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SP15 Anatomy > The Thoracic wall, lungs and middle mediastinum > Flashcards

The Thoracic wall, lungs and middle mediastinum Flashcards

1
Q

what are the functions of the thorax?

A
  1. breathing (all of the tissues, mm., nn., aa., must be flexible to allow for movement)
  2. Protection (of the lungs, heart as well as superior abdominal organs like the liver)
  3. conduit for the esophagus, trachea and aorta
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2
Q

How is the thorax broken up?

A

2 pleural cavities (for each lung) and a central mediastinum cavity
the central mediastinum is broken into a superior portion (above the sternal angle) and an inferior portion. The inferior portion is broken into a anterior (small), middle (for the heart) and posterior mediastinum

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3
Q

the aortic arch is in what portion of the thorax?

A

the superior mediastinum

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4
Q

where is the sternal angle?

A

is between the attachment of the 2nd rib and the 4 and 5th vertebral body

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5
Q

explain the shape of the thorax

A

cylindrical with the apex going down into a large base
the inferior appature follows the curvature of the rib cage and (anterior is more superior) and the superior appature is much smaller with TI, first rib and costal cartilage, and manubrium as its boundary)

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6
Q

where can you take pulmonary and cardiac ascultations?

A

at the sternal angle

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7
Q

what are the bones of the thoracic cavity?

A

T1-12 vertebrae
12 ribs
sternum

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8
Q

parts of the sternum

A

manubrium, body and xiphoid process

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9
Q

manubrium

A

contains clavicular notch for sternoclavicular joint (for SCM) and jugular notch that you can palpate

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10
Q

body of the sternum

A

joins the manubrium at the sternal angle (demifacets for the 2nd rib here)

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11
Q

Xiphoid process of the sternum

A

lowest point of the sternum

**joint ossifies (no flexibility)

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12
Q

parts of the rib

A

head, tubercle, body (angle of the rib) and costal groove

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13
Q

what is another name for the sternal angle?

A

angle of louis

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14
Q

what does the head articulate with?

A

2 vertebral bodies and 1 disc posteriorly

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15
Q

what does the tubercle articulate with?

A

1 transverse process of the vertebrae

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16
Q

why is the angle of the rib important?

A

because this is where the vessels in the intercostal space will split

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17
Q

what is the costal groove of the rib formed by?

A

intercostal v., a. and n.

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18
Q

the superficial pectoral region of the thoracic wall

A

breasts are superficial - made of secretory glands and superficial fascia
(the secretory glands will lead to ducts to sinuses to lactiferous ducts to the nipple)

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19
Q

what is the nn. superficial pectoral region

A

lateral and anterior nn. of the 4th to 6th intercostal nn.

**caries general (cutaneous) sensation

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20
Q

what is the lymph drainage of the superficial pectoral region?

A 
parasternal and axillary nodes
axillary nodes (on the right) will go to the right jugular lymphatic trunk to drain into the subclavian/ IJV angle
**important for breast cancer
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21
Q

what are the vessels for the superficial pectoral region?

A

branches coming from the internal thoracic vessels (off subclavian) to the 2nd to 4th thoracic intercostal spaces (will perforate the mm. to come superficial)

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22
Q

what are the mm. of the pectoral region of the thoracic wall?

A

pec major and minor

attach from UL to anterior chest

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23
Q

pec major mm.

A

divided into 2(or 3 heads) - sterno/costal and clavicular

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24
Q

what is the fascia that surounds pec minor mm.

A

clavipectoral fascia

**helps to cushion the neurovascularture and separate the 2 pec mm.

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25
Q

what is the orientation of the external intercostal mm. fibers?

A

in the pocket

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26
Q

what is the orientation of the internal intercostal mm. fibers?

A

thumbs out of the pocket

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27
Q

what is the transversus toracis mm. attached to?

A

the xyphoid process and the body of the sternum (looks like a fan)

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28
Q

what are the mm. of the anterior thoracic wall that are best seen on the deep surface of the thoracic wall when the chest plate is taken off?

A 
intermost intercostal
subcostal (expands 2 ribs and more lateral)
transversus thoracis (on the anterior portion)
29
Q

what are the mm. that elevate the ribs?

A

external intercostal and serratus posterior superior

30
Q

what are the mm. that depress the ribs?

A

internal intercostal, subcostal, transversus thoracis, intermost intercostal and serratus posterior inferior

31
Q

what mm. of the abdomen does intermost intercostal replicate?

A

transversus abdominus mm.

32
Q

what happens to the ribs and diaphragm during inspiration?

A

ribs raise, diaphragm depresses (expansion)

33
Q

what happens to the ribs and diaphragm during expiration?

A

ribs depress, diaphragm elevates (shrinkage together)

34
Q

where are the neurovascular bundles in the intercostal space?

A

collaterals above each rib and intercostals in the costal groove along the inferior border of each rib

  • *between the internal and innermost intercostal mm.
  • ***V, A, N with vein always closest to the bone
35
Q

where do the posterior intercostal a./ v. come from?

A

a. off the descending aorta and v. drains into the azygous

36
Q

where do ribs 1-2 get posterior intercostal supply?

A

supraclavicular, thyrocervical trunk or costocervical trunk (too high for the aorta)

37
Q

what are the difference in ribs?

A

ribs 1-7 are true (direct connections to sternum through cartilages) ribs 8-12 are false (each other then connect to the sternum) and 11-12 are floating

38
Q

visceral and parietal pleura

A

each lung gets its own pleural cavity (potential space) which is between the visceral (around the lung) and parietal (adheres to thoracic wall)
**parietal is sensitive to pain from intercostal and phrenic nerves

39
Q

what is the difference between the hilum and the root of the lung?

A

the hilum is DEEPER in the lung and contains the opening to the actually lung tissue and the root is the opening of the CT of the pleural cavity

40
Q

does the visceral pleura follow the fissures of the lung lobes?

A

yes

41
Q

what are the regions of the parietal plura?

A

cervical, costal, diaphramatic and mediastinal

42
Q

why is it a problem with the pleural cavity becomes an actual cavity?

A

fluid can fill and compress the lungs. This leads to the loss of the respiratory membrane and surface area for effective breathing

43
Q

pneumothorax

A

accumulation of air in the pleural cavity, collapse of lung due to elasticity

44
Q

hemothorax

A

accumulation of blood in pleural cavity, adhesions due to sticky blood proteins

45
Q

inflammation of the pleura

A

-formations of pleural adhesions between parietal and visceral pleura that can cause a lot of pain

46
Q

where do you want to do a pleural tap? (thoracentesis)

A

(aspire fluids)

superior to inferior rib at midaxillary line and between ICS 6 and 7 to avoid invasion of other structures

47
Q

what are the fissures in the lungs?

A

oblique: separates the upper and lower in the L and the lower and middle on the Right
horizontal: separates the middle and upper lobes on the the right

48
Q

what is the depression on the inferior surface of the lungs?

A

diaphragm

49
Q

what are the depressions on the Right lung from?

A

SVC, IVC, esophagus, azygous vein and r. subclavian

50
Q

what are the depressions on the left lung from?

A

aortic arch, descending aorta, L. subclavian and esophagus

51
Q

Root of the lung

A

connects the lung to the mediastinum
covered in a sleeve of pleura that extends down
has the bronchi and pulmonary vessels in it

52
Q

pulmonary ligament

A

inferior sleeve of the root of the lung pleura
empty, collapsed, doesn’t contain anything except a few lymph nodes
allows for the expanse of lungs against the mediastinum during breathing

53
Q

in the root of the lung, what are the positions of the entering structures?

A

bronchi: post/sup
pulmonary artery: ant/sup
pulmonary vein: inferior

54
Q

carina

A

the inferior extent of the trachea at its bifrucation

55
Q

what is important about segmental bronchi?

A

supplied by br. of the pulmonary a. (smallest funcitonal independent region of the lung

56
Q

sympathetic neurovasculature of the root of the lungs

A 
sympathetic trunk (chain gang) runs paravertebrally to contribute to ant and post pulmonary plexus
-dilates bronchioles
57
Q

parasympathetic innervation of the root of the lungs

A

vagus n.
passes posterior to the root of the lungs
closely applies to the trachea, esophagus and aorta, contributes to ant. and post. pulmonary plexus
-constricts the bronchioles

58
Q

phrenic n.

A

passes anteriorly to the root of the lungs (more closely adhered to the pericardial sac on the the right)

59
Q

pericardiophrenic vessels

A

run with the phrenic nn.

branches of internal thoracic aa. and brachiocephalic vv.

60
Q

bronchial aa.

A

supplies the nutrient to the bronchi (does not take part in gas exchange for oxygen)

61
Q

lymph vessels and nodes of the lungs

A

lymph from lungs drain into the tracheobronchial nodes and R/L bronchomediastinal trunks

62
Q

what is important about the mediastinal subdivisions?

A

anatomical, not clinical

63
Q

Middle mediastinum

A

houses pericardium, heart, phrenic nn., pericardiophrenic vessels and roots of the great vessels to and from the heart

64
Q

pericardium

A

tough fibrous sac (the addition to the normal) that attaches inferiorly to the diaphragm to allow the hear to move when the diaphragm does. Then there is a parietal serous membrane, a pericardial cavity and then a visceral (epicardium) serous membrane

65
Q

what pierces the pericardium?

A

SVC, IVC, aorta, pulm trunk and 4 pulm vv.

**8 vessels

66
Q

pericardial effusion

A

accumulation of excess fluid in the pericardial cavity, results in compression of the heart, common in congestive heart failure

67
Q

hemopericardium

A
  • accumulation of blood in the pericardial cavity
  • caused by heart wounds, perforated heart mm. following a MI, coronary anuerism (not aortic anuerism because thats normally in the aortic arch or desc. aorta not the ascend. aorta)
  • leads to cardiac tamponade
  • *(ESF does not lead to clots, but blood does)
68
Q

cardiac tamponade

A

compression of the heart and roots of the great vessels

69
Q

pericardial sac

A

complete inner pericardial serous membrane (parietal and visceral layers)

SP15 Anatomy (4 decks)

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