SF3 Exam 1 Flashcards by Taylor Spry

Which ribs are true ribs?

1-7

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Which are false ribs?

8-12

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What ribs are palpable?

2-10

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Where is the nipple located?

4th intercostal space

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Explain how ribs connect in the area of the vertebrae

They connect between vertebra with the bottom vertebra being the corresponding number of the rib. Ex) Rib 6 has T5 above it and T6 below it

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What makes up the costal marigin?

Ribs 8-10

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What Sets of vertical lines exist on the body?

Ant. Median Line (AML) (down sternum)
Midclavicular line (MCL)
Ant. Axillary line (AAL)
Midaxillary line (MAL)
Post. Axillary Line (PAL)

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What events happen at the sternal angle?

1) Rib 2 articulates w/ sternum
2) Arch of aorta above angle, ascending and descending aorta below angle
3) Level of T4-T5 intervertebral disc
4) Separates Superior and Inferior mediastina
5) Superior extent of fibrous pericardium
6) trachea divides into main bronchi
7) Azygous vein enters sup. vena cava

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Where do you insert a chest tube for a thoracostomy?

In what order are the structures you pass through during insertion?

between Ant. Axillary line and midaxillary line in the 4th/5th intercostal space near the TOP of the intercostal space to avoid the nerve.

1) serratus ant
2) External intercostals
3) Internal intercostals
4) Innermost intercostals
5) Endothoracic fascia

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Where is the neurovascular bundle located in the ribs?

between internal and innermost muscle layers

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What is the order of structures in the costal groove

Top to bottom VAN
vein
artery
nerve most at risk

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Where are the transversus thoracis muscles?

Attach from sternum/xiphoid to costal cartilage. Ribs 3-6.

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What is the blood supply to posterior intercostals?

Mostly thoracic Aorta

1 and 2 come from costocervical trunk

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What is the blood supply to anterior intercostals?

Upper 6- Internal thoracic artery
7-9- musculophrenic artery
None in 10-11

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Explain the venous drainage of posterior intercostal space.

Azygous (right) and accessory hemiazygous and hemiazygous (left)

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Explain the venous drainage of anterior intercostal space.

internal thoracic and musculophrenic veins

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What type of innervations so intercostal nerves carry?

1) somatic motor to thoracic wall
2) somatic sensory to skin and parietal pleura
3) postganglionic sympathetic to periphery

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What are the types of pleura involved with the lung? Explain location and give any subsectional names too.

Visceral pleura- directly attached to lung

Parietal pleura- forms from coelomic membrane. has subsections of mediastinal, cervical, costal, and diaphragmatic pleura depending on location. Is just deep to the endothoracic fascia. Other side is the pleural cavity.

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Where would you drain fluid from the lungs?

Costodiaphragmatic Recesses. The lung does NOT enter here.

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Inferior borders of the parietal pleura for the lung?

MCL- rib 8
MAL-rib 10
Posterior- T12

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Inferior borders for lungs?

MCL- rib 6
MAL- rib 8
Posterior- T10

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Superior border of lungs?

1 inch above costal cartilage of rib 1

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What is the cardiac notch. How does it effect the lungs?

Left lung goes to rib 4, then had a notch in it that curves to rib 6.

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What do you look for to determine a pneumothorax?

Lung tissue markings. NOT scapula

What is a closed pneumothorax?

air --> pleural cavity from LUNG

What is a open pneumothorax?

air --> pleural cavity from hole in Thoracic Wall | ex) knife stab

``` Describe the following: Hemothorax Pyothorax Chylothorax Hydrothorax *Pleurisy* ```

Hemothorax- blood in pc Pyothorax- pus in pc Chylothorax- lymph/milky fluid from intestine (tear of thoracic duct) in pc Hydrothorax- excessive serous fluid in pc *Pleurisy*- inflammation of pleura. Visceral and Parietal RUB together. Walking on SNOW. pc= pleural cavity

What innervates the mediastinal pleura and medial diaphragmatic pleura?

Phrenic Nerve ** 3/4/5 keeps the diaphragm alive**

What innervates costal pleura and lateral diaphragmatic pleura?

Intercostal nerves

Explain why pleura pain is typically referred pain.

The innervation stems from the phrenic nerve originating in 3/4/5, so the pain is reffered to those dermatomes. For example, mediastinal pain may present in the shoulder

What is the visceral pleura of the lung formed from embryologically

splanchnic mesoderm

What is esophageal Atresia? What does it cause? What usually occurs with this

You have absence of normal lumen regarding the Esophagus. This will cause polyhydraminosis, where amniotic fluid cannot go to intestines in the fetus. A Tracheoesophegeal Fistula (TEF) usually occurs where the esophagus attaces to the trachea. An inserted catheter will ball in the top portion and an Xray can show air pockets in the intestines from the fistula.

Explain the lobes of the lungs.

``` Right lung has: Sup lobe Horizontal Fissure Middle lobe Oblique fissure Inferior lobe ``` Left lung has: Sup lobe Oblique fissure Inf lobe

Where do the horizontal and oblique fissures meet?

MAL around 4th intercostal space

Explain hilum vs root.

Hilum is the doorway while the root is the actual collection of structres that go in the lung via the hilum

What is at the end of the cardiac notch? Where does it enter during respiration?

Lingula Costomediastinal recess

Bronchopulmonary segment contains? Which component can cause issues during surgery and why?

``` segmental bronchus, branch of pulmonary artery, branch of bronchial artery, Pulmonary Vein Lymphatic Vessel ``` You can remove a full segment (usually 10 segments per lung total) but the pulmonary vein risks being cut as it is in the border area between segments.

Blood supply bronchial arteries

Left lung- 2 from aorta Right lung- 1 posterior intercostal artery from 3rd intercostal space

How do bronchial veins drain?

Left- hemiazygous and accessory hemiazygous Right- Azygous The azygous goes to the Sup. Vena Cava

How do nerves get to the lungs? What are the types and their actions?

Pulmonary plexus that rides bronchi to lungs Parasymp: constrict respiratory pathway Dilate blood vessels Increase mucous Symp: Dilate respiratory path Constrict blood vessels decrease mucous

Where does superficial lymph drain to in lungs?

bronchopulmonary nodes

Where does deep lymph drain to in lungs?

pulmonary nodes--> bronchopulmonary nodes

Intercostal arteries in the 8th intercostal space allow anastomoses between?

Aorta and musculophrenic arteries

What does the phrenic nerve provide?

Motor innervation to diaphragm | sensory to mediastinal pleura, fibrous pericardium, central diaphragmatic pleura

How does the phrenic nerve descend from the brachial plexus?

Ant to scalenus anterior between mediastinal pleura and fibrous pericardium anterior to the root of lung

What is fluid build up in the heart called? What is the term for the pressure this fluid puts on the heart? How is this resolved?

Pericardial Effusion Cardiac Tamponade Needle insertion into subxiphoid area or parasternal approach (5th intercostal space)

Borders of fibrous pericardium

Right- - 2nd costal cartilage **ONLY one different from heart - 6th costal cartilage Left- - 2nd intercostal space - 5th intercostal space

What does the transverse pericardial sinus do?

Separates vein from arteries. In the front are the pulmonary trunk and aorta The back is the Sup Vena Cava

Which membrane contains the phrenic nerve during development?

pleuropericardial membrane

What makes up the diaphragm?

1) Septum transversum- Central tendon 2)Pleuroperitoneal membranes- fuse w/ septum transversum and dorsal mesentary 3) Dorsal mesentary of esophagus- crura of diaphragm to spine 4)Myoblasts somatic mesoderm- muscles

What is the Foramen of Bochdalek? what causes it?

abdominal organs go into pleural cavity through diaphragm Pleuroperitoneal membrane doesn't fuse (90% left side)

Esophageal Hiatus hernia is?

herniation of stomach through esophageal hiatus of diaphragm

What is a Foramen of Morgagni?

Abdominal viscera goes through the sternocostal hiatus which houses the superior epigastric artery

What splits the atrium from the ventricle?

Atrioventricular sulcus

What spits the ventricles?

Anterior and Posterior Sulci

What divides the right atriums muscular and smooth parts?

Crista terminalis

What does the azygous vein drain into?

Sup. Vena Cava

What is fibrous pericardium derived from?

body wall (somatic) mesoderm of the lateral plate