs?

A

deep lymphatic plexus (in submucosa and septa) -> intrapulmonary or bronchopulmonary (hilar) lymph nodes -> tracheobronchial nodes ->bronchomediastinal trunks -> then into the venous systems via the thoracic duct if on the left or right lymphatic duct

157
Q

Presynaptic parasympathetic nerves that supply the lungs travel in which nerve and synapse where?

A

travel in the vagus nerve (CN X) and synapse in the walls of the bronchi

158
Q

What are the effects of parasympathetic innervation to the lungs?

A

bronchoconstriction
vasodilation
secretomotor

159
Q

Sympathetic innervation for the lungs comes from what cord levels? Where do they synapse?

A

T2-T5, synapse in sympathetic trunk and postganglionic sympathetic neurons exit the trunk and follow blood vessels to the lungs

160
Q

What are the effects of sympathetic innervation to the lungs?

A

vasoconstriction
inhibition of secretion
(bronchodilation is by lack of parasympathetic not presence of sympathetic)

161
Q

pulmonary visceral afferents travel in which nerve?

A

vagus nerve, CNX

162
Q

What are the reflexive control functions of pulmonary visceral afferents?

A

tactile sensations (cough reflex)
stretch receptors in bronchi
pressure receptors in pulmonary arteries (blood pressure)
chemoreceptors in pulmonary veins (blood gas)

163
Q

Pulmonary visceral afferents are responsive to what stimuli?

A

chemical irritation
ischemia
excessive stretch

164
Q

Pain impulses from visceral pleura and bronchi travels with _____ and may refer pain to ______ dermatomes.

A

sympathetics, T2-T5

165
Q

Pain impulses from the trachea travel with _____ in the ______ nerve

A

parasympathetics, vagus

Gross III (20 decks)

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