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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
Q

Function of intervertebral discs

A

Shock absorbers

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26
Q

Function of intervertebral foramen

A

Allows a spinal nerve to ext

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27
Q

Joints between vertebral arches (cervical vertebrae)

A

Plane synovial joints between superior and inferior articular processes (zygapophyseal joints)
Allow some gliding or sliding movement

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28
Q

What is a vertebral arch made up of

A

Pedicle and lamina

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29
Q

Lumbar disc herniation

Common sites

A

L4-5 intervertebral discs

L5-S1 intervertebral discs

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30
Q

Which are the true ribs

A

1-7

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31
Q

Which are the false ribs

A

8-12

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32
Q

Which are the floating ribs

A

11-12

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33
Q

List the bones of the thorax

A

Sternum

12 pairs of ribs and their retrospective articulations

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34
Q

List the 3 articulations of the thorax

A

Sternoclavilcular joint
Sternocostal joint
Costochondral joint

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35
Q

Superior costotransverse ligament

A

Superior surface of the neck to the transverse process of the vertebra above

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36
Q

Medial costoransverse ligament

A

Neck of rib to transverse process

37
Q

Lateral costotransverse ligament

A

Roughened non-articular part of the tubercle to the tip of the transverse process

38
Q

Sternocostal joints
Which are synovial and which are non-synovial
Exception of rib 2?

A

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
Q

Interchondrial joints
What are they
Which ribs

A

(usually) synovial joints bn costal cartilages of adjacent ribs
Mainly between ribs 7-10 (may also involve 5-6)

40
Q

What kind of joints exist between
manubrium-sternum
sternum-xiphoid process

A

symphyses

41
Q

Difference between a costovertebral vs a costotransverse joint vs a costochondral joint

A

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
Q

How many pairs of intercostals are there

A

11 pairs

43
Q

Function of intercostals

A

Keep the intercostal spaces rigid
Prevent them from bulging out during expiration
Being drawn in during inspiration

44
Q

External intercostals
Origin
Insertion

A

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
Q

Action of external intercostals

A

Active during inspiration - they elevate the ribs

46
Q

Innervation of external intercostals

A

Intercostal nerves

4th IC nerve supplies muscles that occupy the 4th IC space bn 4th and 5th rib

47
Q

Internal intercostals
Origin
Insertion

Action

A

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
Q

Action of internal intercostals

A

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
Q

Innervation of external intercostals

A

Intercostal nerves

50
Q

Innermost intercostals
Origin
Insertion
Orientation

A

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
Q

Transverus thoracis
Origin
Insertion
Innervetion

A

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
Q

Action of transversus thoracis

A

Depresses the ribs

53
Q

Describe the neurovascular bundle

where is is located
what does it consist of

A

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
Q

Subcostal muscles
Origin
Insertion

abundance
plane
fibre direction
innervation

A

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
Q

2 places that anterior + posterior intercostal arteries originate from

A 
Thoracic aorta (posterior)
Internal thoracic arteries (anterior)
56
Q

Where do internal thoracic arteries originate from?

A

From subclavian arteries in the root of the neck

57
Q

Compare L posterior intercostal arteries with R posterior intercostal arteries

A

L are shorter than R (aorta is on the left)

58
Q

Internal thoracic artery - course in the thorax

A

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
Q

Anterior arterial supply to the IC spaces- how does it differ along the thorax

A

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
Q

2 branches of each anterior IC artery

A

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
Q

Relative size of anterior and posterior IC arteries

A

posterior > anterior

62
Q

Venous drainage of the thorax

A

Azygos system of veins -drains into VC

internal thoracic veins - connect with brachiocephalic veins in the neck

63
Q

3 major elements that the sternum consists of

A

Manubrium
Body of sternum
Xiphoid process

64
Q

3 things that attach to the manubrium

A

Clavicle
1st rib
Half of rib 2

65
Q

Thoracic inlet is a ring formed of

A

T1
1 ribs
Manubrium

66
Q

Contents of thoracic inlet (6)

A

Oesophagus
Trachea
Nerves
Lymphatics
Great vessels heading for neck and upper limb
Apex of the lung (3cm above the clavicle)

67
Q

How many intercostal nerves are there?

A

11 intercostal T1-T11

1 subcostal T12

68
Q

Largest branch of IC nerve and what does it innervate

A

Lateral cutaneous branch which has anterior and posteror branches that innervate the overlying skin

69
Q

How do the IC nerves end

A

As anterior cutaneous branches (medial + lateral)

70
Q

IC nerves carry (3)

A

Somatic motor to thoracic muscles
Somatic sensory to skin and parietal pleura
Post-ganglionic sympathetic fibres to the periphery

71
Q

Margins of the safe triangle (4)

above or below the rib?

A

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
Q

Why might you need a chest drain?

A

To drain blood - haemothorax
Air-pneumothorax
To drain liquid - pleural effusion

73
Q

2 heads of pec major

Insertion
Innervation

A 
Clavicular head (medial half of clavicle)
Sternocostal head (sternum and costal cartilages)

Intertubercular sulcus of humerus

Medial and lateral pectoral nerves

74
Q

Function of pec major (3)

A

Adduction
Medial rotation
Flexion of humerus at the shoulder joint

75
Q

Which xray is better PA or AP

A

PA doesn’t show the structures enlarged

76
Q

Black xray

A

Most xrays pass through

77
Q

Grey xray

A

50% xrays pass through

78
Q

White xray

A

Some xrays pass through

79
Q

Sensory innervation of skin overlying the upper thoracic wall

A

Supplied by cutaneous branches of supraclaviular nerves that descend into the neck from the cervical plexus

80
Q

How does T1 differ from the rest of the IC nerves?

A

No lateral cutaneous branch

81
Q

Pec minor

Origin
Insertion
Innervation

A

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
Q

Function of pec minor (2)

A

Depresses tip of shoulder

Protracts scapula

83
Q

Subclavius

Origin
Insertion
Innervation

A

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
Q

Function of subclavius (2)

A

Depresses tip of shoulder

Pulls clavicle medially to stabilise sternoclavicular joint

85
Q

Direction of external ic muslces

A

inferoanteriorly

86
Q

Direction of internal ic muscles

A

inferoposteriorly

87
Q

Direction of innermost ic muscles

A

inferoposteriorly

88
Q

What does quiet expiration rely on?

A

It’s passive

relies on elastic recoil of the lung’s elastic tissue and ribcage

89
Q

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?

A

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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