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CVS-charis > Thoracic wall, vessel, nerves > Flashcards

Thoracic wall, vessel, nerves Flashcards

1
Q

How many cervical vertebrae are there?

A

7

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2
Q

How many thoracic vertebrae are there?

A

12

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3
Q

How many lumbar vertebrae are there?

A

5

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4
Q

How many sacral vertebrae are there?

A

5 fused

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5
Q

How many coccygeal vertebrae are there?

A

last 3 fused

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6
Q

Alternative names for C1 and C2

A

C1: Atlas
C2: Axis

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7
Q

Exceptions for inter-vertebral discs - no discs

A

Between C1 + C2 (atlas and axis)

Between fused sacrum and coccyx

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8
Q

Primary curvatures of the spine include

A

Thoracic + sacral curvature

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9
Q

Secondary curvatures of the spine include and when do they develop

A

Cervical + Lumbar curvature

Develop during infancy

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10
Q

Which regions of the vertebral column allow for greater movement?

A

Cervical and Lumbar

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11
Q

Joint between superior and inferior articular processes

A

Zygapophysial joint

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12
Q

What is the function of the transverse foramen

A

Allows for passage of the vertebral vessels

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13
Q

Level T4-T5 (10)

A

Sternal angle (rib 2)
Marks:
The position of the superior limit of the pericardium
Where the arch of the aorta begins and ends
Bifurcation of the trachea
Superior limit of the pulmonary trunk
The site where the SVC penetrates the pericardium to enter the heart
Azygos vein drains to SVC
Thoracic duct empties into L subclavian vein
Cardiac plexus
Ligamentum arteriosum/Left recurrent laryngeal loops under aortic arch

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14
Q

What is a costotransverse joint

A

Synovial joint bn the tubercle of a rib and the transverse process of the related vertebra

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15
Q

How is a costotransverse joint stabalised

A

superior, medial and lateral sides of the joint: Costotransverse ligaments

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16
Q 
Cervical disc herniation
What is it
How is it caused
What are the consequences
Common sites?
A

Degeneration of annulus fibrosus can lead to herniation of the nucleus pulposus
Dehydration of the nucleus pulposus (not related to trauma)
Motor and sensory loss if herniation compresses a nerve root or a spinal nerve
C5-6, C6-7 inter-vertebral discs

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17
Q

What is the function of the vertebral foramen

A

Houses the spinal cord and its meningeal coverings

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18
Q

What does each of the following articulate with
Superior costal facet
Inferior costal facet
Transverse costal facet

A

Demifacet - Head of its own rib
Demifacet - Head of the rib below
Facet -Tubercle of its own rib

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19
Q

How is the movement of the thoracic spine constrained compared to lumbar and cervical spine?

A

By articulation of ribs to vertebrae posteriorly and to sternum anteriorly

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20
Q

Spinous processes of thoracic vertebrae
Length
Direction

A

Long

Oriented posteriorly

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21
Q

Size of lumbar transverse processes and function

A

Massive for muscle attachment of the trunk and back

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22
Q

Size of body of lumbar vertebrae and fuction

A

Large body to support the weight of the trunk

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23
Q

What is lumbar pain associated with

A

Muscle pain
Ligament pain
disc-related pain often affecting a spinal nerve

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24
Q

Which vertebrae are an exception to the usual way that the ribs articulate with the vertebral bodies

A

T1 - Complete superior facet - only articulates with the rib of its own vertebra
(T9)T10 - No inferior demifacet - Only articulates with its own rib
T11,T12 - No transverse facet, one complete facet - only articulate with heads of their own ribs

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25
Function of intervertebral discs
Shock absorbers
26
Function of intervertebral foramen
Allows a spinal nerve to ext
27
Joints between vertebral arches (cervical vertebrae)
Plane synovial joints between superior and inferior articular processes (zygapophyseal joints) Allow some gliding or sliding movement
28
What is a vertebral arch made up of
Pedicle and lamina
29
Lumbar disc herniation | Common sites
L4-5 intervertebral discs | L5-S1 intervertebral discs
30
Which are the true ribs
1-7
31
Which are the false ribs
8-12
32
Which are the floating ribs
11-12
33
List the bones of the thorax
Sternum | 12 pairs of ribs and their retrospective articulations
34
List the 3 articulations of the thorax
Sternoclavilcular joint Sternocostal joint Costochondral joint
35
Superior costotransverse ligament
Superior surface of the neck to the transverse process of the vertebra above
36
Medial costoransverse ligament
Neck of rib to transverse process
37
Lateral costotransverse ligament
Roughened non-articular part of the tubercle to the tip of the transverse process
38
Sternocostal joints Which are synovial and which are non-synovial Exception of rib 2?
rib 1 - non synovial, fibrolagenous connection ribs 2-7 - synovial, reinforced by sternocostal ligaments rib 2 - joint is divided into 2 by an intraarticular ligament joins to a) junction of manubrium b) body of sternum
39
Interchondrial joints What are they Which ribs
(usually) synovial joints bn costal cartilages of adjacent ribs Mainly between ribs 7-10 (may also involve 5-6)
40
What kind of joints exist between manubrium-sternum sternum-xiphoid process
symphyses
41
Difference between a costovertebral vs a costotransverse joint vs a costochondral joint
Costovertebral: synovial joint between head of rib and costal facets of vertebrae Costotransverse: synovial joint between tuberle of rib and transverse process (ribs 1-10) Costochondral: joints between the ribs and costal cartilage in the front of the rib cage
42
How many pairs of intercostals are there
11 pairs
43
Function of intercostals
Keep the intercostal spaces rigid Prevent them from bulging out during expiration Being drawn in during inspiration
44
External intercostals Origin Insertion
Origin lower border of the rib Insertion upper border of the rib below Extend from the tubercles to the costal cartilages where each layer continues as a thin connective tissue aponeurosis (external IC membrane)
45
Action of external intercostals
Active during inspiration - they elevate the ribs
46
Innervation of external intercostals
Intercostal nerves 4th IC nerve supplies muscles that occupy the 4th IC space bn 4th and 5th rib
47
Internal intercostals Origin Insertion Action
Origin: lateral edge of costal groove or rib above Insertion: upper border of the rib below Layer continues towards the vertebral column in each intercostal space as the internal IC membrane Pull ribcage downwards in forced expiration
48
Action of internal intercostals
Most active in expiration Portions of upper 4-5 internal intercostal muscles elevate the ribs More lateral and posterior portions of the muscles depress the ribs and are active during expiration
49
Innervation of external intercostals
Intercostal nerves
50
Innermost intercostals Origin Insertion Orientation
Origin: Lower border of the ribs (medial edge of costal groove or rib above) Insertion: upper border of the rib below Orientation: Same as the internal intercostals poorly developed and may fuse to the overlying internal intercostals
51
Transverus thoracis Origin Insertion Innervetion
IN THE FRONT Origin: Posterior surface of the lower portion of the sternum and the xiphoid process (inferior attachment) Insertion: Inner surface of costal cartilages 2-6 (superior attachement) related Intercostal nerves
52
Action of transversus thoracis
Depresses the ribs
53
Describe the neurovascular bundle where is is located what does it consist of
Lie in costal groove along the inferior margin of the superior rib bn 2 layers of muscles (innermost and internal intercostal muscles) Vein Artery Nerve Nerve not usually protected, at risk when upper aspect of IC space is perforated Nerve is always outside the artery
54
Subcostal muscles Origin Insertion abundance plane fibre direction innervation
AT THE BACK Origin: Internal surface of one rib Insertion: medial internal surface of the 2nd or 3rd rib below span multiple ribs, numerous in lower regions of the posterior thoracic wall Same plane as innermost intercostals Their fibres parallel the course of the internal intercostals innervation: related intercostal nerves
55
2 places that anterior + posterior intercostal arteries originate from
``` Thoracic aorta (posterior) Internal thoracic arteries (anterior) ```
56
Where do internal thoracic arteries originate from?
From subclavian arteries in the root of the neck
57
Compare L posterior intercostal arteries with R posterior intercostal arteries
L are shorter than R (aorta is on the left)
58
Internal thoracic artery - course in the thorax
posterior to the first 6 ribs at 6th IC space bifurcates: Superior epigastric artery (continues inferiorly to the abdominal wall) Musculophrenic artery (passes along costal margin, goes through the diaphragm and ends near the last IC space)
59
Anterior arterial supply to the IC spaces- how does it differ along the thorax
Upper 6 IC space - lateral branches from the internal thoracic artery Lower spaces - muscolophrenic arery Last 2 IC spaces have no anterior IC arteries
60
2 branches of each anterior IC artery
One passes below the margin of the upper rib | Other one passes above the margin of the lower rib and meets a collateral branch from the posterior artery
61
Relative size of anterior and posterior IC arteries
posterior > anterior
62
Venous drainage of the thorax
Azygos system of veins -drains into VC | internal thoracic veins - connect with brachiocephalic veins in the neck
63
3 major elements that the sternum consists of
Manubrium Body of sternum Xiphoid process
64
3 things that attach to the manubrium
Clavicle 1st rib Half of rib 2
65
Thoracic inlet is a ring formed of
T1 1 ribs Manubrium
66
Contents of thoracic inlet (6)
Oesophagus Trachea Nerves Lymphatics Great vessels heading for neck and upper limb Apex of the lung (3cm above the clavicle)
67
How many intercostal nerves are there?
11 intercostal T1-T11 | 1 subcostal T12
68
Largest branch of IC nerve and what does it innervate
Lateral cutaneous branch which has anterior and posteror branches that innervate the overlying skin
69
How do the IC nerves end
As anterior cutaneous branches (medial + lateral)
70
IC nerves carry (3)
Somatic motor to thoracic muscles Somatic sensory to skin and parietal pleura Post-ganglionic sympathetic fibres to the periphery
71
Margins of the safe triangle (4) above or below the rib?
Anterior border of latissimus dorsi Lateral border of pectoralis major Apex below the axilla 5th IC space anteror to the mid-axillary line (should pass directly on top of the rib, superior border of the rib or lowest position in the IC space)
72
Why might you need a chest drain?
To drain blood - haemothorax Air-pneumothorax To drain liquid - pleural effusion
73
2 heads of pec major Insertion Innervation
``` Clavicular head (medial half of clavicle) Sternocostal head (sternum and costal cartilages) ``` Intertubercular sulcus of humerus Medial and lateral pectoral nerves
74
Function of pec major (3)
Adduction Medial rotation Flexion of humerus at the shoulder joint
75
Which xray is better PA or AP
PA doesn't show the structures enlarged
76
Black xray
Most xrays pass through
77
Grey xray
50% xrays pass through
78
White xray
Some xrays pass through
79
Sensory innervation of skin overlying the upper thoracic wall
Supplied by cutaneous branches of supraclaviular nerves that descend into the neck from the cervical plexus
80
How does T1 differ from the rest of the IC nerves?
No lateral cutaneous branch
81
Pec minor Origin Insertion Innervation
Origin: anterior surfae of 3,4,5 ribs and deep fascia overlying the related intercostal spaces Insertion: Coracoid process of scapula Innervation: Medial pectoral nerves
82
Function of pec minor (2)
Depresses tip of shoulder | Protracts scapula
83
Subclavius Origin Insertion Innervation
Origin: Rib I at junction bn rib and costal cartilage Insertion: Groove on the inferior surface of the middle third of the clavicle Innervation: Nerve to subclavius
84
Function of subclavius (2)
Depresses tip of shoulder | Pulls clavicle medially to stabilise sternoclavicular joint
85
Direction of external ic muslces
inferoanteriorly
86
Direction of internal ic muscles
inferoposteriorly
87
Direction of innermost ic muscles
inferoposteriorly
88
What does quiet expiration rely on?
It's passive | relies on elastic recoil of the lung's elastic tissue and ribcage
89
A thoracocentesis (chest drain) is performed to treat the pneumothorax of a 67-year old male. The needle is most safely inserted at the MAL between which of the 2 ribs?
3+4 or 4+5 3rd or 4th ICS Inferior border is 5th ICS. Ideally we want to avoid the border and going more superiorly is safer

CVS-charis (7 decks)

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