Recap lectures 8-9 (thorax) Flashcards
Thorax and mediastinum
What are the two main parts of the pulmonary cavity?
1) Viscera: primarily lungs, vessels, airways
2) Pleura: Pleural cavity
What are the two main types of pleura found in the thoracic cavity?
Parietal and visceral
1) What is the sternal angle (manubriosternal joint)?
2) What spinal level is it at?
3) What is found here?
1) 2nd rib articulation and connection between manubrium and body of sternum
2) T5
3) Bifurcation of the trachea; base of the heart/root of the ascending aorta
What property is conveyed by the costochondral cartilages? Why?
Flexibility, prevent traumatic fx,
Describe the thoracic inlet and thoracic outlet
1) Thoracic inlet: trachea, esophagus, vessels and nerves
2) Thoracic outlet: closed by diaphragm; IVC, esophagus pass through diaphragm, aorta passes posterior to diaphragm
1) Describe flail chest
2) Is it painful? What does this cause?
1) Multiple rib fractures cause paradoxical wall movement
2) Painful to breathe in, which causes poor ventilation & leads to atelectasis
What causes thoracic outlet syndrome?
Compression of structures between 1st rib and clavicle
List the 8 parts of the sternum
1) Manubrium: upper section of sternum
2) Clavicular notch: superior lateral notches of manubrium
3) Jugular notch: superior medial notch of manubrium
4) Costal cartilage: lateral part of manubrium
5) Costal notches: lateral notches of body
6) Sternal angle: The manubriosternal joint
7) Body: general longer part
8) Xiphoid process: inferior small piece attached to body
What 3 types of muscles can be involved with inhalation?
1) Intercostals
2) Diaphragm
3) Accessory
1) How many pairs of thoracic spinal nerves are there?
2) What do their posterior rami innervate?
1) 12
2) Bones, joints, intrinsic back mm., and over lying skin (dermatomes)
What are the two things formed by the thoracic spinal nerve anterior rami?
1) Anterior rami T1-11: forms intercostal nerves
2) Anterior rami T12: forms subcostal nerve
What is the order of the vessels and nerve in each rib from superior to inferior?
V.A.N (vein, artery, nerve)
1) Where should thoracentesis be performed? Why?
2) What is done during this procedure?
3) Why?
1) To avoid injury to intercostals, go over top of rib, high enough to avoid collaterals.
2) Collect pleural fluid sample for analysis
3) Therapeutic
What space is the chest tube once
appropriately placed?
4th intercostal space, at the mid clavicular line
What are the 4 main arteries that supply the thoracic wall?
1) Posterior intercostal arteries
2) Internal thoracic artery
3) Anterior intercostal arteries (2)
4) Subcostal arteries
1) Where does the internal thoracic artery come from?
2) What two things does it divide into?
1) Subclavian artery
2) Musculophrenic and superior epigastric arteries
Where does the subcostal artery come from?
Aorta
What provide blood to the intercostal space?
1) Posterior intercostal arteries + collateral br.
2) Anterior intercostal arteries + collateral br.
How many thoracic veins are there?
1) 11 pairs intercostal veins
2) 1 pair subcostal veins
1) What do the posterior IC veins anastomose with?
2) What do most posterior IC veins drain into?
1) Anterior IC veins.
2) Azygos/hemi-azygos venous system to SVC
1) What are the lactiferous ducts?
2) What is the lactiferous sinus?
1) Drains each lobule, open independently on the nipple
2) Dilated portion of each lactiferous duct just deep to areola
List all 6 mammary gland structures
1) Nipple
2) Areola
3) Lobules
4) Lactiferous duct
5) Lactiferous sinus
6) Suspensory ligaments
With mastitis, what directions can infection spread?
Superiorly, laterally, or medial to the breast
Where does most drainage from the lymphatic plexus of the breast go? What %?
75% to axillary nodes (pect., central, & apical nodes)
1) Where do the medial breast quadrants drain?
2) Where may the inferior quadrants pass?
1) Parasternal nodes or contralateral breast
2) Deeply to abdominal lymph nodes
What are some visual symptoms of BC
1) Skin dimpling
2) Edema
3) Nipple retraction and deviation
4) Abnormal contours
1) What do the right and left pulmonary cavities contain?
2) What is between the parietal and visceral pleura?
1) Lungs and pleura
2) Pleural cavity
What 6 things are found within the mediastinum?
1) Heart
2) Great vessels
3) Trachea
4) Esophagus
5) Thymus
6) Lymph nodes
What are the 4 parts of the parietal pleura?
1) Apical or cervical pleura
2) Costal pleura
3) Diaphragmatic pleura
4) Mediastinal pleura
What does the parietal pleura cover?
Endothoracic fascia/wall
What do the parietal and visceral pleura of the visceral cavity create?
Pleural “space” or sac
List the lobes of the right lung and what separates each
1) Superior lobe
-Horizontal fissure
2) Middle lobe
-Oblique fissure
3) Inferior lobe
-Has costodiaphragmatic recess
List the lobes of the left side of the lung and what separates them
1) Superior lobe: lingula
-Oblique fissure
2) Inferior lobe
What muscles are recruited during times of increased respiratory effort?
Scalenes and SCM
What separate the breast from the underlying pectoral muscles?
1) SQ tissue
2) Retromammary space (bursa)
3) Pectoral fascia
1) What ribs articulate directly with the sternum?
2) What about via the costal arch?
3) What ribs are floating?
1) First 7 ribs (“true ribs”)
2) 8-10
3) Ribs 11 & 12
Where does most blood supply to the breasts come from? Know where the branches come from.
1) Medial mammary branches of perforating branches and anterior intercostal branches of the internal thoracic artery: originate from the subclavian artery
2) Mammary branches of lateral thoracic and thoraco- acromial arteries: branches of the axillary artery
3) Posterior intercostal arteries: branches of the thoracic aorta that run in the intercostal spaces
Describe the dermatomes of the neck and trunk
1) C1: inferior neck
2) C3: clavicle
3) C4: includes top of shoulder
4) T2: below C4 on thorax
5) T3-12 until L1
>T5 is where the male nipple is
Describe the basic process of lactation
1) Lobules of mammary gland grow and fill up
2) Lactiferous ducts confer milk to the nipple, passing through the lactiferous sinus just before reaching it
Normally lungs are radio_________ and vessels will be more radio________
radiolucent; radiopaque
What supply each segment of the lungs with air, blood to oxygenate, and drainage of blood?
1) Segmental bronchus (air)
2) Tertiary branch of pulmonary artery (blood)
3) Intersegmental parts of pulmonary vein (blood drainage)
What are the bronchopulmonary segments important for?
Lung segment resection (cancer, copd, etc)
What part of the lungs can you find superior to the clavicle?
Cervical pleura and apices of lungs