The Pectoral Region, Thoracic Cage and Lungs (CVR) Flashcards
What are the three parts of the sternum called?
Manubrium
Body
Xiphoid process
What is the superior part of the sternum called? What is the notch called on it?
Manubrium
Suprasternal notch
What two bones does the Manubrium articulate with? What is the joint called that it articulates with the first and most superior bone?
Clavicle (Sternoclavicular joint)
First rib
What is the point called where the Manubrium meets the Body?
Sternal angle
What is the middle part of the sternum called?
Which ribs does it articulate with?
Body
Ribs 2-7
Where does the Body of the sternum articulate with the second rib?
The sternal angle
What is the inferior part of the sternum called?
Xiphoid process
Where does the 7th rib articulate with the sternum?
in between the body and xiphoid process
What are the anterior parts of the ribs composed of? What is the point called where the ribs articulate with the costal cartilage?
Costal cartilage
Costochondral joints
What are known as the true ribs? Why are they called this? where do the costal cartilages of these ribs articulate with the sternum?
Ribs 1-7
Articulate directly with sternum
Sternocostal joints
Which ribs are known as the false ribs? Why are they called this?
Ribs 8-10
Costal cartilages unite and join the seventh one
What do the costal cartilages of ribs 7-10 form?
The costal margin
Which ribs are known as the floating ribs? Why?
11 and 12
Do not articulate with the sternum
What do the ribs articulate with posteriorly? What is this point called?
Thoracic vertebrae
Costovertebral joints
How are adjacent ribs connected to one another?
Intercostal muscles
What are the four parts of a typical rib?
Which ribs are typical ribs?
Head, neck, tubercle and body
ribs 3-9 typical
Which ribs are atypical?
1-2 and 10-12
What does the Head of the rib articulate with? What does the tubercle of the rib articulate with?
Head- Vertebral body
Tubercle- Transverse process
What does the manubrium, first ribs and first thoracic vertebra form?
Boundary of the superior thoracic aperture
What are the Breasts also known as?
Mammary glands
What Part of the breast tissue extends towards the anterior axilla?
Axillary tail
What 7 components is the breast made up of?
Fat
Glandular tissue
Ducts
Connective tissue and ligaments
Blood vessels and lymphatics
What is the skin that converges on the nipple called?
Areola
What two arteries primarily supply the breast?
Internal thoracic artery
Axillary artery
Where does the internal thoracic artery arise from?
The subclavian artery
What arteries does the internal thoracic artery give rise to? What do they supply?
Anterior intercostal arteries
Breast and intercostal spaces
What nerves supply the breast? What type of fibres innervate the skin and smooth muscle of breast respectively?
Intercostal nerves
Somatic sensory fibres and sympathetic fibres
Where does most lymph from the breasts drain into? What are the five groups of lymph nodes in this area?
Axilla
5 groups: Central, Pectoral, humeral, subscapular and apical
What five areas do the lymph nodes in the axilla drain?
Breast
Upper limb
Chest wall
scapular region
abdominal wall
Which nodes receive lymph from all the other lymph nodes in the axilla? What does this mean they are usually involved in?
Apical nodes
Spread of breast cancer
Three layers of intercostal muscles in the intercostal spaces?
External intercostal muscles
Internal intercostal muscles
Innermost intercostal muscles
What is the Most superficial muscle of the anterior chest wall? What three structures does it attach to?
Pectoralis Major
Upper humerus, Clavicle and upper six ribs
What muscle lies deep to the pectoralis major? What two structures does it attach to?
Pectoralis minor
Scapular and ribs 3-5
What is the muscle called that lies on the lateral side of the thoracic cage? What does it attach to?
Serratus anterior
Attaches to scapula and upper eight ribs
Prime function of anterior chest muscles? What can use of these muscles as accessory muscles mean?
Move the upper limb
Respiratory distress
What does the intercostal neurovascular bundle contain?
Intercostal artery
Intercostal Vein
Intercostal nerve
What direction are the fibres of the external intercostal muscle orientated? What does direction does the contraction pull them?
Orientated antero-inferiorly
Where do the external and internal intercostal membranes form respectively? Why?
External- anterior part of intercostal space
Internal- Posterior part of intercostal space
Muscle becomes membranous
What direction are the internal intercostal muscle fibres orientated? What direction does contraction pull them?
Postero-inferior
Contaction pulls them inferiorly
What direction are the inner most intercostal muscles fibres orientated?
Posterio inferior (same as internal intercostal muscle fibres)
What lies deep to the innermost intercostal muscle?
Endothoracic fascia
What three structures does the Intercostal neurovascular bundle supply? Where does it run through?
Intercostal muscles, overlying skin and parietal pleura
Runs through the costal groove of the rib inbetween the inner intercostal muscles and innermost intercostal muscles
Where does the costal groove of the rib lie? What part of the intercostal space would an incision be made during a medical procedure?
Deep surface of rib
Middle to lower part of intercostal space (avoid neurovascular bundle)
What arteries supply the anterior and posterior intercostal spaces respectively? What is the artery that supplies the posterior intercostal space a branch of?
Anterior and posterior intercostal arteries
Descending aorta (gives rise to posterior intercostal artery)
Where do the anterior and posterior intercostal veins drain into respectively?
Internal thoracic vein and azygos system of veins
What are the two layers of membranes that cover the lungs and structures passing in and out of the lungs?
Parietal and Visceral pleura
What is the space called between the parietal and visceral pleura? What does it contain?
Pleural cavity
Pleural fluid
What are the four parts of the parietal pleura? Where do they lie/ what do they cover?
1.Cervical- covers apex of lung
2.Costal- adjacent to ribs
3.Mediastinal-adjacent to heart
4.Diaphragmatic - adjacent to diaphragm
What is the space called around the periphery of the diaphragm where the costal pleura becomes continuous with the diaphragmatic pleura?
The costodiaphragmatic recess
What nerves innervate the parietal and visceral pleura respectively? What does this mean when either are injured?
Parietal- Intercostal nerves
Visceral- Autonomic sensory nerves (visceral afferents)
Injury to parietal is painful, injury to visceral doesn’t reach conscious perception
What is the most superior part of the lung called? How many lobes does each side have?
Apex
Right side- 3 lobes (superior, middle and inferior)
Left side- 2 lobes 9superior and inferior)
What is the Lingula? What does it extend over?
An anterior extension of the left superior lobe
Extends over the heart
What fissure is present in both sides of the lung? What fissure is present in the right lung only?
What do each fissures separate in the right lung?
Oblique fissure (both lungs)
Horizontal fissure (right lung only)
Right lung- Oblique separates middle lobe from inferior lobe and Horizontal separates superior lobe from middle lobe
3 surfaces of lung?
Costal surface
Mediastinal surface
Diaphragmatic surface
What is the region of the lung where the pulmonary artery, pulmonary veins and main bronchus enter and enter the lung?
Hilum
Where does the pulmonary artery lie to the main bronchus in the right and left lung respectively?
Right- Anterior to main bronchus
Left- Superior to the main bronchus
Where do the pulmonary veins lie in both lungs?
Anteriorly and inferiorly
What level does the Trachea bifurcate? What is this point called?
T4/T5 (Sternal angle)
Carina
How is the right bronchius different to the left?
Wider and descends more vertically
What do the bronchi divide into from the main bronchus’ to the alveoli?
Lobar bronchi
Segmental bronchi
Bronchioles
Alveoli
How many segmental bronchi are there? What are the areas they supply called? What does each segment have its own of?
10
Bronchopulmonary segment
Own blood supply
(don’t need to know names of segments)
What do the walls of the trachea and bronchi contain that the bronchioles doesn’t? What do they both contain?
Cartilage
Both contain smooth muscle
What do the Parasympathetic fibers stimulate in the lungs?
What do the sympathetic fibers stimulate in the lungs?
Para- constriction of bronchial smooth muscle and secretions from the glands of the bronchial tree
Sympathetic- relaxation of bronchial smooth muscle and inhibits secretions from the glands of the bronchial tree
What fibers innervate the lungs? Can we usually feel sensations?
Visceral afferents
Do not reach our conscious perception
Where do the apex’s of each lung project to?
Lower neck, superior to the medial end of the clavicle
Where does the inferior border of the lung lie anteriorly, laterally and posteriorly?
ANT-6th rib (mid clavicular line)
LAT-8th rib (midaxillary line)
POS10th rib (vertebral column)
Where does the parietal pleura extend to Anteriorly, Laterally and posteriorly?
ANT-8th rib (midclavicular line)
LAT-10th rib (midaxillary line)
POS-12th rib (vertebral column)
Where does the oblique fissure extend from and to?
Where does the horizontal fissure from?
4th rib posteriorly to 6th costal cartilage anteriorly
Horizontal fissure- 4th costal cartilage to oblique fissure
Where must you place a stethoscope to hear the superior and right middle lobes of the lungs?
Superior lobes- Posterior chest wall
Right middle lobe- Anteriorly or laterally
What is the superior surface of the diaphragm adjacent to and what are the openings in the diaphragm called?
Adjacent to parietal pleura
Apertures
What 5 structures is the diaphragm attached to?
Xiphoid process
Costal margin
tips of 11th and 12th rib
Lumbar vertabrae
What is the central part of the diaphragm called? Why?
Central tendon
Fibrous not muscular
What nerve innervates the Diaphragm? Where do they come from?
Phrenic nerves
C3, C4 and C5
What causes the thoracic cavity to change vertically, laterally and Antero-posteriorly during ventilation?
Vertically- Diaphragm
Laterally- Intercostal muscles
Antero-posteriorly Sternum
What are the 3 accessory muscles of breathing? When are they used?
Sternocleidomastoid, Pectoralis major, Pectoralis minor and serratus anterior
Very vigorous of forced breathing
