Superficial Thorax Flashcards

1
Q

What are the boundries of the thorax

A
  • between the neck and abdomen
  • contains heart and lungs
  • diaphragm separates abdominal cavity
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2
Q

what makes up the thoracic wall

A

vertebrae
ribs
sternum
muscles

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3
Q

what type of fascia is seen in the thorax

A
  • superficial

- deep

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4
Q

what is special about the superficial fascia of the thorax

A

it is just like the hypodermis elsewhere

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5
Q

what is special about the deep fascia of the thorax

A

it is named for the muscles or structures beneath and is thin

exp.
- pectoral fascia
- clavopectoral fascia
- endothoracic fascia

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6
Q

how many vertebrae are found in the thorax

A

12 thoracic vertebrae and their discs

** should really reveiw the thoracic v. from the back section

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7
Q

how many pairs of ribs?

A

there will be 12 pairs of ribs with their costal cartilage a long with the sternum

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8
Q

how many true ribs

A

the 1st 7

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9
Q

how many are false ribs

A

8-10

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10
Q

how many are floating ribs

A

11 and 12

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11
Q

what ribs are typical

A

ribs 3-9 are typical

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12
Q

what does a typical rib contain

A
  • head
  • neck
  • tubercle
  • body
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13
Q

what is found on the head of the rib

A

2 facets separated by crest of head

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14
Q

what is found on the tubercle of the rib

A
  • articular part

- nonarticular part

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15
Q

what is the articular part of the tubercle of the rib

A

this articulated with the transverse process of the lower of the two vertebrae to which the head is connected

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16
Q

what is the non articular part of the tubercle of the rib

A

for attachment to the ligament of the tubercle

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17
Q

what are the atypical ribs

A

ribs 1, 2, 10, 11, 12

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18
Q

what makes rib 1 atypical

A
  • broadest, shortest, widest rib
  • 2 grooves ( 1 for subclavian a. and one for sublavian v.)
  • separated by scalene tubercle
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19
Q

what is an attachment site for anterior scalene m

A

the scalene tubercle on the 1st rib

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20
Q

what makes rib 2 atypical

A
  • articulates with sternum at level of sternal angle
  • head has 2 facets to articulate with bodies of T1 and T2
  • tubersoity for serratus anterior
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21
Q

what makes 10 rib atypical

A

only has 1 facet

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22
Q

what makes 11, 12th ribs atypical

A

they only have 1 facet and they are short wiht NO necks or tubercles

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23
Q

what are part of the sternum

A
  • manubrium
  • sternal angle
  • xiphoid process
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24
Q

what can be found on the manubrium

A
  • level of T3 or T4

- jugular notch

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25
Q

where can the sternal angle be foudn

A

level of T4 or T5

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26
Q

where can the xiphoid process be found

A
  • anterior limit of thoracic
  • midline indicator
  • inferior border of heart
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27
Q

how are the intercostal spaces between the ribs named

A

they are named for the rib of the superior border of the space

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28
Q

what is filled within these spaces

A

intercostal muscles

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29
Q

how many intercostal spaces are there

A

there are 11 intercostal spaces that are filled with muscles, vessels and nerves

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30
Q

what is below the 12th spaces of the ribs

A

this is the subcostal space with subcostal nerve

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31
Q

what is deep to the intercostal muscles

A

the nuerovascualr bundles

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32
Q

what is a neurovascular bundle

A

this is an intercostal vein, artery and nerve arranged in that order form above downward ( superior in the space)

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33
Q

what type of joint is the costovertebral joint

A

synovial plane joint

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34
Q

what does the costovertebral joint do

A

joints head of ribs

- the head of each rib articulates with the demifacets of 2 adjacent vertebrae

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35
Q

what is the intra articular ligament

A

this attaches head to intervertebral disc and works with the costovertebral joint

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36
Q

what is the radiate ligament

A

attach head to vertebral bodies and disc between and works with the costovertebral joint

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37
Q

which ribs do not have the intra articular legament

A

rids 1, 11, 12 AND MAYBE 10 articulate with only one body so they do not need this ligament

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38
Q

what type of joint is the costoransverse

A

synovial plane joint

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39
Q

what doe the costotransverse joint do

A

facet of the rib tubercle articulates transverse process of its own vertebra

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40
Q

what is the costotransverse ligament

A

this connect the neck of rib to the transverse process

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41
Q

what is the lateral costotransverse ligament

A

this connects the tubercle- nonarticular part to transverse process

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42
Q

what is the superior costotransverse ligament

A

this connects neck to transverse process superior to it

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43
Q

what does the space between the costotransverse ligmanets allow

A

they allow passage of spinal ns.

44
Q

where can the sternocostal joint be found

A

in the first 7 ribs costal cartilages

45
Q

what type of joint is the sternocostal joint of the 1st RIB

A

primary cartilaginous joint ( snychondrosis)

46
Q

what type of joint is the sternocostal joint of the 2nd to 7th RIBS

A

synovial plane joints

47
Q

what ligamnet is used in with the sternocostal joints

A

anterior and posterior radiate sternocostal ligaments

48
Q

what does the sternocostal ligament do

A

strengthen the joints of the first 7 ribs

49
Q

what type of joint is the costochondral joint

A

primary cartilaginous joint

**slide 14 for picture

50
Q

what type of joint is the interchondral joint

A

synovial plane joint

**slide 14 for picture

51
Q

what type of joint is the sternoclavicular joint

A

saddle type synocvial joint

**slide 14 for picture

52
Q

what type of joint is the manubriosternal joint

A

secondary cartilaginous joint

**slide 14 for picture

53
Q

what type of joint is the siphisternal joint

A

primary cartilaginous joint

**slide 14 for picture

54
Q

how does the thorax move during inspiration

A

the sternum and anterior ends of the ribs rise

– this increase anterior and posterior diameter of the thorax

55
Q

what are some accessory muscles of respiration

A

scalenes, scm, serratus anterior , pec Major and minor … and a lot more see slide 16 for the whole list

56
Q

what are some muscles that elevate ribs and expand thoracic cavity

A
  • pec Major
  • pec minor
  • serratus anterior
57
Q

what fixes the ribs

A

scalenes muslces

58
Q

what are the levator costarum

A

brevis and longs

  • deep posterio muscles
  • vertebral movement and proprioception
59
Q

what are the serratus posterior m

A
  • there is a superiro and posterior and they may have proprioceptive fx
60
Q

what are the intercostal mm

A

there are

  • external
  • internal
  • innermost
61
Q

what are the external intercostal mm

A

replaced anterio by external intercostal membrane and internal intercostalm

62
Q

what are the internal intercostal mm

A

posterio replaced by interna intercostal membrane and they extend to about the angle of the ribs

63
Q

what are the innermost intercostal mm

A

deeper part of internal interocstal mm separated from internal intercostals by intercostal nn and vessels

64
Q

what are the subcostal mm

A

lower posterior thoracic wall

  • cross 1 or 2 spaces
  • thought to be part of the innermost intercostal m – run in same direction as internal intercostals
65
Q

what is the transverse thoracis

A

this is in the anterior thorax

  • 4 or 5 slips
  • sternum to costal cartilage
  • may be proprioceptive
66
Q

where do the thoracis nerves leave the spinal cord

A

they leave the intervertebral foramen and then divide into anterior and posterior primary rami

67
Q

what becomes the intercostal nn

A

the anterior rami of T1-11

68
Q

what is the T12 nerve

A

this is the subcostal n

69
Q

what are typical intercostal n.

A

3 to 6 intercostal spaces

70
Q

what is the path of the typical intercostal n.

A

they enter intercostal space posteriorly THEN near the angle of ribs n pass between internal and innermost intercostals THEN run inferior to intercostal arteries THEN continues aroudn on an anterior course giving off branches

71
Q

what are branches of the intercostal nerves

A
  • rami communicantes
  • collateral branches
  • lateral cutaneous branches
  • anterior cutaneous branches
  • muscular branches
72
Q

where does the collateral branches arise

A

they come form near angles of ribs

– then run parallel to main nerve on upper border of rib below and then terminates as lower anterio cutaneous nerve

73
Q

what does the collatera branches supply

A

intercostal mm and parietal pleura

74
Q

where does the lateral cutaneous branches arise

A

beyond the angles of ribs

– THEN they divdie into anterior and posterior branches

75
Q

what does the lateral cutaneous branches supply

A

skin on anterior and posterio lateral aspect of thoracic annd abdominal wall

76
Q

what does the anterior cutaneous branches divide into

A

meidal and lateral branches

77
Q

what does the muscular branches supply

A

intercostal, subcostal, transverse thoracic, levatores costarum and serratus posterior m.

78
Q

what is an atypical intercostal n.

A

T1, T2, T7-T11

79
Q

what does the atypical T1 intercostal n divide into

A

large superior part
small inferior part
anterior cutaneous branch of thorax
NO ( most of the time) lateral cutaneous branch

80
Q

what does the T1 intercostal n end as

A

the anterior cutaneous branch BUT this occasionally is missing

81
Q

what doe the T1 intercostal n large superior division joint

A

brachial plexus

82
Q

what doe the T1 intercostal n small inferior division joint

A

becomes the 1st intercostal n

83
Q

What does the T2 intercostal n give rise to

A

the intercostobrachial n ( which is a large lateral cutaneous branch)

84
Q

what is the intercostobrachial n path

A

this is the atypical T2 n.
- leaves at the angle and innervates skin of the axilla and communiates with the medial brachial cutaneous n to medial arm

85
Q

what does the T7-11 intercostal n do

A

the lateral cutaneous branches then supply abdominal skin and muscles as the thoracoabdominal nn

86
Q

what are dermatomes

A

segmental innervation of thoracic wall

87
Q

what are main arterial feed of the thoracic wall

A
  • thoracic aorta
  • subclavina artery
  • axillary artery
88
Q

how many arteries does each intercostal space have

A

they have 3
1 large posterior intercostal a
2 anterior intercostal aa

(10th and 11th DO NOT follow this)

89
Q

where does the posterior intercostal a of the 1st 2 spaces come from

A

they are branches of supreme intercostal a which is the branch off of the costocervical trunk of subclavian

90
Q

where does the posterior intercostal a of the 3rd to 11th and subcostal a come from

A

they come from the descending thoracic aorta

91
Q

where does the anterior intercostal a of the 1st 6 space come from

A

they come from internal thracic a which is a branch of the subclavian a

92
Q

what does the internal thoracic a divide into

A
  • superior epigastric a ( to umbilicus )

- musculophrenic a

93
Q

where does the anterior intercostal a of the 7-9 spaces come from

A

musculophrenic a

94
Q

where does the anterior intercostal a of the 10-11 spaces come from

A

there are no anterior intercostal aa in these spaces is is supplied by posterior intercostal a

95
Q

where does the intercostal vv come from

A

they come from the anterior inercostal vv and run with their ateries

96
Q

where does the internal thoracic vv come from

A

they company vv of the artery

97
Q

where does the posterior intercostal vv going to of the 1st 3 or 4 spaces

A

they are going to the supreme intercostal vein then drain into brachiocephalic vein

98
Q

where does the posterior intercostal vv going to of the 4 maybe to 5-11 spaces RIGHT side

A

Right= drain into azygos vein then vena cava

99
Q

where does the posterior intercostal vv going to of the 4 maybe to 5-8 spaces LEFT side

A

left ( 5-8)= drain into accessory hemiazygos

100
Q

where does the posterior intercostal vv going to of the 4 maybe to 9-11 spaces LEFT side

A

left ( 9-11)= drain into hemiazygos veins

101
Q

what forms the azygos and hemiazigos

A

formed by the union of ascending lumbar vv with subcostal vv

102
Q

where does the azygos vein get blood from

A

posterior wall of thorax and abdomen to superior vena cava

  • run up the right side of thoracic vertebral column
  • arches over the right main bronchus at the root of lung ( T5-6 level )
103
Q

where does the hemiazygos drain into

A

drains the lower left thoracic region INTO azygos

104
Q

where is the hemiazygos path

A

runs superiorly next to thoracic vertebrae at the level of T8 or 9 crosses midline to enter azygos vein

105
Q

where does the accessory hemiazygo drain

A

this drians the 5-8th intercostal spaces on left side INTO azygos or brachiocephalic v

106
Q

where does the accesoory hemiazygos path

A

–descends next to the thoracic vertebrae and crosses midline at T8 to enter azygos vein