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Anatomy > Thoracic cage, bone, joints, and blood & nerve supply > Flashcards

Thoracic cage, bone, joints, and blood & nerve supply Flashcards

0
Q

What structures make up the superior thoracic aperture?

A

T1, 1st rib/costal cartilage, manubrium

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1
Q

What is the point where the manubrium and the body of the sternum articulate? What rib does this correspond with?

A

The sternal angle. It corresponds with rib/costal cartilage #2.

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2
Q

What makes up the inferior thoracic aperture? (posterior, posterolaterally, anterolaterally, and anteriorly)

A

Posteriorly: T12
Posterolaterally: 11th and 12th RIBS
Anterolaterally: 7, 8, 9 and 10th COSTAL CARTILAGE
Anteriorly: Xiphisternal joint

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3
Q

Which vertebrae make up the thoracic cage?

A

12 thoracic vertebrae

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4
Q
  1. ) What are the true ribs are why?
  2. ) What are the false ribs and why?
  3. ) What are the floating ribs and why?
A
  1. ) 1-7 because their costal cartilage articulates directly with the sternum.
  2. ) 8-10, because they articulate with one another, and articulate with the sternum via the 7th rib.
  3. ) 11-12, because they don’t wrap around anteriorly and have NO ATTACHMENT TO THE STERNUM.
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5
Q

Describe the components and function of the TYPICAL rib

A
  1. ) TWO (2) articular facets on the head which articulate with the BODY of the vertebrae.
  2. ) Tubercle –> articulates with the transverse process of the transverse process of the vertebrae.
  3. ) Costal groove (intercostal vein and artery lie here).
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6
Q

What are the atypical ribs and why?

A
  • 1st, 2nd, and 10th-12th*
    1. ) 1st rib:
  • The broadest, shortest, and most sharply curved.
  • Has a SINGLE facet to articulate with T1 ONLY.
  • Scalene tubercle and ridge (for attachment of scalene muscle)
  1. ) 2nd rib: Rough area on upper surface known as the tuberosity for serratus anterior (it originates here).
    * TWO FACETS for T1 and T2*
  2. ) 10th and 12th ribs:
    - ONE FACET.
    - Short, no neck or tubercle.
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7
Q

Describe the connection of the costovertebral joints

A
  • HEAD of rib articulates with the BODY of the thoracic vertebrae.
  • TUBERCLE of rib articulates with the TRANSVERSE PROCESS of corresponding thoracic vertebrae.
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8
Q
  1. ) The inferior articular facet of rib #6 articulates with what?
  2. ) The superior articular facet of rib #6 articulates with what?
A
  1. ) Superior articular facet of T6 vertebrae.
  2. ) Inferior articular facet of T5 vertebrae.
    * The rib also articulates with the IV disc in between*
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9
Q

What is the sternal angle? aka ______?

A

The sternal angle, aka Angle of Louis, is the junction between the manubrium and the body of the sternum.

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10
Q

What strengthens the capsule of the costovertebral joints? Describe the three parts of this structure.

A

The radiate ligament (p.184 Netter).

  1. ) Superior part: Goes to the inferior articular facet of the vertebral body ABOVE IT.
  2. ) Middle: Goes to the IV disc.
  3. ) Inferior: Goes to the corresponding vertebral body.
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11
Q

What are the three ligaments that run from the tubercle of the ribs to the vertebral transverse processes and what do they connect?

A

(p. 184 Netter)
1. ) Lateral costotransverse ligament: From tubercle of rib to the TP.
2. ) Costotransverse ligament: From neck of the rib to the TP.
3. ) Superior constotransverse ligament: Joins the crest of the neck of the rib to the transverse process ABOVE IT (superior to it).

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12
Q

Where are the interchondral joints found? What type of joint?

A

(p.80 Moore, p.184 Netter)
Found between the costal cartilages of ribs 6-7, 7-8, and 8-9. They are SYNOVIAL PLANE JOINTS.

These joints exist where two ribs articulate with one another (i.e. between the false ribs)

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13
Q
  1. ) What is the structure and function(s) of the lactiferous ducts?
  2. ) What are the two main cell types in the lactiferous ducts?
A

(Moore pp.98-99)
1.) A branched system connecting the lobules of the mammary gland to the tip of the nipple. They are the structures that CARRY MILK TOWARD THE NIPPLE in a lactating female. They also give rise to the buds that develop in 15-20 lobules of the mammary gland, which constitute the parenchyma of the mammary gland.

2.) a.) Columnar epithelium that are supported by…b.) Myoepithelial cells

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14
Q

About how many lobules are there in a typical breast? Where do lobules drain into?

A

(Moore p.98)

15-20 lobules per breast. They drain into a lactiferous duct.

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15
Q

Describe the layers of the breast from superficial to deep

A

Skin & superficial fascia –> subcutaneous fat –> breast tissue/mammary glands (lobules, lactiferous duct) –> pectoral fascia –> pectoralis major

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16
Q

What structure(s) supports the breast?

A 
(p.98 Moore)
Suspensory ligaments (of Cooper)
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17
Q

The mammary gland is separated from the deep fascia covering the underlying muscles by an area of loose alveolar tissue known as the __________.

A

Retromammary space (p.35 BRS).

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18
Q

What is the name of the small portion of the mammary gland that extends into the axilla?

A

(p.98 Moore)

Axillary process/tail (of Spence)

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19
Q

The areola contains numerous ______ which provide _______.

A

(p.99 Moore)
Numerous SEBACEOUS GLANDS which enlarge during pregnancy and provide protective lubrication for the areola and nipple (while nursing).

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20
Q

Nipples have no ____ , _____, or _____.

A

(p.99 Moore)

Fat, hair, or sweat glands

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21
Q

Nipples have ____________ that constricts the lactiferous ducts.

A

Circularly arranged smooth muscle.

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22
Q

Inferior lateral mammary branch arteries arise from where?

A

??? What and where are these ???

Posterior intercostal arteries (2nd, 3rd, and 4th intercostal spaces).

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23
Q

Venous drainage of the breast mainly goes into the ________.

A

(p.99 Moore)

Axillary vein, but there is some drainage to the INTERNAL THORACIC VEIN.

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24
Q

Where do the posterior intercostal arteries arise from?

A

Thoracic aorta

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25
Q
  1. ) In what quadrant of the breast do most cancers occur?

2. ) What anatomical structure(s) of the breast do carcinomas typically arise within?

A
  1. ) Upper-outer quadrant (Superolateral) <–p.104 Moore

2. ) From the epithelial cells of the lactiferous ducts in the mammary gland lobules.

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26
Q

Describe where lymph from the 1.) lateral 2.) medial and 3.) inferior breast quadrant drains to.

A

(p. 99 Moore)
1. ) Axillary lymph nodes, initially to the anterior or pectoral nodes ( >75%), then to the clavicular (infra- and supra-) lymph nodes, and finally to the subclavian lymph trunk.
2. ) Parasternal lymph nodes (or to opposite breast), then to the bronchomediastinal lymphatic trunks.
3. ) Abdominal lymph nodes (subdiaphragmatic inferior phrenic lymph nodes)

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27
Q

What is the nerve supply for breast tissue?

A

(p.99 Moore)

Inferior and lateral cutaneous branches of the 4th-6th intercostal nerves.

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28
Q

What is the lymphatic drainage for the medial portion of the breast?

A

Parasternal lymph nodes (para- = beside/adjacent to).

29
Q

Name the axillary lymph nodes (5) and their general location

A

(p. 101 Moore) Mnemonic: CHAPS
1. ) Central nodes: Lie near the base of the axilla between the lateral thoracic and subscapular veins.
2. ) Humeral (lateral) nodes: Lie posteromedial to the axillary veins.
3. ) Subscapular (posterior) nodes: Lie along the subscapular vein.
4. ) Pectoral (anterior) nodes: Lie along the inferolateral border of the pectoralis minor muscle.
5. ) Apical (medial or subclavicular) nodes: Lie at the apex of the axilla medial to the axillary vein.

30
Q

Name the boundaries of the thoracic wall. 1.) Posterior 2.) Anterior 3.) Lateral 4.) Inferior 5.) Superior

A
  1. ) Posterior: T1-T12, ribs, intercostal muscles.
  2. ) Anterior: Sternum, costal cartilage, ribs, intercostals.
  3. ) Lateral: Ribs and intercostals.
  4. ) Inferior: Diaphragm and diaphragmatic pleura.
  5. ) Superior: Dome of the neck, esophagus, trachea.
31
Q

Name the intercostal muscles. Give innervation, blood supply, and action.

A
  1. ) External intercostals: Intercostal nerves (T1-T11), elevate ribs in inspiration. ALL THREE ARE SUPPLIED BY INTERCOSTAL ARTERY.
  2. ) Internal intercostals (deep to external intercostal): Intercostal nerves, Depress ribs (costal part); elevate ribs (interchondral part). Fiber direction OPPOSITE OF EXTERNAL INTERCOSTAL
  3. ) Innermost intercostals: Intercostal nerves, elevates ribs. Only found on the LATERAL ASPECTS OF THE THORACIC CAGE
32
Q
  1. ) As the EXTERNAL intercostal muscles approach the lateral end of the costal cartilage anteriorly, they ________.
  2. ) Between the ribs posteriorly, the INTERNAL intercostals are replaced by the ________.
A
  1. ) They disappear and are replaced by the external intercostal membrane.
  2. ) INTERNAL intercostal membrane.
33
Q

Posterior intercostal arteries #1-2 arise from the _________, which is a branch of the _________. The rest of the intercostal arteries (3-12) arise from the ________.

A

Arise from the superior intercostal artery, which is a branch of the subclavian artery. 3-12 arise from the dorsal/thoracic aorta.

34
Q

Trace the path of venous drainage in the RIGHT thorax

A

Intercostal veins –> Azygous vein –> Superior vena cava (SVC)

35
Q

How many spinal nerves are there? How many of them supply the thorax?

A

31 pairs of spinal nerves

12 pairs are thoracic

36
Q

Each spinal nerve (and, thus, thoracic nerve) divides into an _____ and _______.

A

Divides into an anterior and posterior ramus.

37
Q

________ of ________ are called intercostal nerves. Describe their location, course, and position relative to the veins and arteries.

A

Anterior rami of T1-T11 are called intercostal nerves. They lie in the costal grooves on the inferior surface of the ribs, and run BETWEEN the INTERNAL and INNERMOST layers of muscles. The intercostal veins and arteries lie above the nerves (VAN, from top to bottom).

38
Q

______ of ______ becomes the subcostal nerve, which runs ______.

A

Anterior ramus of T12 becomes the subcostal nerve, which runs beneath the 12th rib.

39
Q

Posterior/dorsal rami of thoracic nerves supply the ________. Are they referred to as “intercostal nerves?”

A

Muscle, skin, and joints of the back. They are NOT referred to as intercostal nerves.

40
Q

Intercostal nerves # ______ are typical, the rest are atypical. What makes them typical?

A 
(p.92 Moore)
# 3-6: Typical intercostal nerves have a standard course and branching pattern that is the same for 3-6. See Moore's.
41
Q

List and describe (location, course, innervation) the branches of a typical intercostal nerve (7).

A

(Moore p.93)
1.) Rami communicantes (aka communicating branches): Connect each intercostal nerve to the ipsilateral sympathetic trunk (i.e. a ganglion of the sympathetic trunk that lies adjacent to the vertebral column on both sides).

  1. ) Collateral branches: Arise near the angles of the ribs and descend to course along the superior margin of the lower rib, helping supply INTERCOSTAL MUSCLES and PARIETAL PLEURA.
  2. ) Lateral cutaneous branches: Arise near the MAL (???) and pierce the internal and external intercostal muscles. Innervates the skin on the side of the thoracic wall by dividing into anterior and posterior branches.
  3. ) Anterior cutaneous branches: The terminal portion of the intercostal nerves and innervates the skin near the midline of the chest by dividing into medial and lateral branches.
  4. ) Muscular branches: All the muscles of the intercostal spaces are innervated by the various muscular branches of intercostal nerves.
  5. ) Pleural branches: Sensory branches that go to the parietal pleura.
  6. ) Peritoneal sensory branches: Similar to the pleural sensory branches, but arise FROM THE LOWER INTERCOSTAL NERVES because the lower intercostal spaces are more related to the PERITONEUM than to the PARIETAL PLEURA.
42
Q

Describe the special features of the 1st and 2nd intercostal nerves (atypical).

A

(Moore p.93)
1.) First intercostal nerve: Divides into a large superior and a small inferior part. The SUPERIOR part joins the BRACHIAL PLEXUS. ALSO, there is NO ANTERIOR CUTANEOUS BRANCH

2.) Second intercostal nerve: Joined to the medial cutaneous nerve of the arm by a branch called the “INTERCOSTOBRACHIAL nerve.” ***This branch is equivalent to the LATERAL CUTANEOUS branch of the remaining nerves. Thus, the SECOND INTERCOSTAL NERVE supplies NOT ONLY the second intercostal space, but ALSO –> The skin of the armpit and the UPPER MEDIAL SIDE OF THE ARM.

43
Q

Describe the special features of atypical intercostal nerves T7-T11.

A

(Moore p.93)
After they give off their lateral branches, they cross the costal groove and continue on to supply the skin and muscles to the abdomen. At this point they are no longer between the ribs (intercostal), and thus are referred to as THORACOABDOMINAL nerves at this point.

44
Q

What nerve is responsible for the referred pain radiating down the arm during a heart attack or angina?

A

Intercostobrachial nerve (T2)

45
Q

Give the innervation for all divisions of the parietal pleura

A
  1. ) Costal pleura: Respective intercostal nerves.
  2. ) Diaphragmatic pleura: Phrenic nerve.
  3. ) Mediastinal pleura: Phrenic nerve.
  4. ) Cervical pleura ???
46
Q

Name the potential pleural spaces and what defines them

A
  1. ) Costodiaphragmatic recess: Where the peripheral diaphragmatic pleura is in contact with the lowermost parts of the costal pleura.
  2. ) Costomediastinal recess: Posterior to the sternum where costal pleura is in contact with the mediastinal pleura.
47
Q

Define the clinical significance and borders of the costodiaphragmatic recess.

A

p.109 Moore
Anteriorly (mid-clavicular line): Between the 6th and 8th rib.
Laterally (mid-axillary line): Between the 8th and 10th rib.
Posteriorly (paravertebral line): Between the 10th and 12th rib.
Clinical significance: PLEURAL EFFUSION (p.141 BRS) –> An abnormal accumulation of excess fluid in the pleural space. It is important to know the borders because when fluid is drained, you DON’T WANT TO TOUCH LUNG PARENCHYMA. Best spot to insert needle for drainage is PARAVERTEBRALLY BETWEEN THE 10th and 12th RIB

48
Q

Describe the major divisions of the right and left lungs and the main structural differences between them.

A
  1. ) Right lung–>
    - Three lobes delineated by a right oblique and horizontal fissure: Superior, middle, and inferior.
    - Larger and heavier than the left lung, but shorter and wider.
  2. ) Left lung –>
    - Two lobes delineated by a single oblique fissure: Superior and inferior lobes.
    - Cardiac notch on the anterior border: An indentation consequent to the deviation of the apex of the heart on the left side. This notch primarily indents the ANTERO-INFERIOR aspect of the SUPERIOR LOBE.
49
Q
  1. ) The lungs are attached to the mediastinum by the _______.
  2. ) Through what anatomical structure do the structures that form the root pass?
  3. ) What structures pass through here (right and left hilum)?
A

p. 113 Moore’s
1. ) Roots of the lungs
2. ) Hilum of the lung (hilum = “doorway”)

3.) a.) Right hilum, anterior to posterior, superior to inferior: Right superior pulmonary veins, right pulmonary arteries, right superior lobar (EPARTERIAL) bronchus, right bronchal artery.
Inferior: Bronchopulmonary (hilar) lymph nodes.
Inferior: Right inferior pulmonary veins.

b.) Left hilum: Superior-most: Left pulmonary artery.
Inferior (ant to sup): Left superior pulmonary veins, left main bronchus, left bronchial arteries.
Inferior: Bronchopulmonary (hilar) lymph nodes.
Inferior: Left inferior pulmonary vein.

50
Q

What is the most superior structure in the…

  1. ) LEFT HILUM?
  2. ) RIGHT HILUM?
A
  1. ) Left pulmonary artery

2. ) Superior lobar (eparterial) bronchus

51
Q
  1. ) What is the term for the largest subdivisions of a lung lobe?
  2. ) How many of these are there in each lung?
  3. ) What are they shaped like and what do they consist of (4 things)?
A

p. 115 Moore’s
1. ) Bronchopulmonary segments
2. ) 10 in each lung
3. ) Pyramidal in shape. Consists of:
a. ) A segmental (tertiary of lobular) bronchus
b. ) A segmental branch of the pulmonary artery
c. ) A segment of the lung tissue
d. ) A connective tissue septum.

52
Q

At what level does the trachea divide/bifurcate into the two bronchi?

A

T5/transverse thoracic plane/sternal angle

53
Q

List the order (superior to inferior) of the respiratory tree (12)

A

Larynx –> Trachea –(T5)–> Principle bronchi –> Segmental bronchi (10 in each lung) –> Bronchioles –> Terminal bronchioles –> Respiratory bronchioles –> Alveolar ducts –> Alveolar sacs

54
Q

Where does gas exchange occur in the lungs?

A

Alveolar capillary membrane

55
Q

What carries oxygenated blood back to the heart?

A

Pulmonary veins

56
Q

Define a bronchopulmonary segment in terms of segmental bronchus, segmental artery, and pulmonary veins.

A

Refers to the portion of the lung supplied by each SEGMENTAL BRONCHUS and SEGMENTAL ARTERY. The PULMONARY VEINS are said to be INTERSEGMENTAL.

57
Q

Describe where each of the bronchial arteries arise

A
  • Three in total*
  • TWO left bronchial arteries: Usually arise from the thoracic aorta.
  • Right bronchial artery: May arise from one of THREE places –>
    1. ) Directly from the aorta
    2. ) Upper posterior intercostal arteries (proximally)
    3. ) From a common trunk with the left superior bronchial artery
58
Q

Describe right and left bronchial venous drainage in the lungs

A

Left: Bronchial veins –> accessory hemiazygous veins –midline–> azygous vein

Right: Bronchial veins –> DIRECTLY to azygous vein –> Superior vena cava (SVC)

59
Q

Name the two general lymphatic plexus of the lungs and

A
  1. ) Superficial lymphatic plexus: Drains the visceral pleura and the tissue below it.
  2. ) Deep lymphatic plexus: Begins in the bronchopulmonary segments and ascends up.
60
Q

Describe the chain of lymphatic drainage in the lungs

A
  1. ) Pulmonary lymph nodes
  2. ) Bronchopulmonary (hilar) lymph nodes, drains into…
  3. ) Superior and inferior tracheo-bronchial (carinal) lymph nodes, drains into…
  4. ) Paratracheal lymph nodes, drains into…
  5. ) Bronchomediastinal trunk (left and right), which then joins the SUBCLAVIAN VEIN.
61
Q

In the chain of lung lymphatic drainage, which portions of the lung drain into the a.) Right subclavian, and b.) Left subclavian?

A

a. ) Right subclavian: Right lung and LEFT INFERIOR LOBE.

b. ) Left subclavian: Left superior lobe.

62
Q

The nerves of the lungs and visceral pleura are derived from the _________, which contain what 3 types of fibers?

A

1.) Pulmonary plexuses: Contains parasympathetic, sympathetic, and visceral afferent fibers.

63
Q

What does sympathetic stimulation do in the lungs?

Parasympathetic?

A
  1. ) Sympathetic: Bronchodilation, vasoconstriction, and inhibition of the alveolar glands of the bronchial tree.
  2. ) Parasympathetic: Bronchoconstriction, vasodilation, and secretory to the glands of the bronchial tree.
64
Q

What is the effect of asthma in the lungs? What drugs would be given as treatment?

A

Bronchoconstriction. Treat with a bronchodilator (stimulates SYMPATHETIC NERVOUS SYSTEM).

65
Q
  1. ) What nerve supplies parasympathetic innervation to the lungs?
  2. ) What does the phrenic nerve supply in the lungs?
  3. ) From which cervical nerves does the phrenic nerve arise?
A
  1. ) Vagus nerve (CN X).
  2. ) Mediastinal and diaphragmatic pleura.
  3. ) C3-C5
66
Q

The phrenic nerve runs ____ to the root of the lung, whereas the vagus nerve runs _____ to the root of the lung.

A 
Phrenic = anterior to the root of the lung.
Vagus = posterior to the root of the lung.
67
Q

What type of fibers do the lungs receive from the phrenic nerve?

A

afferent and efferent parasympathetic preganglionic.

68
Q

Trace the source and flow of the posterior intercostal arteries (1-12)

A

Posterior intercostal arteries #1-2: Second branch of subclavian (costocervical trunk) –> Superior intercostal artery –> Posterior intercostals #1-2.

Posterior intercostal arteries #3-12: Thoracic/descending aorta –> a.) Posterior intercostals #3-11, and b.) Subcostal artery, aka 12th posterior intercostal artery.

69
Q

Trace the source and flow of the anterior intercostal arteries (1-9)

A

1st branch of subclavian artery –> Internal thoracic artery (aka mammary artery)–> Anterior intercostal arteries #1-6 (x2) —[6th intercostal space]—> a.) musculophrenic artery –> anterior intercostal arteries #7-9 (x2) XXX
b.) superior epigastric

70
Q

Trace and describe the venous drainage of the intercostals (right and left)

A

RIGHT: Intercostal veins –> Azygous vein –> Superior vena cava (SVC)

LEFT:

a. ) Intercostal vein #1 –> Subclavian vein.
b. ) Intercostal veins #2-4 –> Left superior intercostal vein –> Subclavian vein.
c. ) Intercostal veins #5-8 –> Accessory hemiazygos vein —[midline]–> Azygos vein.
d. ) Intercostal veins #9-12 –> Hemiazygos vein —[midline]—> Azygos vein.

Anatomy (22 decks)

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