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ESA 3 - Respiratory > Session 1.2d - Gray's Anatomy for Students - Thorax - Regional anatomy - Thoracic wall CLINICAL and IMAGES > Flashcards

Session 1.2d - Gray's Anatomy for Students - Thorax - Regional anatomy - Thoracic wall CLINICAL and IMAGES Flashcards

https://www.clinicalkey.com/#!/content/book/3-s2.0-B9780702051319000031?scrollTo=%23hl0001925

1
Q

Fig. 3.18

Label the images.
Include anterior/posterior directions.
Caption images with the view.

Caption overall image.

A 
SUPERIOR VIEW
Anterior (top), Posterior (bottom)
- Vertebral body
- Vertebral foramen
- Facet for articulation with tubercle of rib
- Spinous process
- Lamina
- Superior demifacet
- Pedicle
- Transverse process

SUPEROLATERAL VIEW
Superior, Anterior, Inferior, Posterior (clockwise direction from top)
- Facet for articulation with tubercle of rib
- Superior articular process
- Inferior articular process
- Demifacets for articulation with head of ribs

Typical thoracic vertebra.

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2
Q

Fig. 3.19

Label the images and identify which vertebra each image is showing.

Caption the overall image.

A

Vertebra TI
- Superior costal facet for head of rib I

Vertebra TX
- Single complete costal facet for head of rib X

Vertebra TXI
- No costal facet on transverse process

Atypical thoracic vertebrae

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3
Q

Fig. 3.20

Label and caption the image

A
  • True ribs I-VII
  • False ribs VIII-XII
  • Intercostal space
  • Costal cartilage
  • Floating ribs
  • Costal margin

Ribs.

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4
Q

Fig. 3.21A

Label the diagram with anterior and posterior end. Caption it.

A 
POSTERIOR
- Head
- Neck
- Tubercle
- Angle
- Internal surface
- Costal groove
- External surface
- Costal cartilage
ANTERIOR

Anterior view.

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5
Q

Fig. 3.21B

Label the image and caption it.

A
  • Nonarticular surface
  • Tubercle
  • Articular facet
  • Neck
  • Articular facets
  • Crest

Posterior view of proximal end of rib.

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6
Q

Fig. 3.22

Label the image and label which ribs these are showing. Caption it.

A

RIB I

  • Head
  • Neck
  • Tubercle
  • Grooves
  • Scalene tubercle
  • Costal cartilage

RIB XII

Atypical ribs.

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7
Q

Fig. 3.23

Label and caption the image

A
  • Jugular notch
  • Articular site for clavicle
  • Manubrium of sternum
  • Attachment site for rib I
  • Sternal angle (manubriosternal joint)
  • Articular demifacets for rib II
  • Transverse ridges
  • Articular facets for ribs III-VI
  • Body of sternum
  • Articular facets for rib VII
  • Xiphoid process

Sternum

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8
Q

Fig. 3.24

Label the image. State the two views of the vertebrae. Caption it.

A

SUPEROLATERAL VIEW

  • Superior costotransverse ligament
  • Costotransverse joint
  • Joint with vertebral body

SUPERIOR VIEW

  • Lateral costotransverse ligament
  • Costotransverse ligament
  • Joint capsule
  • Rib
  • Joint cavities
  • Vertebra
  • Disc
  • Intra-articular ligament
  • Vertebra

Costovertebral joints.

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9
Q

Fig. 3.25

Label the image and caption it.

A
  • Manubriosternal joint (symphysis)
  • Fibrocartilaginous joint
  • Sternal angle
  • Synovial joint (two compartments)
  • Xiphisternal joint (symphysis)
  • Synovial joint
  • Interchondral joints

Sternocostal joints.

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10
Q

Fig. 3.26A

Label and caption the image.

A

Intercostal space

  • Aorta
  • Posterior intercostal artery and vein
  • Posterior ramus of spinal nerve
  • INTERCOSTAL NERVE
  • Lateral branches of intercostal nerve and vessels
  • Costal groove
  • Collateral branches of intercostal nerve and vessels
  • ANTERIOR INTERCOSTAL ARTERY AND VEIN.
  • Internal thoracic artery and vein
  • Anterior cutaneous branch of intercostal nerve
  • Anterior perforating branches of intercostal vessels.

Anterolateral view.

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11
Q

Fig. 3.26B

Label and caption the image.

A

Intercostal space.

  • Serratus anterior muscle
  • External intercostal muscle
  • internal intercostal muscle
  • Innermost intercostal muscle
  • Skin
  • Superficial fascia
  • Lung
  • Pleural cavity
  • Visceral pleura
  • Parietal pleura
  • INTERCOSTAL VEIN
  • INTERCOSTAL ARTERY
  • INTERCOSTAL NERVE
  • Collateral branches
  • Endothoracic fascia

Details of an intercostal space and relationships. Intercostal space.

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12
Q

Fig. 3.26C

Label and caption the image.

A

Intercostal space.

  • Lateral cutaneous branch
  • Innermost intercostal muscle
  • Internal intercostal muscle
  • External intercostal muscle
  • Anterior cutaneous branch
  • Internal thoracic aartery
  • Anterior perforating branch
  • Anterior intercostal artery
  • Lateral cutaneous branch
  • Aorta
  • Posterior intercostal artery
  • Spinal nerve
  • Posterior ramus
  • Anterior ramus (intercostal nerve)
    Right Lung
    Left Lung
    Mediastinum

Transverse section.

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13
Q

(IN THE CLINIC: Cervical ribs)

How common are cervical ribs?

A

They are present in approximately 1% of the population.

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14
Q

(IN THE CLINIC: Cervical ribs)

What is a cervical rib?

A

An accessory rib articulating with vertebra CVII.

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15
Q

(IN THE CLINIC: Cervical ribs)

What does the anterior end of cervical ribs attach to?

A

The superior border of the anterior aspect of rib I.

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16
Q

(IN THE CLINIC: Cervical ribs)

How is a cervical rib visualised on a plain radiograph?

A

As small horn-like structures (Fig. 3.106).

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17
Q

(IN THE CLINIC: Cervical ribs)

In those with cervical ribs, what commonly extends from the anterior tip of the small cervical ribs to rib I?

A

A fibrous band, producing a “cervical band” that is not visualised on radiography.

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18
Q

(IN THE CLINIC: Cervical ribs)

What happens to structures in patients with cervical ribs and cervical bands?

A

Structures that normally pass over rib I (Fig. 3.7) are elevated by, and pass over, the cervical rib and band.

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19
Q

(IN THE CLINIC: Cervical ribs)

What is thoracic outlet syndrome?

A

Clinically used to describe symptoms resulting from abnormal compression of the brachial plexus of nerves as it passes over the first rib and through the axillary inlet into the upper limb.

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20
Q

(IN THE CLINIC: Cervical ribs)

Where does the anterior ramus of T1 pass?

A

Superiorly out of the superior thoracic aperture to join and become part of the brachial plexus.

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21
Q

(IN THE CLINIC: Cervical ribs)

How are cervical ribs related to thoracic outlet syndrome?

A

The cervical band from a cervical rib is one cause of thoracic outlet syndrome by putting upward stresses on the lower parts of the brachial plexus as they pass over the first rib.

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22
Q

(IN THE CLINIC: Collection of sternal bone marrow)

Where is sternal bone marrow collected?

A

The subcutaneous position of the sternum makes it possible to place a needle through the hard outer cortex into the internal (or medullary) cavity containing bone marrow.

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23
Q

(IN THE CLINIC: Collection of sternal bone marrow)

Where can bone marrow be aspirated?

A

Through the hard outer cortex of the sternum into the internal (or medullary) cavity containing bone marrow.

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24
Q

(IN THE CLINIC: Collection of sternal bone marrow)

What is sternal bone marrow used for?

A

Evaluation of this material under the microscope helps clinicians diagnose certain blood diseases such as leukemia.

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25
Q

(IN THE CLINIC: Rib fractures)

What is the consequence of single rib fractures?

A

There is actually little consequence, though extremely painful.

26
Q

(IN THE CLINIC: Rib fractures)

What can occur after severe trauma to the ribs?

A

The ribs may be broken in two or more places.

27
Q

(IN THE CLINIC: Rib fractures)

What can occur if enough ribs are broken?

A

A loose segment of chest wall, a flail segment (FLAIL CHEST), is produced.

28
Q

(IN THE CLINIC: Rib fractures)

What is a flail segment?

A

A loose segment of chest wall produced from multiple rib fractures (FLAIL CHEST).

29
Q

(IN THE CLINIC: Rib fractures)

What occurs in inspiration in flail chest?

A

When the patient takes a deep inspiration, the flail segment moves in the opposite direction to the chest wall, preventing full lung expansion and creating a paradoxically moving segment.

30
Q

(IN THE CLINIC: Rib fractures)

What can occur and may need to be done in a large presentation of flail chest?

A

If a large enough segment of chest wall is affected, ventilation may be impaired and assisted ventilation may be required until the ribs have healed.

31
Q

Fig. 3.27

Label and caption the image.

A
  • External intercostal membrane
  • External intercostal muscle
  • EXTERNAL INTERCOSTAL MUSCLE
  • INTERNAL INTERCOSTAL MUSCLE
  • INNERMOST INTERCOSTAL MUSCLE
  • Intercostal nerve
  • Intercostal artery
  • Intercostal vein
  • Collateral branches

Intercostal muscles.

32
Q

Fig. 3.28

Label the image

A

A - Subcostal muscles
B - Transversus thoracic muscle

A. Subcostal muscles. B. Transversus thoracic muscles.

33
Q

Fig. 3.29

Label and caption the image.

A
  • Supreme intercostal artery
  • Costocervical trunk
  • Subclavian artery
  • POSTERIOR INTERCOSTAL ARTERY
  • Collateral branch of posterior intercostal artery
  • Musculophrenic artery
  • Aorta
  • Internal thoracic artery
  • Anterior perforating branches
  • ANTERIOR INTERCOSTAL ARTERY
  • Superior epigastric artery

Arteries of the thoracic wall.

34
Q

Fig. 3.30

Label and caption the image

A
  • Right brachiocephalic vein
  • RIGHT SUPERIOR INTERCOSTAL VEIN
  • Posterior intercostal vein
  • AZYGOS VEIN
  • Anterior intercostal vein
  • LEFT SUPERIOR INTERCOSTAL VEIN
  • Left brachiocephalic vein
  • Accessory hemiazygos vein
  • INTERNAL THORACIC VEIN
  • Anterior perforating branches
  • Hemiazygos vein

Veins of the thoracic wall.

35
Q

Fig. 3.31

Label and caption the image

A
  • Right jugular trunk
  • Right subclavian trunk
  • Right bronchomediastinal trunk
  • Brachiocephalic nodes
  • Right parasternal lymphatic vessel
  • INTERCOSTAL NODES
  • Thoracic duct
  • Lateral aortic nodes
  • Cisterna chyli
  • Diaphragm
  • DIAPHRAGMATIC NODES
  • PARASTERNAL NODES
  • Left parasternal lymphatic vessel
  • Left bronchomediastinal trunk
  • Left subclavian trunk
  • Left jugular trunk
  • Thoracic duct

Major lymphatic vessels and nodes of the thoracic wall.

36
Q

Fig. 3.32

Label and caption the image.

A
  • Spinal cord
  • Posterior ramus
  • INTERCOSTAL NERVE
  • Posterior branch
  • LATERAL CUTANEOUS BRANCH
  • Anterior branch
  • Small collateral branch
  • Lateral branch
  • Medial branch
  • ANTERIOR CUTANEOUS BRANCH

Intercostal nerves

37
Q

(IN THE CLINIC: Surgical access to the chest)

Why is a surgical access potentially more challenging in the chest?

A

Due to the rigid nature of the thoracic cage

38
Q

(IN THE CLINIC: Surgical access to the chest)

What is surgical access dependent upon?

A

The organ that is operated upon and its relationships to subdiaphragmatic structures and structures in the neck.

39
Q

(IN THE CLINIC: Surgical access to the chest)

Where would a standard incision site for surgical access to the chest be?

A

A standard incision site would include a median sternotomy to obtain access to the heart, including the coronary arteries and the cardiac valves.

40
Q

(IN THE CLINIC: Surgical access to the chest)

What is a left or right lateral thoracotomy?

A

An incision through an intercostal space to access the lungs and the mediastinal structures. (See Google images for pictures)

41
Q

(IN THE CLINIC: Surgical access to the chest)

What is a median sternotomy used for?

A

This surgical incision down the midline is used to obtain access to the heart, including the coronary arteries and the cardiac valves.

42
Q

(IN THE CLINIC: Surgical access to the chest)

Give an example of a minimally invasive thoracic surgery.

A

Video-assisted thoracic surgery (VATS)

43
Q

(IN THE CLINIC: Surgical access to the chest)

What does minimally invasive thoracic surgery involve?

A

Making small (1-cm) incisions in the intercostal spaces, placing a small camera on a telescope, and manipulating other instruments through additional small incisions.

44
Q

(IN THE CLINIC: Surgical access to the chest)

What procedures can be performed via minimally invasive thoracic surgeries?

A

A number of procedures, including:

  • Lobectomy
  • Lung biopsy
  • Esophagectomy
45
Q

(IN THE CLINIC: Thoracostomy (chest) tube insertion)

Why is insertion of a chest tube normally done?

A

This commonly performed procedure is indicated to relieve air or fluid trapped in the thorax between the lung and the chest wall (pleural cavity).

46
Q

(IN THE CLINIC: Thoracostomy (chest) tube insertion)

What conditions can chest tube insertion be used for?

A

This commonly performed procedure is done for:

  • pneumothorax (air)
  • haemothorax (blood)
  • haemopneumothorax (air and blood)
  • malignant pleural effusion empyema (pus)
  • hydrothorax (fluid)
  • chylothorax (chyle)
  • after thoracic surgery
47
Q

(IN THE CLINIC: Thoracostomy (chest) tube insertion)

Where should the thoracostomy tube be positioned?

A

Between the anterior axillary and midaxillary anatomical lines from anterior to posterior and either the fourth or fifth intercostal space from cephalad to caudad.

48
Q

(IN THE CLINIC: Thoracostomy (chest) tube insertion)

What needs to be clearly marked when performing a thoracostomy?

A

The position of the ribs in the region of the chest utbe insertion

49
Q

(IN THE CLINIC: Thoracostomy (chest) tube insertion)

Where should anaesthetic be applied in a thoracostomy?

A

To the superior border of the rib and the inferior aspect of the intercostal space, including one rib and space above and one rib and space below.

50
Q

(IN THE CLINIC: Thoracostomy (chest) tube insertion)

Why is the tube positioned on the superior border of the rib?

A

The neurovascular bundle runs in the neurovascular plane, which lies in the superior aspect of the intercostal space (just below the rib); hence, the reason for positioning the tube on the superior border of a rib (i.e., at the lowest position in the intercostal space).

51
Q

(IN THE CLINIC: Intercostal nerve block)

How might we provide analgesia to patients with chest trauma?

A

Local anaesthesia of intercostal nerves

52
Q

(IN THE CLINIC: Intercostal nerve block)

Local anaesthesia of intercostal nerves produces excellent analgesia in patients with chest trauma. What else can it be used for?

A

In patients requiring anaesthesia for a

  • thoracotomy
  • mastectomy
  • upper abdominal surgical procedures
53
Q

(IN THE CLINIC: Intercostal nerve block)

Where are the intercostal nerves situated?

A

Inferior ot the rib borders in the neurovascular bundle

54
Q

(IN THE CLINIC: Intercostal nerve block)

Where are the neurovascular bundles situated?

A

Deep to the external and internal intercostal muscle groups

55
Q

(IN THE CLINIC: Intercostal nerve block)

How might the nerve block be undertaken?

A

Using a “blind” technique or under direct imaging guidance.

56
Q

(IN THE CLINIC: Intercostal nerve block)

What might we do to access the rib in the patient?

A

Place them in an appropriate position

57
Q

(IN THE CLINIC: Intercostal nerve block)

How would we typically induce nerve block.

A

Typically, under ultrasound guidance, a needle may be advanced into the region of the subcostal groove, followed by an injection with local anaesthesia.

58
Q

(IN THE CLINIC: Intercostal nerve block)

Is the analgesia for nerve block short- or long-acting?

A

Depending on the type of local anaesthetic, analgesia may be short- or long-acting.

59
Q

(IN THE CLINIC: Intercostal nerve block)

What complications may occur in nerve block?

A

Given the position of the neurovascular bundle and the subcostal groove, complications may include puncture of the parietal pleura and an ensuing pneumothorax.

60
Q

(IN THE CLINIC: Intercostal nerve block)

How could bleeding occur in nerve block?

A

Bleeding may also occur if the artery or vein is damaged during the procedure.

ESA 3 - Respiratory (28 decks)

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