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Anatomy > Thorax > Flashcards

Thorax Flashcards

1
Q

The thorax represents what region?

A

axial region

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2
Q

What is the thorax characterized by?

A

bony, expandable cage (rib cage)

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3
Q

What does the rib cage protect?

A

cardiopulmonary + GI viscera

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4
Q

What does the rib cage permit?

A

respiratory movements

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5
Q

The bony thoracic cage is made up of how many paired ribs?

A

12

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6
Q

The ribs connect the _____ vertebrae posteriorly w the _____ anteriorly.

A

thoracic, sternum

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7
Q

What does the thoracic cavity contain?

A

heart, lungs, esophagus, other associated structures

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8
Q

The contents of the thoracic cavity are organized into 3 main regions, what are they?

A

right pulmonary artery, left pulmonary artery, midline mediastinum

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9
Q

T/F all structures in the thorax are self-contained in the thoracic cavity:

A

FALSE - only some structures are self-contained in the thoracic cavity

(others pass thru the thorax from the neck to the abdomen)

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10
Q

Some structures pass through the thorax from the neck to reach what cavity?

A

to reach the abdominal cavity

(from neck to abd)

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11
Q

Palpation is often used to identify important surface landmarks of the thorax during a physical exam. What are the bony landmarks of the thorax?

A
  • sternoclavocular joint
  • jugular (suprasternal notch)
  • sternal angle
  • xiphoid process
  • costal margin
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12
Q

What bony landmark is used to assess musculoskeletal impairment?

A

sternoclavicular joint

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13
Q

What bony landmark is used to assess aortic pathology?

A

juglar (suprasternal) notch

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14
Q

What bony landmark is a demarcation between superior and inferior mediastinal regions?

A

sternal angle

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15
Q

What bony landmark overlies the T6 dermatome?

A

xiphoid process

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16
Q

What bony landmark is used to assess hepatomegaly (liver enlargement)?

A

costal margin

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17
Q

There are imaginary direction lines that allow for consistent and reliable anatomical description in the thorax. What are they?

A
  • anterior midsternal lines
  • clavicular lines (bilateral)
  • anterior, mid, posterior axillary lines
  • posterior median line
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18
Q

For examination and diagnostic purposes, the breast is divided into four quadrants. What are they?

A
  • superior lateral
  • superior medial
  • inferior lateral
  • inferior medial

(imagine vertical and horizontal lines are drawn through middle of nipple)

vertical = 12-6 o’ clock
horizontal = 9-3 o’ clock

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19
Q

What quadrant of the breast articulates with the axillary process?

A

superior lateral

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20
Q

What type of approach should be taken when palpating the breast to ensure a thorough assessment?

A

systemic approach

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21
Q

Describe how you would palpate the breasts during a physical exam (hint: systemic approach):

A
  • use pads of 2-4 digits
  • keep fingers flat
  • apply pressure to asses levels of depth

systemic approach to palpation

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22
Q

What should you always remember to include when palpating the breast during a physical exam?

A

the axillary process

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23
Q

What are the two common methods used for palpation of the breasts?

A
  1. spiral method
  2. vertical strips
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24
Q

Describe the spiral method used for breast palpation:

A

palpate outwardly from the nipple using concentric circles

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25
Q

Describe the vertical strips method used for breast palpation:

A

palpate medial to lateral in a superior/inferior strip pattern

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26
Q

What type of construction does the thoracic wall have?

A

semi-rigid

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27
Q

What lines the inner surface of the thoracic wall?

A

serous parietal pleural layer

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28
Q

What two layers create two pleural cavities within the thoracic cage?

A
  1. serous parietal pleural layer
  2. visceral layer
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29
Q

The thoracic cage is formed by a combination of what type of structure?

A

bony and cartilaginous

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30
Q

What are the bony and cartilaginous structures that form the thoracic cage?

A
  • sternum
  • 12 pairs of ribs and costal cartilages
  • thoracic vertebrae 1-12 (with associated intervertebral discs)
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31
Q

Name the 3 parts of the sternum from superior to inferior:

A

manubrium, body, xiphoid process

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32
Q

The manubrium articulates laterally with what three things?

A
  • clavicle (sternoclavicular joint)
  • first costal cartilage
  • body (inferiorly)
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33
Q

The manibrium articulates inferiorly with what?

A

the body

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34
Q

What is the palpable landmark between the junction of the manubrium and body?

A

sternal angle (Angle of Louis)

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35
Q

Imagine a line is drawn posteriorly from the sternal angle through the intervertebral disc between T4 and T5. This divides the central thorax into what two mediastinal regions?

A

superior and inferior mediastinal regions

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36
Q

Which lymph node is the first lymph node into which a breast tumor drains?

A

sentinel lymph node

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37
Q

What are 4 general rib features?

A
  • head
  • neck
  • tubercle
  • body
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38
Q

Ribs 1-7 are classified as what?

A

true (direct)

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39
Q

Ribs 8-10 are classified as what?

A

false (indirect)

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40
Q

Ribs 11-12 are classified as what?

A

floating (no articulation)

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41
Q

Floating ribs have no connection to the sternum, as they terminate where?

A

in the abdominal wall musculature

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42
Q

The head of the ribs articulate with the what of the adjacent thoracic vertebra?

A

demifacets on the bodies of the adjacent thoracic vertebrae

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43
Q

The inferior head facet articulates with the vertebrae that corresponds to what?

A

to the rib numerically

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44
Q

T/F the neck of the ribs is present in ribs 11-12:

A

FALSE (the neck of ribs 11-12 is NOT present)

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45
Q

What region connects the neck of the ribs to the head?

A

tubercle region

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46
Q

At the transition between the neck and body of the ribs, the tubercle articulates with the corresponding _____ _____ process:

A

thoracic transverse

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47
Q

What part of the rib serves as an attachment site for ligamentous support?

A

tubercle

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48
Q

What part of the rib is thin, flat, and long?

A

body

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49
Q

The body of the rib is marked by the _____ _____ laterally and an internal _____ _____.

A

costal angle, costal groove

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50
Q

What part of the rib contains an intercostal neurovascular bundle?

A

the costal groove of the body

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51
Q

The distal, anterior end of the rib body articulates with what?

A

costal cartilages

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52
Q

What do the costal cartilages of the rib articulate with?

A

the sternum

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53
Q

1% of the population has an accessory cervical rib. This rib may articulate with what vertebra?

A

C7

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54
Q

An accessory cervical rib in 1% of the population could potentially contribute to what type of syndrome?

A

thoracic outlet syndrome

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55
Q

What is thoracic outlet syndrome?

A

the accessory rib puts pressure on the subclavian artery or lower brachial plexus trunk or both

(1% of the population)

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56
Q

What are the sx of thoracic outlet syndrome?

A
  • numbness
  • tingling in C7-C8 nerve distribution
  • pain
  • temperature changes in upper limb
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57
Q

How many thoracic vertebrae contribute to the posterior boundary of the thoracic cage?

A

12

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58
Q

Thoracic ____ serve as attachment sites for ligamentous, muscular, capsular, and costal structure.

A

processes

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59
Q

What are the two thoracic apertures?

A
  1. superior thoracic aperture
  2. inferior thoracic aperture
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60
Q

What is another name for the superior thoracic aperture?

A

thoracic inlet

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61
Q

Which thoracic aperture is small and kidney-shaped?

A

superior thoracic aperture

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62
Q

Which thoracic aperture is large and irregularly shaped?

A

inferior thoracic aperture

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63
Q

T/F the superior thoracic aperture is bound by the manubrium anteriorly:

A

TRUE

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64
Q

T/F the superior thoracic aperture is bound by the 1st rib pair laterally:

A

TRUE

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65
Q

T/F the superior thoracic aperture is bound by the T1 vertebral body posteriorly:

A

TRUE

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66
Q

The superior thoracic aperture is bound by 3 things, what are they?

A
  1. manubrium (anteriorly)
  2. 1st rib pair (laterally)
  3. T1 vertebral body (posteriorly)
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67
Q

What allows for structural continuity between the neck and thorax?

A

superior thoracic aperture

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68
Q

T/F the inferior thoracic aperture is bound by the xiphoid process anteriorly:

A

TRUE

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69
Q

T/F the inferior thoracic aperture is bound by the costal arch and 12th rib pairs laterally:

A

TRUE

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70
Q

T/F the inferior thoracic aperture is bound by the 12th vertebral body posteriorly:

A

TRUE

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71
Q

The inferior thoracic aperture is bound by what?

A
  1. xiphoid process (anteriorly)
  2. costal arch & 12th rib pairs (laterally)
  3. T12 vertebral body (posteriorly)
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72
Q

What closes off the inferior thoracic aperture?

A

the muscular diaphragm

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73
Q

Openings within the diaphragm allow for communication of structure between what two cavities?

A

thorax and abdomen

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74
Q

Respiration requires that the thoracic cage be able to expand and retract. What does it mean to “expand”?

A

increase volume

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75
Q

Respiration requires that the thoracic cage be able to expand and retract. What does it mean to “retract”?

A

decrease volume

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76
Q

When the thoracic cage expands, is this facilitating inspiration or expiration?

A

inspiration

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77
Q

When the thoracic cage retracts, is this facilitating inspiration or expiration?

A

expiration

78
Q

What two things allow for thoracic cage movement and volume changes?

A
  1. articulations between the vertebra, ribs, costal cartilages, and sternum
  2. contraction and relaxation of diaphragm
79
Q

The movement and volume of the thoracic cage changes in 3 planes. What are they?

A
  1. anterior/posterior plane
  2. lateral plane
  3. superior/inferior plane
80
Q

This plane allows for thoracic cage movement and volume changes and is analogous to a water pump handle.

A

anterior/posterior plane

81
Q

This plane allows for thoracic cage movement and volume changes and is like a bucket hat.

A

lateral plane

82
Q

This plane allows for thoracic cage movement and volume changes and has a dome-shaped appearance.

A

superior/inferior plane

83
Q

Which plane of the thoracic cage involves the upward rational movement of ribs 1-6 and anterior movement of the sternum?

A

anterior/posterior plane

84
Q

Which plane of the thoracic cage involves elevation of the lower ribs, where the lateral portions swing superolaterally?

A

lateral plane

85
Q

Which plane of the thoracic cage involves contraction and relaxation of the muscular diaphragm?

A

superior/inferior plane

86
Q

T/F in the superior/inferior plane of the thoracic cage, contraction of the diaphragm flattens the muscle to increase volume:

A

TRUE

87
Q

T/F in the superior/inferior plane of the thoracic cage, relaxation of the diaphragm resumes its dome-shaped appearance:

A

TRUE

88
Q

The upper ribs are similar to a pump-handle because they increase what?

A

increase anterior/posterior volume

(hint: get pumped UP for anatomy)
(upper ribs = pump-handle)

89
Q

The lower ribs are similar to a bucket-handle because they increase what?

A

increase lateral volume

(hint: buckle DOWN and study hard)
(lower ribs = bucket-handle)

90
Q

What muscles of the thoracic wall assist in respiration and are arranged in 3 layers?

A

intrinsic muscles

91
Q

What are the 3 intrinsic muscles of the thoracic wall that assist in respiration?

A
  1. superficial
  2. intermediate
  3. deep
92
Q

The intrinsic muscles of the thoracic wall receive innervation and blood supply from what? (hint: 3 things)

A
  • intercostal nerves (thoracic anterior rami)
  • arteries
  • veins
93
Q

What is another name for the intercostal nerves?

A

thoracic anterior rami

94
Q

The superficial layer of the thoracic wall contains what muscles?

A

external intercostal muscles

95
Q

The external intercostal muscles of the superficial layer of the thoracic wall span the intercostal space from the _____ to the _______ _______.

A

tubercle to the costochondral junctions

96
Q

The external intercostal muscles run in an inferomedial direction from superior to _____ ribs.

A

inferior

97
Q

The external intercostal muscles are replaced anteriorly by external intercostal membranes along the costal cartilage to the ______.

A

sternum

98
Q

The internal intercostal muscles of the intermediate layer of the thoracic wall span the intercostal space from the _____ and _____ ______.

A

sternum and costal cartilages

99
Q

The deep layer of the thoracic wall is also called what layer?

A

incomplete layer

100
Q

The muscles that span two intercostal spaces in the deep layer of the thoracic wall are called what?

A

subcostal muscles

101
Q

T/F the diaphragm is considered an intrinsic muscle of the thoracic wall:

A

FALSE

the diaphragm is not an intrinsic muscle

102
Q

What is the dome-shaped muscle in the thoracic wall?

A

diaphragm

103
Q

What are the 3 posterior openings in the diaphragm and what vertebral levels do they correlate to?

A

IVC, esophagus, aorta

T8, T10, T12

“I EAT APPLES AT 8, 10, AND 12”

104
Q

What are the accessory respiratory muscles that contribute to the thoracic wall and aid in respiratory function?

A
  1. serratus posterior superior
  2. serrates posterior inferior
  3. levator costrum
105
Q

What muscles play a role in proprioception of the thoracic cage?

A

accessory respiratory muscles

(serratus posterior superior, serratus posterior inferior, levator costrum)

106
Q

The axioappendicular, neck, and abdominal muscles attach to what 3 structures?

A
  1. ribs
  2. sternum
  3. costal cartilages
107
Q

The external intercostal muscles are most active during _____?

A

inspiration
remember: “EX-IN”

108
Q

internal intercostal muscles are most active during _____?

A

expiration
remember “IN-EX”

109
Q

The anterior rami that trail inferior to the 12th rib are called what?

A

subcostal nerves

110
Q

From superior to inferior, what makes up the intercostal neuromuscular bundle?

A

vein, artery, nerves
remember “VAN”

111
Q

The intercostal nerves gives off to what branches?

A

lateral and anterior cutaneous branches

112
Q

The diaphragm receives motor innervation from what nerve?

A

phrenic nerve (C3-C5)

113
Q

Internal thoracic arteries arise from what?

A

thoracic arteries

114
Q

What two intercostal arteries anastomose?

A

posterior and anterior intercostal arteries

115
Q

What do the posterior intercostal vein drain?

A

thoracic wall (via azygos venous system)

116
Q

What do the anterior intercostal veins drain?

A

internal thoracic veins

117
Q

What two things does the female breasts contain?

A

mammary glands and adipose tissue

118
Q

The lobules within the female breast are supported by what?

A

suspensory ligaments (Cooper’s ligaments)

119
Q

What general area can you find the female nipple?

A

6th intercostal space

120
Q

What is a reliable landmark to locate the male nipple?

A

4th intercostal space

121
Q

How many stages are there in the Tanner Stages of Breast Development?

A

5

122
Q

What does the Tanner Stages of Breast Development assess?

A

if a female adolescent is developing normally

123
Q

Describe the Tanner Stages of Breast Development:

A

1 - papillae elevations
2. - palpable buds, areolae enlarge
3. - elevation of contours, areolae enlarge
4. - form secondary areolar mounds
5. - adult breast contour

124
Q

The breast drains glandular tissue first into what?

A

subareolar plexus (deep to nipple)

125
Q

The subareolar plexus is continuous with what?

A

circumareolar plexus

126
Q

The circumareolar plexus communicates with what?

A

the contralateral breast

127
Q

75% of breast lymph drainage travels laterally toward what?

A

axillary lymph nodes

128
Q

25% of breast lymph drainage travels medially via what?

A

parasternal nodes

129
Q

The R/L pleural sac is formed by what?

A

continuous serous membrane

130
Q

What serous membrane lines the inner surface of the thoracic cavity?

A

parietal pleura

131
Q

What serous membrane lines the surface and fissures of the lung?

A

visceral pleura

132
Q

The pleural sac can be described as a “fist in an inflated balloon” what does the fist represent in this analogy?

A

the lung

133
Q

The pleural sac can be described as a “fist in an inflated balloon” what does the outer surface of the balloon represent in this analogy?

A

parietal pleura

134
Q

The pleural sac can be described as a “fist in an inflated balloon” what does the inner surface of the balloon in contact with he fist represent in this analogy?

A

visceral pleura

135
Q

The pleural sac can be described as a “fist in an inflated balloon” what does the air/space in the balloon represent in this analogy?

A

pleural cavity

136
Q

The pleural sac can be described as a “fist in an inflated balloon” what does the wrist represent in this analogy?

A

root of lung (where 2 layers are continuous)

137
Q

The space between the parietal and visceral pleura is called what?

A

pleural cavity

138
Q

What separates the costal parietal pleura from the internal surface of the thoracic cage?

A

endothoracic fascia

139
Q

The costodiaphragmatic recess is a common site for what?

A

fluid accumulation

140
Q

The visceral pleura is supplied by what?

A

bronchial arteries

141
Q

Sensory innervation from parietal pleurae is mediated by:

A

phrenic and intercostal nerves

142
Q

Sensory innervation from visceral pleurae is mediated by:

A

GVA fibers

143
Q

Which pleura is pain sensitive? (hint: parietal or visceral)

A

parietal pleura

144
Q

Which pleura is pain insensitive? (hint: parietal or visceral)

A

visceral pleura

145
Q

Where does lymph from the visceral pleura drain into?

A

superficial lymphatic plexus

146
Q

What are the arteries that supply the thoracic wall, diaphragm, and parietal pleura?

A

intercostal, internal thoracic, and musculophrenic arteries

147
Q

Where the costal parietal pleura and media spinal pleura meet is called what?

A

costomediastinal recess

148
Q

What lymph nodes travel in the lung hilum?

A

bronchopulmonary nodes

149
Q

What lymph nodes drain at the tracheal bifurcation?

A

tracheobronchial nodes

150
Q

What do air-filled, fuild-filled, and solid-filled lungs sound like?

A

resonant, dull, flat sound
(respectively)

151
Q

What are the lobes of the right lung?

A

superior, inferior, middle

152
Q

How many bronchopulmonary segments does the right lung have?

A

10

153
Q

How many fissures does the right lung have and what are they?

A

2 - horizontal & oblique

154
Q

How many lobes does the left lung have and what are they?

A

2 - superior and inferior

155
Q

How many bronchopulmonary segments does the left lung have?

A

8

156
Q

How many fissure(s) does the left lung have. What is it called?

A

1 oblique fissure

157
Q

The left lung has two notches, what are they called?

A

cardiac notch and lingual notch

158
Q

The skeleton of the trachea is composed of what?

A

C-shaped cartilaginous rings

159
Q

The trachea bifurcates into what?

A

R/L primary bronchi

160
Q

What is the ridge of cartilage that serves as an important visual landmark at the tracheal bifurcation?

A

carina

161
Q

The primary bronchi divide into what?

A

multiple secondary (lobar) bronchi

162
Q

Which bronchi supplies each bronchopulmomary segment?

A

tertiary (segmental) bronchi

163
Q

The vagus nerve travels _____ to the bronchi.

A

posterior

164
Q

The R primary bronchus is ____ and ____ than the L primary bronchus

A

wider and shorter

165
Q

The L primary bronchus is ____ and ____ than the R pulmonary bronchus

A

narrow and longer

166
Q

Where do bronchial arteries arise from?

A

thoracic aorta or thoracic intercostal branches

167
Q

Bronchial arteries supply what? (hint: two things)

A

lung parenchyma and root structures

168
Q

Bronchial veins drain structures supplied by:

A

bronchial arteries near root of lung

169
Q

Respiratory structures receive autonomic innervation from what?

A

pulmonary plexus

170
Q

Anterior pulmonary plexus is located anterior to what?

A

tracheal bifurcation

171
Q

The R bronchomediastinal lymph trunk drains into what?

A

R lymphatic duct

172
Q

The L bronchomediastinal lymph trunk drains into what?

A

thoracic duct

173
Q

Lymph from the bronchopulmonary lymph nodes drains to where?

A

superior and inferior tracheobronchial lymph nodes

174
Q

Brachiocephalic veins are formed by junction of what?

A

internal jugular and subclavian veins

175
Q

The R & L brachiocephalic veins join to form SCV, which drains into what?

A

R atrium of heart

176
Q

Where does the trachea bifurcate?

A

sternal angle

177
Q

What does the thoracic duct travel between?

A

esophagus and L vagus nerve (duck between 2 gooses)

178
Q

Preganglionic sympathetic:

A

lateral horn spinal cord thoracic levels

179
Q

Postganglionic sympathetic:

A

thoracic sympathetic ganglia

180
Q

Preganglionic parasympathetic:

A

medulla

181
Q

Postganglionic parasympathetic:

A

in walls of viscera

182
Q

Blood from mother is distributed to the fetus from placenta via:

A

left umbilical vein

183
Q

What controls venous return of the heart?

A

azygos and internal thoracic vein tributaries

184
Q

What are the major branches of the heart?

A

SA nodal
R marginal
AV nodal
Posterior IV

185
Q

The R atrium has a smooth inner surface called what?

A

sinus venarum

186
Q

The R atrium has a rough inner surface called what?

A

pectinate muscle

187
Q

What is the small oval depression within the sinus venarum?

A

fossa ovalis

188
Q

What is the rough muscle of the inner surface of the R ventricle called?

A

tabeculae carne muscle

189
Q

What is the smooth membranous portion of the IV septum?

A

conus arteriosus

190
Q

What is visible from inside the L atrium?

A

valve of foramen ovale

191
Q

What are the inner structures of the left ventricle? (hint: there’s 3)

A
  1. papillary muscles (anterior/posterior)
  2. trabecular carneae
  3. chord tendineae
192
Q

Explain the “try before you buy” analogy:

A

tricuspid valve comes before bicuspid valve in sequence of blood flow through the heart

Anatomy (3 decks)

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