Thorax 1 + 2 Flashcards

1
Q

Thorax (3)

A
  • superior thoracic aperature -> diaphragm
  • 3 cavities in thorax = R/L pleural + central pericardial cavity
  • heart (perfusion) + lungs (gas exchange)
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2
Q

Thorax Functions (3)

A
  • conduit = structures from head/neck - ab cavity
  • protection (bony structure)
  • respiration (gas exchange)
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3
Q

looking down body (5)

A
  • trachea
  • rib 1
  • VB
  • clavicles
  • manubrium
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4
Q

Inferior Thorax Boundary (3)

A
  • diaphragm -> ribs 11 + 12
  • Anteriorly: xiphoid process of sternum
  • cavity = slanted structure
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5
Q

Superior Thoracic Aperature

A
  • over rib 1, manubrium, T1

- subclavian vein and artery over rib 1

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6
Q

Pectoral region

A
  • Superficial cmpt – mamillary glands

- Deep cmpt – muscles over bony cage

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7
Q

Breast

A
  • sweat gland, w/structural/support suspensory ligaments of cooper (cont w/dermis)
  • axillary process on side - imp for breast exam
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8
Q

Breast perfusion

A
  • axillary art, thoracocaromial process, lateral thoracic artery, internal thoracic artery (TAIL)
  • veins parallel these
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9
Q

Lymph Drainage/Tumor spread

A
  • lateral tumor -> axillary nodes
  • medial tumor -> parasternal node
  • inferior tumor -> subdiapraghmatic nodes
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10
Q

Breast Cancer

A
  • mass puts tension on ligs of cooper = skin pitting/dimpling = Peau d’range
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11
Q

Pectoralis Major

A
  • innervation = medial/lateral pectoral nerves

- function = adduction, medial rotation, flexion of humerus shoulder

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12
Q

Subclavius

A
  • innervation = nerve to subclavius

- fn = Pulls clavicle medially to stabilize sternoclavicular joint

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13
Q

Pectoralis Minor

A
  • innervation = Medial pectoral nerves

- Depresses tip of shoulder; protracts scapula

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14
Q

breastbone

A
  • costacondral junction (expansion to breathe) for ribs + sternum
  • manubrium - articulation for clavicle, rib 1 + 2
  • xiphoid process on bottom
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15
Q

Ribs

A
  • rib 8-12 = false ribs = connect to other costochondral junctions, not sternum
  • 11-12 = floating ribs
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16
Q

Special TV

A
T1 = small VB, complete face for rib 1 
T10 = single complete facet for rib 10
T11 = no articulation pt on TP due to floating rib
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17
Q

Rib structure

A
  • Int surface = art, vein, nerve (protective mech)
  • rib 1 = short flat rib, 2 circular pits for subclavian art/vein, scalene muscles attach
  • rib 11/12 = bony finger
  • other ribs similar (rib 7 biggest, most curved)
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18
Q

Rib joint to VB

A
  • Joint capsules btwn facets of ribs + VBs
  • Superior costotransverse lig = from TP, supports capsule
  • costotransverse lig + lateral costotransverse lig
  • Ribs held by 3 lig connections
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19
Q

Rib joints

A
  • Rib 6-10 ribs = interchondral + synovial joints in cartilaginous connections
    Rib 1 = fibrocartilaginous joint
    upper 7 ribs = sternocostal synovial joint
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20
Q

External intercostal

A
  • plane (hands in pocket) btwn ribs
  • innervation = intercostal nerves, T1-T11
  • fn = inspiration, moves ribs superiorly
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21
Q

Internal + innermost intercostal

A
  • opposite plane btwn ribs – provides strength
  • innervation = intercostal nerves, T1-T11
  • fn = expiration, moves ribs inferiorly
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22
Q

Subcostals

A
  • span rib/2, connect rib to rib
  • innervation = related intercostal nerves
  • fn = depress ribs
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23
Q

Transversis thoracis

A
  • radiate out from breast bone
  • innvervation = related intercostal nerves
  • fn = depress costal cartilages, exhaling
24
Q

thoracic arterial system

A
  • Aorta = brachiocephalic trunk, common int. carotid, subclavian + anterior/posterior intercostal
25
Subclavian
off subclavian = 2 lateral internal thoracic arteries -> bifurcate at rib 7 to terminal musculophrenic and superior epigastric art
26
Anterior + posterior intercostal
- anterior intercostal arts branch off internal thoracic arteries at each rib. - Posterior intercostal off aorta -> costal groove -> form anastamotic connection (still bleed when cut) at midaxillary line
27
Azygos Vein
- right side = Ant + post intercostal vein -> azygos vein -> brachiocephalic vein - left side = accessory hemiazygos (ribs 1-9) + hemiazygos (ribs 10-12) -> azygos system - draining R/L thoracic cages
28
Thorax Lymphatics
- post thorax lymph -> intercostal nodes (in back - infections in back go to these nodes) - Anterior -> parasternal nodes - all return to braciocephalic nodes -> thoracic duct -> venous system
29
Thorax Wall Inntervation
all autonomic Nipple level = T4 Xiphoid Process = T6 Umbilical/ belly button = T10
30
Intercostal nerve/space
- ventral rami, wrap around - over sternum w/ant cutaneous branch - space = vein, artery, nerve (VAN) - chest tube - decompress pressure, can cause damage
31
Manubriotsternal + xiphisternal joints
symphysis
32
Pleural Cavities
- R/L pleural cavity, pericardial cavity | - pericardial in mediastinum
33
Diff Parts of Pleura
Costa (ribs) + mediastinal (heart) + | diaphragmatic + cervical pleura = where lungs sit
34
Pleural recess
- space for lung to expand | - space for infection/fluid buildup
35
costodiaphragmatic recess
- space for lungs to go down on inhalation – # 1 location for fluid accumulation
36
Lungs
- Right lung = 3 lobes; left lung = 2 lobes - mediastinal to lungs = pul art superior to pul veins - Pleural mem – hilum – surrounds lung roof
37
Left Lung
- superior + inferior lobes separated by oblique fissure (rib 6) - Cardiac notch = space for heart - Lingula – tongue like projection - depressions on mediastinal surface
38
Left Lung Vasculature
- aorta + aortic arch | - left subclavian art + braciocephalic vein at lung apex (above superior thoracic aperature, tumor site)
39
Right Lung
- 3 lobes = superior, middle and inferior - horizontal fissure (superior from middle at 4th intercostal) - oblique (middle from inferior at 5th intercostal space, rib 6)
40
Right Lung Vasculature
- inferior + superior vena cava - Azygos system - esophagus - subclavian art + vein
41
Trachea
- CV 6 -> TV 4, bifurcates to R/L bronchus
42
Bronchi
- R bronchus = more vertical, gets more foreign bodies (least resistance) - L bronchus - shallow, longer, for heart - main bronchus -> lobar/secondary bronchi (supplies lobes -> segmental/tertiary bronchi (supplies bronchopulmonary segments)
43
Bronchoscopy
- stick scope down pt’s windpipe - Carina = bifurcation of trachea - 3/2 secondary -> keep branching off and get smaller
44
Bronchopulmonary Segments
- Segmental bronchus - Pul art branch - Pul venous drainage – pass intersegmentally btwn/around margins of segments
45
Pulmonary Arteries
- Originate from pul trunk (right ventricle) - Trunk bifurcates ~ T4-T5 (anterior/inferior to bronchus) - Deoxygenated blood
46
Right Pulmonary Artery
- longer than left - posterior to ascending aorta, superior vena cava and upper right pulmonary vein - anterior to right main bronchus
47
Left Pulmonary Artery
- shorter than right - anterior to descending aorta and left main bronchus - posterior to superiorpulmonary vein
48
Pulmonary Veins
- each side contain two pulmonary veins - Superior + Inferior pulmonary vein - Carry oxygenated blood to left atrium
49
Pulmonary Vasculature
- Bronchi + pulmonary arteries pair/branch in unison. | - Pulmonary veins from pul caps, drain toward and course in septa btwn adjacent segments.
50
Bronchial Arteries + Veins
- thoracic aorta -> post surface of bronchus | - Veins drain to pul veins/left atrium + azygos system
51
R/L bronchial artery
- R Bronchial art - from 3rd posterior intercostal artery | - L Bronchial art - from aorta
52
Pulmonary Innervation
- GVA/GVE via anterior and (mainly) post pul plexus - Vagus nerve = parasymp – constrict bronchioles - Symp (T4) chain = symp – dilate bronchioles - pul plexus accompany bronchi + arts in lung.
53
Lymph Drainage
- Lungs drain to tracheobronchial nodes -> bronchomediastinal trunks - Right lung + L inferior lung lymph to inferior tracheo-bronchial (carinal nodes), ascend up right side - L superior of left lung – goes bronchopulmonary (hilar nodes) and goes up left side
54
Lymph nodes
- Pulmonary = lobar bronchi - Bronchopul = hilum of lung (drain from superficial lymphatic plexus) - Inf. Tracheobronchial (Carinal nodes) - Superior tracheobronchial - Tracheal
55
Lung Sounds
- Apex of lung – above clavicle - Superior lobe – 3rd intercostal space on either side - Right side – middle lobe – 5th intercostal space, close to sternum - Inferior lobe – more axillary, 7th intercostal space
56
things you don't want in pleural space
- Pneumo (air) – from penetrative trauma, pneumothorax - Hydro (water) – due to infection - Hemo (blood) – infection, intenral trama
57
Thoracocentesis
- withdraw fluid – syringe on superior border of lower rib, needle at upward angle - aim for middle 7th intercostal space mid axillary (make sure in thoracic cavity, also go as low as possible because of gravity + fluid.