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Block 3 - CV > Thoracic wall and pleural cavities > Flashcards

Thoracic wall and pleural cavities Flashcards

1
Q

thorax is bounded by _______

A

superior thoracic aperture (opening or space) which is a anterior (front) wall formed by superior (toward the head) border of manubrium, the posterior (back) wall is formed by T1

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2
Q

inferior (away from head) thoracic aperture is a (anterior front) wall formed by xiphisternal joint which wall is formed by T12

A

posterior (back) wall

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3
Q

thorax can be divided into three compartments

A

right lateral (away from midline)
left lateral
central compartment

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4
Q

lateral (away from midline) thoracic compartments consist of their respective

A

pleural sac and lungs

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5
Q

why is the right lateral thoracic compartment more wider and shorter than left

A

the liver is pushing up on the right side / and or heart is pushing down on the left

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6
Q

which compartment of thorax consists of mediastinum and its contents

A

central compartments

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7
Q

bones of the anterior (front) of thoracic wall include

A

clavicle
sternum
ribs

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8
Q

Subcutaneous
felt along its length under skin

A

clavicle

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9
Q

largest breast done in midline
consists of manubrium
body and xiphoid (spear like in Greek)

A

sternum

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10
Q

“roof over”
helps to give shape to the cavity of the thorax

A

ribs

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11
Q

which ribs are directly attached to the sternum by their own costal cartilage

A

the first 7 ribs

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12
Q

which ribs dont attach to the sternum by costal cartilage but instead to the costal cartilage of the rib above

A

ribs 8-10

because this helps to create the costal margin of thoracic cavity

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13
Q

what are the floating ribs and dont have anterior (front) attachment to sternum - anchored by abdominal wall muscles

A

Ribs 11-12

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14
Q

what are the bones of the posterior (back) thoracic wall

A

scapula

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15
Q

whats the major bone associated with the thorax but its more important for muscle attachment in the upper limbs

A

scapula

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16
Q

important structures as landmarks for the thorax

A

vertebrae

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17
Q

what provides resilience to ribs

A

costal cartilages

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18
Q

cartilage has elasticity so compression may cause injury to organs but ribs will not be broken

A

in old age costal cartilages may undergo progressive ossification

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19
Q

which rib is mostly to be broken or fractured and which is least likley

A

1st rib is least
ribs 2-7 mostly break

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20
Q

whats flail chest

A

multiple rib fractures , paradoxical movement of ribs during breathing

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21
Q

___ is rarely cracked
easy access most common site for bone marrow extraction

A

sternum

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22
Q

extrinsic muscles include the following anterior (front) muscles

A

pectoralis major
pectoralis minor
serratus anterior

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23
Q

extrinsic muscles include the following posterior (back) muscles

A

trapezius
rhomboids
latissimus dorsi

which all have to do with movement of upper limbs

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24
Q

main action of intrinsic muscles

A

responsible for moving the ribs during respiration

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25
Q

main action of extrinsic muscles

A

movement of upper limbs

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26
Q

what projects posteriorly (back) onto T2 and T3

A

suprasternal notch/jugular notch

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27
Q

where the manubrium and body of sternum join
projects posteriorly (back) to T4 and T5

A

sternal angle aka Angle of louis

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28
Q

sternum is directly anterior (front) to the ____

A

heart
like during CPR you pump over the sternum to compress the heart and pump blood

if you do it to left side that would crack ribs

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29
Q

projects to T9 posteriorly (back)

A

xiphisternal joint

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30
Q

in males nipple is in which intercostal space

A

4th

it varies in females

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31
Q

whats in the 5th intercostal space
3 1/2 from midline on the left side

A

apex beat of heart

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32
Q

describe the location of the breast

A

superficial to the pectoralis major and serratus anterior; extends
superiorly (up towards head) to the clavicular edge, laterally (side) to the edge of the latissimus dorsi, medially to
the sternum, and inferiorly (towards bottom) to the rectus sheath

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33
Q

what are the tissue types located in the breast and what do they do

A

the breast has glandular tissue including the breast lobules
rounded segments/unit) produce milk transported through the
lactiferous duct to the sinus and out through the nipple
-Composed of 12-15 ductal openings into the nipple

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33
Q

what is suspensory ligaments of cooper

A

is the connective tissue that connects between skin and fascia of pectoralis major

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34
Q

what are the 5 arteries that supply blood to the breast

A

a. Internal mammary artery branches (to intercostals)
b. Lateral thoracic artery
c. Thoracodorsal artery
d. Intercostal artery (perforators)
e. Thoracoacromial artery

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35
Q

which lymph nodes are responsible for majority of lymphatic drainage

A

axillary lymph nodes

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36
Q

which lymph nodes are at a greater risk of cancer metastases

A

supraclavicular

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37
Q

cancer may infect one breast and then move to the other breast via _____

A

internal mammary lymph nodes

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38
Q

what are the typical ribs and why are they called that

A

ribs 3-9

These have head (w/ 2 facets), neck (connects
head and rest of body), tubercle (at head/body junction) and body (which has
costal groove at concave internal surface)!
* One facet of the head articulates with the vertebra superior to it and the
other facet articulates with the vertebra that has the same #/is on the
same plane as the ribs.
* The tubercle articulates with the transverse process of the vertebra on
the same plane as rib

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39
Q

what are a typical ribs and why are they called that

A

*Atypical ribs include ribs 1, 2, 10, 11, 12. These are called atypical because
they are distinct and do not have all the features that typical ribs do

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40
Q

superior large fan shaped muscle . Innervated by medial and lateral pectoral
nerves

A

pectoralis major

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41
Q

inferior smaller triangular muscle. Innervated by medial pectoral nerve

A

pectoralis minor

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42
Q

lateral fan shaped muscle (at sides of thoracic wall;!). Innervated by long
thoracic nerve

A

serratus anterior

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43
Q

whats the direction of fibers of external intercostal (outermost)

A

infero-anteriorly
(hands in pocket)

innervates intercostal nerve

elevates ribs during inspiration

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44
Q

direction of fibers innervation and action of internal intercostal (middle)

A

infero-posteriorly
(praying hands)

intercostal nerve

active during expiration

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45
Q

Expiration involves gases leaving the lungs. During inspiration, the diaphragm and intercostal muscles contract allowing air to enter the lungs. During expiration, the ______

A

During expiration, the inspiration muscles relax forcing gases to flow out of the lungs

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46
Q

direction of fibers innervation and action of innermost intercostal

A

infero-posteriorly
(praying hands)

intercostal nerve

active during expiration

47
Q

what are the 2 types of nerves innervating the thoracic wall

and define them

A

intercostal and subcostal

48
Q

This is made up of anterior rami of spinal nerves T1-T11. They run long the intercostal
spaces and divide into anterior and lateral cutaneous branches. They carry somatic motor
in nervation to thoracic wall muscles, somatic sensory innervation from skin to parietal
pleura (dermatomes!) and postganglionic sympathetic fibers to the periphery.

A

intercostal nerves

49
Q

describe the aterial supply of the thoracic wall

A

The arterial supply to the thoracic wall derives from the thoracic aorta through the posterior
intercostal arteries, and from the internal thoracic arteies which give rise to anterior intercostal
arteries (terminate at 6th intercostal space and bifurcates (divides or goes into) into musculophrenic & superior
epigastric arteries).
* The anterior and posterior intercostal arteries anastomose (direct connection b/w vessels)
within intercostal spaces.

49
Q

this consists of the anterior ramus of spinal nerve T12 (subcostal as not
between ribs but instead below final rib in this case!

A

subcostal nerve

50
Q

describe the veins of the throacic wall and remember that Venous drainage from the thoracic wall generally parallels the pattern of arterial supply.

A

Anteriorly: anterior intercostal veins drain into internal thoracic veins which drain into
brachiocephalic veins in the neck.

  • Posteriorly: posterior intercostal veins drain into the azygos system of veins (azygos vein,
    hemiazygos vein and accessory hemiazygos vein) which then drains into the superior
    vena cava
51
Q

The neurovascular plane is protected by the costal groove (which is a duvet in the rib) and
consists of the neurovascular bundle. The bundle components can be remembered as intercostal

A

VAN. V - Vein, A - Artery, N - Nerve.

52
Q

The superior thoracic aperture is an opening at the top of the thoracic cavity that is bordered by the
T1 vertebra, Ribs 1 and the manubrium. It hosts the ______

A

trachea, esophagus, apices and nerves/vessels (of
head/neck/upper limbs).

53
Q

The inferior thoracic aperture is an opening at the bottom of the thorax bordered
by the costal margin, xiphisternal joint and

A

ribs 12

54
Q

describe the vasculature of the breast

A

it has an arterial supply and a venous drainage

54
Q

The mammary glands (of breast) are supported by suspensory ligaments of Cooper. When lactation occurs,
the lobule drains into the

A

lactiferous ducts and accumulates in the lactiferous sinus

55
Q

Arterial Supply. (breast)
* The mammary gland is supplied by perforating branches of the

A

internal thoracic artery
(medially) and by the axillary artery (laterally).

56
Q
  • Venous Drainage. (breast)
  • Venous drainage parallels arterial supply and is to the
A

the axillary vein and internal thoracic
vein.

57
Q

what are the different divisions of the thoracic cavity

A

left pleural cavity
mediastinum
right pleaural cavity

58
Q

houses the right lung.
* Note that the left and right pleural cavities are DISTINCT from one another. Therefore,
pathology in one cavity doesn’t necessarily spread to other

A

right pleural cavity

59
Q

located centrally and separates the left and right pleural cavities. The heart sits
in the middle mediastinal compartment

A

mediastinum

60
Q

houses the left lung

A

left pleural cavity

61
Q

The _______ is a double layer serous membrane that lines the lung and the
thoracic wall

A

pleura

62
Q

The 2 layers are visceral pleura and parietal pleura.

A

Visceral pleura - layer lining the lung.
* Parietal pleura - layer lining the thoracic wall.
* Has 4 subdivisions.
* The layers connect (aka reflect) at the hilum of the lung

63
Q

this is the potential space formed by the pleural layers. Under normal
circumstances, the space is small and there is a little serous fluid present (to reduce friction).
Under pathological circumstances, fluid can accumulate (pleural effusion).

A

pleural cavity

64
Q

what are the 4 types of pleural effusions and describe them

A

Hydrpthorax - fluid in the pleural cavity
* Hemothorax - blood in the pleural cavity
* Chylothorax - lymph fluid in the pleural cavity
* Pneumothorax - air in the pleural cavity leading the lungs to collapse because negative
pressure necessary for lung expansion is not there anymore.

65
Q

fluid in the pleural cavity

A

hydrpthorax

66
Q

blood in the pleural cavity

A

hemothorax

67
Q

lymph fluid in the pleural cavity

A

chylothorax

68
Q

air in the pleural cavity leading the lungs to collapse because negative
pressure necessary for lung expansion is not there anymore.

A

pneumothorax

69
Q

procedure used to address pleural effusion. The patient is made to
sit upright so that gravity pulls the fluid downwards. A syringe is inserted at an

A

thoracentesis

angle through the 9th intercostal space at midaxillary line and into the
costodiaphragmatic recess and the excess fluid id removed.

70
Q

what are recessess and how many are there

A

spaces where the pleural cavity isn’t completely filled up by the lung. There are 2
recesses:

costomediastinal recess and costodiaphragmatic

71
Q

located posterior to the sternum where the costal pleura is in
contact with the mediastinal pleura. Smaller recess.

A

costomediastinal recess

72
Q

soft, spongy, elastic organs used to oxygenate blood. They both have:
* An apex - the apex of the lung is the blunt superior tip and it ascends above the 1st rib
into the root of the neck.
* A base - the base of the lung is concave and is located inferior to the apex. It
rests on the diaphragm

A

lungs

73
Q

located at the inferior end of the thoracic cavity. It is the
largest recess and is more clinically relevant.

A

costodiaphragmatic recess

74
Q

what are the three surfaces of lungs and describe them

A

costal - the surface next to ribs
* mediastinal - the surface between mediastinum and lungs. This includes the
hilum of the lung, in which structures forming the root of the lung enter and
exit.
* diaphragmatic - the surface facing the diaphragm

3 borders (anterior, inferior and posterior).
* Multiple lobes

75
Q

what are the structures that make up the root of the lung

A

1 Pulmonary artery
* Superior pulmonary vein (most anterior)
* Inferior pulmonary vein (most inferior)
* Bronchi (thick cartilaginous wall)

Bronchial vessels
* Nerves
* Lymphatics

76
Q

for the left lung the pulmonary artery is —- to the bronchus

A

SUPERIOR (UP)

76
Q

For the right lung, the pulmonary artery is _____ to the bronchus.
*

A

ANTERIOR (front)

77
Q

RALS mnemonic for remembering ________

A

RALS: Right Anterior | Left Superior
* Knowing RALS will help you on test day. Once you pick out the bronchus (easy to identify),
you will be able to find pulmonary arteries, then use RALS to help you determine left vs right
lung then you can identify the other structures of the root in relation to each other

78
Q

the right lung is divided into 3 lobes _____

A

Right lung is divided into 3 lobes (superior, middle and inferior) by 2 fissures (a superior
‘horizontal’ fissure and an inferior ‘oblique fissure).

79
Q

left lung is divided into 2 lobes

A
  • Left lung is divided into 2 lobes (superior and inferior) by 1 fissure (oblique fissure).
80
Q

The anterior border of the left leg has a _____ notch

A

Cardiac notch

which is an indentation caused by the apex pot the
heart. This indentation shapes the most anterior and inferior part of the superior lobe into a tongue-like
projection called the lingula

81
Q

think of contact impressions

right lung impressions include

A

smaller cardiac impression, superior vena cava, right brachiocephalic
vein, arch of azygos vein, esophagus

82
Q

think of contact impressions
left lung impressions include

A

Left Lung Impressions: larger cardiac impression, aortic arch, thoracic aorta

83
Q

describe the anatomy of the trachea it is important and there are many steps

first the tracheobronchial tree is often considered as our airway
it starts with the trachea at C6 then descends to the _____

A

sternal angle (T4/T5) where it bifurcates into 2 main primary bronchi (1 to each lung)

84
Q

each bronchus divides further into ______

A

secondary lobar bronchhi
3 to the right lung and 2 to the left lung

85
Q

each lobar bronchus divides even further into multiple tertiary segmental bronchi

the _____ supply the bronchopulmonary segments

A

segmental bronchi

86
Q

At the sternal angle where we have the tracheal bifurcation, we have a structure called the ______
which is an internal ridge of cartilage positioned slightly to the left of the median plane (making
R main bronchus wider and more vertical - food tends to fall in here). This ridge is a useful
landmark in bronchoscopy!

A

carina

87
Q

trachea is made up by series of incomplete C shaped cartilaginous rings with the incomplete portion located ______

A

posteriorly and is filled in by the smooth muscle of the esophagus

88
Q

know the differences between the left main primary bronchus and the right main primary bronchus

A
89
Q

left or right primary bronchus

Longer, narrower, runs inferolaterally (inferior to
aortic arch, anterior to esophagus and thoracic
aorta)

A

left

90
Q

left or right primary bronchus

Divides into 2 secondary lobar bronchi ->
segmental bronch

A

left

91
Q

left or right primary bronchus

the ____ superior lobar bronchus gives off singular
bronchus

A

left

92
Q

left or right primary bronchus

Wider, Shorter, runs more vertically (passes
directly to hilum - courses inferior to azygos vein
arch and anterior to right pulmonary artery)

A

right

93
Q

left or right primary bronchus

Divides into 3 secondary lobar bronchi ->
segmental bronchi

A

right

94
Q

left or right primary bronchus

The right superior lobar bronchus passes superior
to pulmonary artery

A

right

95
Q

what are bronchopulmonary segments

A

large pyramid-shaped subdivisions of a lobe

96
Q

bronchopulmonary segments are supplied by a segmental _____ bronchus and tertiary segmental ____

A

tertiary bronchus

pulomnary artery

97
Q

usually humans have about ___ bronchopulmonary segments in total

A

18-20 segments in total, 10 in the right lung and 8-12 in the left lung

98
Q

Pulmonary vasculature connects to the heart and is involved in the oxygenation of blood.how many veins and arteries does each lung have

A

1 pulmonary artery and 2 pulmonary veins

99
Q

we know pulmonary arteries arise from pulmonary trunk but at what levels and what do they drain

A

level of the sternal angle and they drain oxygen poor blood from the right ventricle and carry it to the lungs for oxygenation

100
Q

which pulmonary artery divides into 3 lobar arteries: superior, middle and
inferior secondary lobar arteries. These further divide into tertiary segmental
arteries

A

RIGHT

101
Q

which pulmonary artery divides into 2 lobar arteries: superior and inferior
secondary lobar arteries. These further divide into tertiary segmental arteries

A

LEFT

102
Q

_____ drain oxygen rich blood from the
lobes of each lung and carry it to the left atrium of the heart. These veins run
independently of arteries and bronchi in the lungs.

A

Pulmonary veins (superior and inferior on each side)

103
Q

for which lung is the superior lobe drained by the right superior vein, the middle
lobe is drained by the middle lobe vein (an offshoot of the right superior vein) and
the inferior lobe is drained by the right inferior vein

A

right lung

104
Q

for which lung is the superior lobe drained by the left superior vein and the
inferior lobe is drained by the left inferior vein

A

left lung

105
Q

bronchial arteries supply oxygen and nutrition rich blood to the lungs

true or false

A

true

106
Q

there are two left
bronchial arteries and one right bronchial artery.

T or F

A

true

107
Q

the left bronchial arteries arise from

A

thoracic aorta and the right bronchial artery arises from various sources

108
Q

Bronchial veins partially drain blood supplied to the lungs (rest drained by pulmonary
veins).

T or F

A

T

109
Q

right bronchial vein drains into the

A

azygos vein

110
Q

left bronchial vein
drains into the

A

accessory hemiazygos vein or the left superior intercostal vein

111
Q

The lungs and visceral pleura are innervated by

A

anterior and posterior pulmonary plexuses
which originate from sympathetic trunks and vagal nerves

112
Q

parietal pleura is innervated somatically by

A

intercostal and phrenic nerves

113
Q

Lymph from the lungs drains along the root of the lung and into the

A

tracheobronchial lymph
nodes.

Block 3 - CV (6 decks)

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