Thoracic Skeleton and Lungs Flashcards
- Attachment for upper limb
- Protection and landmarks to underlying cavities
- Openings for communication
- Movement for respiration
Thoracic Skeleton
Ribs 1-7
Articulate directly with sternum
True ribs
Ribs 8-10
Attaches to the superior ribs costal cartilage
False ribs
Ribs 11/12
Not attached to anything
Floater ribs
Inferior border anterior thoracic wall
Attach to diaphragm and abdominals
Palpable landmark
Costal margin
Connects manubruim to the body of the sternum
Palpable landmark of 2nd rib
T4/T5 transverse section
Sternal angle
Which of the following joints connects the sternum and costal cartilage?
A. Costchondral
B. Costovertebral
C. Costotransverse
D. Sternocostal
D. Sternocostal
Which of the following connects costal cartilage and ribs 1-10? A. Costchondral B. Costovertebral C. Costotransverse D. Sternocostal
Costchondral
What joint is the head of the rib to the vertebral body?
A. Costchondral
B. Costovertebral
C. Costotransverse
D. Sternocostal
Costovertebral
What joint connects the rib tubercle to the transverse process of the vertebrae?
A. Costchondral
B. Costovertebral
C. Costotransverse
D. Sternocostal
Costotransverse
What increases the elasticity of the rib cage and provides the structure with better movement?
Costal cartilage
If you are auscultating the R intercostal space, what valve is that?
Aortic valve
If you are auscultating the L 2nd intercostal space, what valve is that?
Pulmonic valve
Where does the superior thoracic aperture start?
1st rib
T1
jugular notch
What encloses the inferior thoracic aperture?
Diaphragm
What passageways run through the aperture’s for vital structures?
Inferior vena cava
Esophagus
Thoracic aorta
What passageway runs inferior to superior through the apertures?
A. Inferior vena cava
B. Esophagus
C. Thoracic aorta
Inferior vena cava
What passageways run superior to inferior through the apertures? A. Esophagus and inferior vena cava B. Inferior vena cava and thoracic aorta C. Thoracic aorta and esophagus D. All 3
Thoracic aorta and esophagus
What level and hiatus does the inferior vena cava and R phrenic nerve pass through?
T8 and cava opening/vena cava hiatus
What level and hiatus does the esophagus and vagus trunks pass through?
T10 and esophagus hiatus
What passes through the aortic hiatus on T12 level?
Thoracic aorta
Azygos vein
Thoracic duct
Sympathetic trunk
Inhalation or expiration
- Contraction of diaphragm (flattens)
- Ribs/sternum go up
- R/L domes descend inferiorly
- Increase thoracic diameter and volume
- Decrease pressure
Inhalation
Inhalation or expiration
- Relaxation of diaphragm (mountain)
- Ribs and sternum go down
- R/L domes ascend to resting position
- Decrease in thoracic diameter and volume
- Increase in pressure
Expiration
If you are doing normal breathing, which muscles are active? A. Diaphragm B. Sternocleidomastoid C. External obliques D. Scalenes
Diaphragm
If you are doing deep breathing, which of the following muscles would be active? A. Internal intercostals B. Recuts abdominus C. External intercostals D. External obliques
External intercostals
If you are blowing out candles, which of the following muscles would be active? A. External intercostals B. Internal intercostals C. Sternocleidomastoid D. Scalenes
Internal intercostals
- Elevate ribs
- External intercostals
- Sternocleidomastoid
- Diaphragm
- Scalenes
Forced inhalation
- Depress ribs
- Internal intercostals
- Recuts abdominus
- External obliques
- Diaphragm
Forced expiration
How do you name a rib?
Inferior costal facet of above vertebrae
Superior costal facet of same # vertebrae
Vertebrae # = to transverse process
What is the weakest point in a rib and possible injury if rib is fractured?
Anterior angle is weakest point
Pneumothorax
Lots of pain due to nerve being so close to rib
Muscles at the wall
Pec minor/major Serrated anterior Sternocleidomastoid Scalenes External obliques Recuts abdominus
Muscles that act on the wall
Transverse thoracis
Subcostal
External, internal, innermost intercostals
What muscles help with rib depression? A. Transverse thoracis B. Levatores costarum C. Subcostal D. A and C
Transverse thoracis and Subcostal
What muscles help with rib elevation? A. Transverse thoracis B. Levatores costarum C. Serratus posterior superior and inferior D. Both B and C
Levatores costarum and serratus posterior sup/inf
Inferior to superior rib
Depress rib during ACTIVE expiration
Internal intercostals
Superior to inferior rib
Elevate rib during ACTIVE inspiration
External intercostals
Mostly found along lateral section of thoracic wall
V.A.N between layers
Innermost intercostals
Which of the following pleura is for the intercostals? A. Mediastinal B. Diaphragmatic C. Costal D. Visceral
Costal
Which of the following pleura is for the mediastinum? A. Mediastinal B. Diaphragmatic C. Costal D. Visceral
Mediastinal
Which of the following pleura is for the diaphragm? A. Mediastinal B. Diaphragmatic C. Costal D. Visceral
Diaphragmatic
Which of the following pleura is for the lining of the lung? A. Mediastinal B. Diaphragmatic C. Costal D. Visceral
Visceral
Motor: intercostals, subcostal, transverse thoracis
Sensory: costal pleura and skin
Carry sympathetic innervations
Intercostal nerve T1-11
Subcostal nerve T12
Motor: diaphragm
Sensory: pericardium, mediastinal and diaphragmatic pleura
Phrenic nerve C3-5
Thoracic aorta gives off to the posterior intercostal arteries T3-11 and Subcostal arteries T12
Posterior arteries
Subclavian artery gives off to two branches.
- Internal thoracic artery which gives off to anterior intercostal artery.
- Costocervical trunk which gives off to the 1st/2nd posterior intercostal arteries.
Anterior arteries
From inferior to superior, the Anterior intercostal vein gives off to internal thoracic vein that gives off to the brachiocephalic vein.
Anterior veins
The superior vena cava can receive blood from two pathways.
- The azygos vein which relieves blood from the posterior intercostal veins and hemi-azygos veins.
- The brachiocephalic vein receives blood from the posterior intercostal veins.
Posterior veins
Sternum to tubercle of ribs
Replaces muscle fibers to the vertebral body posteriorly
Internal intercostal membrane
Vertebral body to costal cartilage
Replaces muscle fibers anteriorly
External intercostal membrane
What is the space created by the reflections of the parietal pleura called
Called a recess
Lungs do not completely fill space
What is the costophrenic angle?
Extreme outermost lower corner of each lung where diaphragm meets ribs
Recess
What is pleural effusion
Fluid in the pleural recess prevents lung from expanding
How lobes and fissures does the right long have?
3 lobes: superior, middle, inferior
2 fissures: horizontal and oblique
How many lobes and fissures does the left lung have
2 lobes: superior and inferior
1 fissure: oblique
What immersions are on each lung
R lung- esophagus, azygos vein, some cardiac notch
L lung- aortic and most cardiac notch
What is the lingula
Tongue like projection off L lung
What is the hilum
The doorway structure of lung when dissected
Root of lung is when lungs are still connected to structures
What makes up the root of the lung
Pulmonary artery/veins and primary bronchus
How do you describe the position of the pulmonary artery related to the bronchus
Right Anterior Left Superior
RALS
What is the function of the cartilage of the trachea
Maintains airway
Ring like
Keeps it open
Trachea bifurcates at what spinal level
Anteriorly- T2/sternal level
Posteriorly- T4-5
Trachea is lined with
Smooth muscle and secretory glands
Order of bronchi
Trachea
Primary/main
Secondary/lobar
Tertiary/segmental
Bronchioles bifurcate into
Alveolar sacs and ducts
Help with gas exchange
Made of thin endothelial tissue
Blood supply from lung structures come from
Bronchial arteries branching from descending aorta
Drain back into azygos veins
Where can we see bronchial arteries
Hilum on mediastinal surface
BronchodilatIon
Inhibits secretion
Pulmonary plexus
“Dilated and dry”
Sympathetic nervous system airways
Bronchoconstriction
Activates secretion
Vagus nerve
Constricted and congested
Parasympathetic nervous system airways
Which bronchus us wider, shorter, and steep?
R
Goes to the R inferior lobe