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Anatomy > Thoracic wall > Flashcards

Thoracic wall Flashcards

1
Q

difference between upper, middle, floating ribs

A

rib 1 and 2 - somewhat square, flat, irregular, bumpy shape
rib 3 thru 10 - gently curved, has costal heads and tubercles projecting notably
rib 11 and 12 - floating ribs; dont connect to sternum, subtle tuberosity

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2
Q

which ribs attach to the sternum through individual costal cartilages

A

1-7

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3
Q

what ribs attach to cartilage of rib 7

A

8-10

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4
Q

what ribs do not attach to sternum but are tipped by cartilage?

A

11 and 12

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5
Q

what ligament attaches the head of the rib to vertebral facets/demifacets?

A

radiate ligament

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6
Q

what ligament attaches from the neck of rib to transverse process at the same level and one level above?

A

costotransverse ligaments

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7
Q

how do ribs 1 and 2 move during inspiration?

A

they elevate

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8
Q

how do ribs 3-10 move during inspiration?

A

laterally (bucket-handle)

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9
Q

how do ribs 11 and 12 move?

A

swing laterally (pincers)

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10
Q

the movement of ribs causes the sternum to move how?

A

anteriorly

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11
Q

what part of the body is responsible for most of the movement during inspiration?

A

diaphragm

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12
Q

what is the purpose of ribs?

A

protection
expansion

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13
Q

what 2 things can damage the long thoracic nerve and/or lateral thoracic artery?

A

surgery
breast cancer

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14
Q

external intercostal muscles have what type of direction?

A

inferomedial (hands in pockets)

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15
Q

internal intercostal muscles run in what type of direction?

A

superomedial direction

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16
Q

innermost intercostal muscles run in what type of direction?

A

parallel to internal intercostal

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17
Q

where are the innermost intercostals only present in?

A

lateral region between ribs

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18
Q

what part forms the floor of the thoracic cavity?

A

diaphragm

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19
Q

where does the diaphragm attach?

A

bilaterally from xyphoid process around costal arch to 12th thoracic and upper lumber vertebrae

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20
Q

what 3 structures run through the diaphragm

A

inferior vena cava
aorta
esophagus

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21
Q

what type of hernia can occur near the diaphragm?

A

parastomal hernia

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22
Q

name the muscles involved during inspiration

A

diaphragm
ext. intercostals
int. intercostals (parasternal portion)
scalene muscle

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23
Q

name the muscles involved during forced expiration

A

int. intercostals (lateral portion)
innermost intercostals
abdominal obliques
rectus abdominis
transversus thoracic

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24
Q

what is relaxed expiration a result of?

A

recoil of soft tissue

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25
Q

what happens to the muscles of COPD or emphysema patients when respiration is forced?

A

abnormal hypertrophy

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26
Q

what is the function of the trapeizus, levator scapulae, and rhomboids during respiration

A

stabilizes/fix the scapula so that other muscles can work on the ribcage

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27
Q

what is the function of scalenes during respiration

A

elevate 1 & 2

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28
Q

what is the function of the pectoralis muscles?

A

elevate anterior ribcage if scapula is fixed; uses scapula as an anchor

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29
Q

what is the function of the serratus anterior?

A

elevates lateral ribcage if scapula is fixed; uses scapula as an anchor

30
Q

what is the main blood supply of the thoracic wall

A

intercostal arteries

31
Q

where do the intercostal arteries originate and where do they run?

A

internal thoracic artery and aorta
within each intercostal space

32
Q

innervation of thoracic wall

A

intercostal nerves, anterior rami from each spinal level T1-T12

33
Q

what artery supplies the serratus anterior muscle?

A

thoracic artery - branch of axillary a.

34
Q

innervation of serratus anterior muscle

A

long thoracic nerve

35
Q

both intercostal nerves and arteries have what branches?

A

lateral cutaneous
anterior cutaneous

36
Q

where do intercostal veins drain to?

A

internal thoracic veins anteriorly
azygos system posteriorly

37
Q

what is the drainage pattern from the R. side azygos vein?

A

receives R. intercostal veins and R. ascending lumbar vein
draining into superior vena cava
carrying deoxygenated blood

38
Q

what is the drainage pattern of the L. side hemiazygos vein?

A

receives from lower L. intercostal veins and L. ascending lumbar vein
connecting to azygos and accessory hemiazygos vein

39
Q

what veins does the accessory hemiazygos vein receive from?

A

upper L. intercostal veins connecting to L. brachiocephalic vein

40
Q

what is the order of the 3 intercostal supply starting from most superior

A

Vein
Artery
Nerve

41
Q

what is a thoracocentesis

A

receiving fluid in pleural cavity

42
Q

what is a intercostal nerve block?

A

superficial injection of anesthetic between intercostals
avoiding underside of rib to avoid arteries

43
Q

what are the subdivisions inside of the thorax?

A

two pleural cavities
midline mediastinum

44
Q

the superior mediastinum contains what

A

greater vessels - superior vena cava, brachiocephalic veins, arch of aorta
nerves - vagus, phrenic, left recurrent laryngeal
thoracic duct
trachea
esophagus
thymus
(10 things)

45
Q

what are the subdivisions of the inferior mediastinum

A

anterior
middle
posteior

46
Q

what is in the anterior mediastinum

A

thymus
lymph nodes
fat and CT

47
Q

what is in the middle meiastinum

A

pericardium and heart
roots of great vessels
arch of azygos vein
primary bronchi

48
Q

what is in the posterior mediastinum

A

esophagus
aorta
azygos and hemiazygos veins
thoracic duct
vagus nerves
sympathetic trunk
splanchnic nerves

49
Q

the transverse thoracic plane separates the mediastinum how?

A

superior and inferior

50
Q

how is the thymus gland an important immune organ?

A

where T cells mature and become active

51
Q

what happens to the thymus as we age

A

gets smaller and atrophies

52
Q

how is the thymus in children?

A

large in children
sometimes mistaken as a tumor in radiology

53
Q

what cervical nerves are responsible for the diaphragm?

A

c3, c4, c5

54
Q

what part of the pulmonary circulation carries deoxygenated blood

A

pulmonary trunk
blood from the heart to lungs

55
Q

what part of the pulmonary circulation carries oxygenated blood

A

pulmonary veins
blood from lungs to heart

56
Q

what CN is mainly responsible for parasympathetic action

A

let vagus nerve
branches of the vagus descends down to the esophagus

57
Q

what nerve travels on its own

A

thoracic splanchnic nerve

58
Q

what vein carries deoxygenated blood from the lower and middle part of the body back to the heart?

A

inferior vena cava

59
Q

the multiple lobules from the breast make milk which drains through where?

A

lactiferous ducts to lactiferous sinuses to nipple

60
Q

where is the retromammary space

A

between breast and pectoralis major

61
Q

what are suspensory ligaments

A

ligaments between lobules that extend from thoracic wall and attach to skin of breast

62
Q

what are 2 indications/signs of breast cancer

A

“orange peel” - retracts the skin during inflammation

asymmetry - cancers can adhere to the body wall, passing through retromammary space and even invade pectoralis major, fixing the breast

63
Q

what are the primary vessel that supply the breast

A

internal thoracic
lateral thoracic
small contributions from lateral cutaneous branches of intercostal artery and vein

64
Q

about 3/4 lymphatic flow from the breast travel to where?

A

axillary lymph nodes

65
Q

where does lymph first pass through before reaching to its main lymph node

A

interpectoral nodes first, then pectoral axillary lymph nodes

66
Q

where do the remaining 1/4 lymph flow drain to?

A

parasternal nodes
draining to mediastinum and crossing to opposite breast

67
Q

what is the major route for cancer?

A

lymph channels

68
Q

if the lymph flow from the breast is going more medially, what node is it going to

A

parasternal nodes

69
Q

if the lymph flow from the breast is going more laterally, what node is it going to

A

pectoral axillary nodes

70
Q

what part of the intercostal arteries anastomoses with each other

A

anterior and posterior intercostal arteries

71
Q

where do posterior intercostal arteries and nerves run?

A

in the plane between internal intercostal and innermost intercostal muscles

Anatomy (8 decks)

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