Thorax Flashcards
What part of the sternum ossifies with age?
Xyphoid process
_____ attach to the sternum through individual costal cartilages
Ribs 1-7
_____ attach to the costal cartilages of rib 7
Ribs 8-10
_____ do not attach to the sternum but are tipped by cartilage
Ribs 11 and 12
What is the purpose of the subclavius muscle?
Stabilizes clavicle
______ connects the ribs to vertebral facets/demifacets
Radiate ligament of head of the rib
______ connect from neck of rib to transverse process at same level and one level above
costotransverse ligaments
During expansion of the thorax during inspiration:
The 1st and 2nd ribs _____
elevate
During expansion of the thorax during inspiration:
The 3rd-10th ribs _____
Open laterally in a bucket handle motion
During expansion of the thorax during inspiration:
The 11th and 12th ribs _____
Swing laterally in a pincers motion
During expansion of the thorax during inspiration:
The ribs movements ???
push the sternum anteriorly
What is the function of the serratus posterior inferior?
proprioception
_____ muscle protracts the scapula and attaches to the lateral aspect of the ribs.
Serratus anterior
What artery supplies the serratus anterior?
Lateral thoracic artery
The serratus anterior is innervated by the ____
Long thoracic nerve
________ muscles have an inferomedial direction (hands in pocket).
External intercostal
The ______extend from vertebrae, around thorax, and become the ______ membrane before reaching the sternum.
External intercostal muscles
External intercostal membrane
______ muscles run in a superomedial direction, extending from the sternum, around the thorax, and become the ______ before reaching vertebrae
Internal intercostal muscle
Internal intercostal membrane
______ muscles run parallel to the internal intercostal and are only present in the lateral region between the ribs.
Innermost intercostal
On the inside of the thorax, the _______ muscles extend from the sternum towards the ribs and costal cartilages.
transversus thoracis
The _____ forms the floor of the thoracic cavity
diaphragm
The diaphragm attaches ???
bilaterally from the xyphoid process around the costal arch to the twelfth thoracic and upper lumbar vertebrae.
What three things travel through the diaphragm to reach the abdomen?
Inferior vena cava, aorta and esophagus
When the diaphragm contracts what happens?
It flattens
The diaphragm, external intercostals, internal intercostals (parasternal portion) and scalene muscles are involved with ??
Inspiration
Internal intercostals (lateral portion), innermost intercostals, abdominal obliques, rectus abdominis and transversus thoracis are involved with ??
Expiration
Relaxed expiration is largely a result of ___ of the soft tissues
Recoil
When a patient has COPD or emphysema ______, ______ and _____ will fix the scapula so that other muscles can then work on the ribcage
Trapezius, levator scapulae and rhomboids
During inspiration/expiration ______ works to elevate the 1st and 2nd rib
Scalenes (**anterior, middle and posterior)
What muscles work to elevate the anterior ribcage if the scapula is fixed?
Pectoralis major and minor
_____ elevates the lateral ribcage if scapula is fixed
Serratus anterior
The blood supply of the thoracic wall is largely via the ______, which run within each intercostal space.
intercostal arteries
Where do the intercostal arteries originate from?
Internal thoracic artery and aorta
The skin and muscles of the thoracic wall are innervated via _____
intercostal nerves
The intercostal nerves are extension of _____ from each spinal level T1-T12
anterior rami
Both intercostal nerves and arteries have ______ branches and _____ branches.
lateral cutaneous
anterior cutaneous
Anterior intercostal arteries come from ??
Internal thoracic artery
Posterior intercostal arteries comes from ??
Aorta
the _____ and ____ form an anastomoses in the ribcage
Anterior and posterior intercostal arteries
Anteriorly the intercostal veins drain into ____
Internal thoracic veins
Posteriorly the intercostal veins drain into ____
azygos system
The _____ on the right side of the vertebral bodies receives the ___ intercostal veins and _____ ascending lumbar vein. It drains to the _______.
azygos vein
Right
Right
Superior Vena Cava
On the left are _____ that receives blood from LOWER ____ intercostal veins and ____ ascending lumbar vein.
hemiazygos vein
Left
Left
_____ which receives UPPER left intercostal veins and connects to the left brachiocephalic vein
accessory hemiazygos vein
What three things are protected by the costal groove of the superior rib?
Intercostal Vein, Artery and Nerve
VAN in that order
_____ arteries and _____ nerves run in the plane between the internal intercostal and innermost intercostal muscles.
Posterior intercostal
intercostal
Each nerve and artery also gives off a very small branch that runs ______ within the intercostal space.
Inferiorly
If you are trying to do a nerve block in the intercostal space, where would you put the needle?
Aim for the UPPER part of the intercostal space
If you are trying to take a sample of the fluid, where do you put the needle?
aim for the middle of the intercostal space
Inside of the thorax is subdivided into two ____ and the midline _______
pleural cavities
mediastinum
The superior mediastinum contains what 10 things:
- Superior vena cava
- Brachiocephalic vein
- Arch of aorta
- Vagus
- Phrenic
- Left recurrent laryngeal
- Thoracic duct
- Trachea
- Esophagus
- Thymus
What level does the superior and inferior mediastinum split between?
T4-5
The inferior anterior mediastinum contains what 3 things?
- Thymus
- Lymph nodes
- Fat and connective tissue
The middle anterior mediastinum contains what 4 things?
- Pericardium and heart
- Roots of great vessels
- Arch of azygos vein
- Primary bronchi
The posterior anterior mediastinum contains what 7 things?
- Esophagus
- Aorta
- Azygos and hemiazygos veins
- Thoracic duct
- Vagus nerve
- Sympathetic trunk
- Splanchnic nerve
The ______ is an important immune organ where T lymphocytes mature and become active.
thymus gland
Where does T lymphocytes mature and become active?
Thymus gland
What gland is quite large in children but is small and atrophies in adults?
Thymus gland
The breast is a modified sweat gland with multiple ____ that can produce milk, which drains through _____, to _______ that then empty at the ____. Fat fills spaces between lobules
lobules
lactiferous ducts
lactiferous sinuses
nipple
There is a ______ between the breast and pectoralis major muscle.
retromammary space
Between lobules are ______ that extend from the thoracic wall and attach to the skin of the breast.
suspensory ligaments (of Cooper)
A fixed breast to the body wall with “orange peel” skin is a sign of ?
breast cancer
What is the primary blood supply to the breasts? What else contributes?
Internal thoracic and lateral thoracic
lateral cutaneous branches of the intercostal artery and vein
The majority (3/4) of lymphatic flow travels in what direction? Towards what lymph nodes? but first pass through _____ before reaching ______.
Laterally
Axillary lymph nodes
interpectoral nodes- between pectoralis major and minor
Pectoral axillary nodes
Medial breast lymph drains where? What 2 other places can they go?
parasternal nodes
mediastinum or cross into the opposite breast
The right border is composed of ?
Superior vena cava
Right atrium
Inferior vena cava
The Inferior border of the heart is composed of ?
Right ventricle
The superior border of the heart is composed of ?
Left atrium
Right atrium
The left border of the heart is composed of ?
left ventricle
Left auricle
What is the reminisce when the right and left atrium were connected?
Fossa ovalis
Where is the SA node located?
Crista terminalis
______: The outer lining of the heart
Epicardium
_______: The actual heart muscle
myocardium
_____: The inner lining of the heart
Endocardium
The ______ has a serous lining that releases lubricating fluid
epicardium
In the epicardium deep to the serous layer there is a layer of ______. What does it contain?
Loose connective tissue and adipose tissue
contains coronary blood vessels and nerves
What is a difference between heart and skeletal muscle?
The cardiac muscle branches and connects to other cardiac muscles
______ are the “spot welds” that connect it to its neighbors
intercalated discs
Where are the nucleus located in myocardium?
located centrally
______ layer prevents clots from happening
endothelium layer of endocardium
_____ layer or endocardium that is dense irregular CT
Subendothelial Connective Tissue
_____ layer of endocardium, connective tissue layer next to myocardium that contains small vessels and nerves to the myocardium.
Subendocardium
Reminder to look at this slide
Look at this slide
The fibrous skeleton of the heart is a layer of insulating _____ that electrically isolates ____ from _____
connective tissue
atria from ventricles
What is contracting during systole?
Ventricles
What is contracting during diastole?
Atria
Atroventricular valves are _____ during systole
Closed
Semilunar valves are _____ during diastole
closed
When listening to the valves, where do you position your stethoscope for the aortic semilunar?
right 2nd intercostal space next to the sternum
When listening to the valves, where do you position your stethoscope for the pulmonary semilunar?
left 2nd intercostal space next to sternum
When listening to the valves, where do you position your stethoscope for the tricuspid?
left 5th intercostal space next to sternum
When listening to the valves, where do you position your stethoscope for the bicuspid?
left 5th intercostal space in midaxillary line
