Thoracic Wall And Pleural Cavity

Question 1

Most superficial intercostal muscle fibers, innervated by intercostal nerves (t1-t11)

Fibers directed antero-inferiorly

Answer 1

External layer

Question 2

Intercostal fibers directed postero-inferiorly

Answer 2

Internal

Innermost

Question 3

Neurovascular supply for the intercostal muscles are where?

Answer 3

Located between the internal and innermost muscle layers

Question 4

The interior intercostal membrane is where

Answer 4

From the angle of the ribs to the vertebral column

Question 5

The external intercostal membrane is where?

Answer 5

Near the sternum and costal margins

Question 6

Located on the deep surface of anterior thoracic wall

Attach to posterior surface of lower sternum and ribs 3-6

Deep to internal thoracic vessels

Answer 6

Transversus thoracis muscles

Question 7

Located at lower regions of posterior thoracic wall

Spans multiple ribs

Answer 7

Subcostal muscles

Question 8

Order of intercostal neurovascular bundle structures from superior to inferior

Answer 8

Vein

Artery

Nerve

Question 9

What muscles is the intercostal neurovascular bundles in between ?

Answer 9

Between internal and innermost muscles.

It is at the inferior border of rib in costal groove

Question 10

Where should you put chest tubes?

Answer 10

Between the anterior axillary line and the mid-axillary lines. At the 4th or 5th intercostal spaces, on the superior border of the rib.

Question 11

Indication for chest tube? (Thoracostomy)

Answer 11

Indicated to drain abnormal air or fluid in the pleural cavity

Question 12

Intercostal arteries are?

Answer 12

Posterior intercostal artery (branch of aorta)

Anterior intercostal artery (branch of internal thoracic, which is branch of subclavian)

Question 13

Origin of the 1st and 2nd posterior intercostal arteries are where?

Answer 13

They are from the supreme intercostal artery which are a branch of the costocervical trunk from the subclavian artery.

[Not from the aorta]

Question 14

Supplies anterior intercostal arteries to 7-9th intercostal spaces and to the diaphragm

Terminal branch of the internal thoracic artery

Answer 14

Musculophrenic artery

Question 15

Continues inferiorly into the anterior abdominal

Terminal branch of internal thoracic artery

Answer 15

Superior epigastric arteries

Question 16

Posterior intercostal veins drain into ?

Answer 16

The azygos vein on the right

Hemiazygous and accessory hemiazygous veins on the left

Question 17

Anterior intercostal veins drain into ?

Answer 17

Internal thoracic vein and musculophrenic vein

Question 18

Types of innervation in the intercostal nerve

Answer 18

Sympathetic

Somatic sensory innervation

Somatic motor innervation

Question 19

What dermatome is at roughly the level of teh nipples

Answer 19

T4

Question 20

Potential space between the parietal pleura and visceral pleura

Contains a thin layer of serous fluid

Answer 20

Pleural cavity

Question 21

Pleural cavity develops from ?

Answer 21

Coelomic space

Question 22

Slit-like spaces of reflection of costal pleurae to diaphragmatic pleurae

Answer 22

Costodiaphragmatic recesses

Question 23

Air enters into pleural cavity from channel through thoracic wall made by knife wound

Answer 23

Open pneumothorax

Question 24

Air enters into pleural cavity from rupture of air tubes at surface of lungs

Answer 24

Closed pneumothorax

Question 25

Blood in pleural cavity

Answer 25

Hemothorax

Question 26

Pus in pleural cavity

Answer 26

Pyothorax

Question 27

Excess tissue fluid in pleural cavity duue to CHF

Answer 27

Hydrothorax

Question 28

Milky lymph fluid from the intestines?

Answer 28

Chylothorax

Question 29

Chyle in pleural cavity due to tear in thoracic duct

Answer 29

Chylothorax

Question 30

Inflammation of pleura; fibrous adhesions on pleura can result in audible friction rub

Answer 30

Pleurisy

Question 31

The visceral pleura is relatively _________ to pain

Answer 31

Insensitive

Question 32

Costal pleura is innervated by ?

Answer 32

Intercostal nerves,

Question 33

Mediastinal diaphragmatic pleura are innervated by ?

Answer 33

Phrenic nerve

Question 34

Visceral pleura is formed from ?

Answer 34

Intraembryonic sphlanchnic mesoderm

Question 35

____ forms linings of the airways

Answer 35

Endoderm

Question 36

Forms connective tissue, cartilage, and muscle of airways

Answer 36

Splanchnic mesoderm

Question 37

The horizontal fissure follows which rib from the sternum until it reaches the oblique fissue?

Answer 37

4th rib

Question 38

Tracheea divides into main bronchi at the level of the ___-

Answer 38

Sternal angle

Question 39

Bronchial arteries branch from ? ?

Answer 39

Either the aorta or right 3rd posterior intercostal artery

Question 40

The right bronchial artery branches off of the ?

Answer 40

Right 3rd posterior intercostal artery

Question 41

The left bronchial arterys arise from ?

Answer 41

The aorta

Question 42

Parasympathetic pulmonary nerves do what?

Answer 42

Constrict respiratory passageways Dilate blood vessels Increase mucous secretion

Question 43

Sympathetic pulmonary nerves do what?

Answer 43

Dilate respiratory passageways Constrict blood vessels Decrease mucous secretion

Question 44

Palpable ribs

Answer 44

2-10

Question 45

Floating ribs

Answer 45

11 and 12

Question 46

True ribs are which ones Why are they called true?

Answer 46

Ribs 1-7 Because the articulate with the sternum

Question 47

False ribs

Answer 47

8-12

Question 48

Intercostal spaces are numbered for /

Answer 48

The rib immediately superior of the space

Question 49

Formed by the costal cartilages of ribs 8,9, 10 joining costal cartilage of rib above

Answer 49

Costal margin

Question 50

Where is the nipple

Answer 50

Approximately 4th intercostal space (think chest tube) Depending on breast size At the midclavicular line

Question 51

Located only in the lateral half of an intercostal space Muscle fibers span only one intercostal space Muscle fibers oriented in same direction as internal intercostals

Answer 51

Innermost intercostals

Question 52

Branch of subclavian artery Located parasternally, between internal intercostal and transversus thoracis muscles Divides into two terminal branches at level of 6th intercostal space

Answer 52

Internal thoracic artery

Question 53

Originate from internal thoracic artery in upper 6 intercostal spaces Originate from musculophrenic artery in the 7th - 9th intercostal spaces

Answer 53

Anterior intercostal arteries

Question 54

Lungs invaginate the

Answer 54

Pleural cavity

Question 55

Closed, separate cavity w/in each side of the thoracic cavity. Potential space under negative pressure Located between parietal pleurae and visceral pleura

Answer 55

Pleural cavity

Question 56

Separates the parietal pleura from the ribs and intercostal muscles of the thoracic wall Allows surgeons to easily separate pleura from the thoracic wall and avoid entering the pleural cavity

Answer 56

Endothoracic fascia

Question 57

Only thing present within the pleural cavity

Answer 57

Serous substance that acts as a lubricant and forms a film on the visceral and parietal pleurae

Question 58

Inferior borders of pleura

Answer 58

Rib 8 at midclavicular line Rib 10 at midaxillary line Rib 12 at vetebra

Question 59

Superior border of pleura

Answer 59

About 1 inch above costal cartilage of rib 1 (above the clavicle

Question 60

Where is the cardiac notch of pleurae

Answer 60

Rib 4 around to just past sternal margin then turns down and goes to rib 6

Question 61

Posteriorly marks the superior extent of the pleura

Answer 61

Spinous vertebrae of C7

Question 62

Sensory innervation to costal pleura and peripheral part of diaphragmatic pleura

Answer 62

Intercostal nerves

Question 63

Sensory innervation to mediastianl pleura and central part of diaphragmatic pleura

Answer 63

Phrenic nerve

Question 64

______ pleura is insensitive

Answer 64

Visceral

Question 65

When does the laryngotracheal groove appear in the floor of the endodermal foregut?

Answer 65

Week 4

Question 66

The laryngotracheal tube bifurcates into long buds which form:

Answer 66

1. Main Bronchi (primary) 2. Lobar Bronchi (secondary) 3. Segmental Bronchi (teriary)

Question 67

Laryngotracheal tube grows _____, divides into right and left lung buds, which grow into pleural sacs.

Answer 67

Caudally

Question 68

Describe tracheoesophageal fistula with esophageal atresia. I

Answer 68

Improper fusion at tracheoesophageal folds (tracheoesophageal septum) which requires surgical intervention. -1 in 2500 births Results in polyhydramnios since amniotic fluid drank by fetus cannot enter stomach and small intestine which is the site of absortion by fetal circulation

Question 69

Fistula

Answer 69

Abnormal channel between two structures

Question 70

Atresia

Answer 70

Absence of normal lumen or opening

Question 71

Polyhydramnios

Answer 71

Excess amniotic fluid in the amniotic sac

Question 72

Where is the cardiac notch

Answer 72

Rib 4-6

Question 73

Right lung has __- lobes

Answer 73

3

Question 74

Left lung has __ lobes

Answer 74

2

Question 75

Separates middle lobe from superior lobe in right lung

Answer 75

Horizontal fissure (follows 4th rib from sternum to oblique fissure

Question 76

In both lungs, separates inferior and superior lobe. Starts about at spinous process of T4, then moves laterally and downward across 4th and 5th intercostal space and anteriorly runs along the contour of thee 6th rib

Answer 76

Oblique fissure

Question 77

Tongue of the left superior lobe located inferior to cardiac notch. Extends into left costomediastinal recess during normal inspiration

Answer 77

Lingula

Question 78

The base of the lung is ____ rib levels higher than parietal pleura

Answer 78

2

Question 79

Where are paracentesis done?

Answer 79

Needle is inserted in midaxillary line at intercostal space 4 to lessen possibility of puncturing diaphragm.

Question 80

Part of the lung wehre nerves and vessels enter and leave Contains bronchi, pulm A., Pulm V., bronchial arteries, and veins to and from stroma of lung, lymph vessels and autonomic nerves

Answer 80

Hilum of lung

Question 81

The eparterial bronchus is only on the____ side

Answer 81

Right side It goes to right upper lobe Superior to pulmonary artery

Question 82

Right and left pulmonary arches send branches that divide and follow what to supply respiratory cells

Answer 82

They follow the bronchial trees

Question 83

Oxygenated blood supply to non-respiratory lung tissue comes from?

Answer 83

Bronchial arteries - two branches from aorta to left lung - one branch from posterior intercostal artery to 3rd intercostal space (Leaves through bronchial veins)

Question 84

How is non-respiratory tissue supplied in the left lung?

Answer 84

Two bronchial arteries branch from aorta to left lung

Question 85

Surgical/function unit of lung Has 1 pulm A branch and one bronchial A. Two of these share 1 pulmonary vein. Can be removed surgically without pneumothorax or excessive bleeding (in case of abscess/cancer)

Answer 85

Bronchopulmonary segments

Question 86

Aeration of lungs brought about by actively increasing the size of the thoracic cavity which decreases pressure in the pleural cavity

Answer 86

Inspiration

Question 87

Ways that the thoracic cavity is enlarged for inspiration

Answer 87

Vertical Transverse Anterior and posterior

Question 88

How is vertical diameter of thoracic cavity changed

Answer 88

Contraction of the muscular diaphragm, resulting in flattening of its domes

Question 89

How is anteroposterior diameter increased in thoracic cavity?

Answer 89

Raising the inferior sloping ribs at their sternal attachmens, thrusting inferior end of sternum anteriorly. Due to fixing first rib by neck muscles and contraction of intercostal muscles.

Question 90

How is transverse diameter increased in thoracic cavity

Answer 90

Raising the inferior sloping ribs at their sternal attachmens, thrusting inferior end of sternum anteriorly. Due to fixing first rib by neck muscles and contraction of intercostal muscles.

Question 91

Two types of inspiration

Answer 91

Quiet inspiration Forced inspiration

Question 92

Type of inspiration; First rib fixed by contraction of scalene muscles. Intercostals contract and draw ribs toward rib 1 and the diaphragm contracts. These cause increase in size of thoracic cavity

Answer 92

Quiet inspiration

Question 93

Type of inspiration that involves powerful, contraction of the neck muscles raising rib 1

Answer 93

Forced inspiration

Question 94

Type of expiration. Passive Due to relaxation of intercostal muscles and diaphragm and elastic recoil of lungs Thoracic cavity returns to its pre-inspiratory volume

Answer 94

Quiet expiration

Question 95

Type of expiration Active Posterior abdominal muscles (quadratus lumborum) contract to pull down rib 12 and ant abd muscles contract to force abdominal organs upwards against diaphragm

Answer 95

Forced expiration

Question 96

Two layers of pleura in direct contact w/ each other inferior to the root of the lung Does not contain major neurovascular structures

Answer 96

Pulmonary ligament

Question 97

At the end of week ____ of development, the coelom is a horseshoe shaped cavity in the trilaminar embryo prior to head, tail, and lateral folding

Answer 97

3

Question 98

Lateral folding of the embryo after week 3 does what?

Answer 98

Brings right and left sides of horse-shoe shaped coelomic spaces together to form single coelom