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Gross Anatomy_JM > Thorax > Flashcards

Thorax Flashcards

1
Q

What is the anatomical landmark for:

  1. Suprasternal notch
  2. Sternal angle
  3. Xiphisternal joint
  4. Subcostal line
  5. Umbilicus
A
  1. Suprasternal notch - T3 vertebral body
  2. Sternal angle - T4/T5 IV disc
  3. Xiphisternal joint - T9/T10 IV disc
  4. Subcostal line - L4 vertebrae (inferior aspect of rib 12)
  5. Umbilicus - L4 (iliac crest)
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2
Q

What are the boundaries of the the superior thoracic aperture?

A

Superior border of manubrium and 1st rib, around to the body of T1 (underneath the clavicle

Thoracic Outlet Syndrome - compression of subclavian artery and inferior trunk of BP (C8, T1)

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3
Q

Boundaries of the inferior thoracic aperture?

A

xiphesternal joint, laterally to the costal cartilages of ribs 7 - 10, down to the body of T12

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4
Q

Explain the differences between the 3 intercostal muscles

What are they innervated by?

A
  • External ICs
    • Fibers run superolaterally to inferomedially (mcluggage’s italian suit pockets)
    • Respiration muscles
  • Internal ICs
    • Extend from sternum to angles of ribs
      • Fibers run superomedially to inferolaterally (perpendicular to External)
    • Respiration muscles
  • Innermost ICs
    • Fibers run in similar direction to internal ICs
    • VANs run in btw internal and innermost

All innervated by ventral rami

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5
Q

Where would you place a needle for a thoracocentesis?

How about an IC nerve block?

What is the orientation of the neurovasculure bundle relative to the ribs

A
  • Thoracocentesis
    • Needle would enter in the mid-axillary line in btw 9th and 10th rib (9th IC space)
    • As close to the middle as possible to avoid Nerves
  • IC Nerve block
    • do so closer to the nerve bundle (NOT in the middle of the IC space)
  • VAN (on inferior of rib)
  • NAV (collateral branch on superior of rib)
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6
Q

What are the layers of tissue you would penetrate for a thoracocentesis?

A
  1. Skin
  2. Superficial Fascia
  3. Fat
  4. Superior Muscle layer (serratus anterior)
  5. External IC
  6. Internal IC
  7. Innermost Intercostals
  8. Parietal Pleura
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7
Q

How many articulations does the typical rib have? Name the typical ribs.

A
  • Ribs 3 - 9
  • Have 3 total articulations
    • 2 + 1 = 3
    • 2 demifacets on the head articulate with numerically corresponding vertebral body and with vertebral body immediately superior (5th rib articulates with T4 and T5)
    • 1 articulation of rib tubercle with transverse process of numerically corresponding rib
      *
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8
Q

What are the atypical ribs? Name a property of each one

A
  • 1st rib
    • 1 facet with T1 ONLY
    • Contain scalene tubercle
    • Groove for SCV and SCA on superior rib surface
  • 2nd rib
    • 2 facets for T1 and T2
    • Articulates with manubriosternal jxn
  • 10th - 12th ribs
    • 1 facet for articulation with numerically corresponding vertebra
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9
Q

Differentiate between the bucket handle and pump-handle mechanisms

A

Bucket handle effect increases the transverse diameter of the rib ( increase in left to right axis dimension)

Pump Handle - increase in the anterior to posterior distance by elevation of the upper limbs

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10
Q

List the level of pleura reflections (3 for each parietal and visceral)

A
  • Parietal
    • 8th rib - midclavicular line
    • 10th - mid axillary line
    • 12th - paravertebral line
  • Visceral
    • 6th - midclavicular
    • 8th - midaxillary
    • 10th - paravertebral
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11
Q

What are the different innervations of the parietal pleura (4 unique structures)

A
  1. Costal Pleura, Cervical, and Lateral Diaphragm, - IC nerves
  2. Mediastinal and Medial Diaphragmatic - Phrenic (C3 - C5)
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12
Q

Which pulmonary mainstem bronchus do foreign objects tend to lodge?

A

Right pulmonary bronchus

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13
Q

Which lobe has lymphatic drainage route with the possibility of crossing the midline?

A

The inferior left loe crosses the midline and drains on the right side

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14
Q

Important landmarks on the right lung

A
  • SUlcus for SVC, Azygos vein, and SCV
  • Eparterial bronchus - supplies superior lobe of right lung and arises above level of the pulmonary artery
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15
Q

Name the contents of the hilum of the left lung, superior to inferior.

A
  1. Pulmonary Artery
  2. Primary bronchus
  3. PUlmonary Vein
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16
Q

What are the anatomical landmarks for the horizontal and oblique fissures

A
  • Horizontal fissure (right lung only) - 4th costal cartilage
  • Oblique fissures of both lungs - 6th costal cartilage
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17
Q

What is the transverse thoracic plane?

A

Line from sternal angle (angle of louie) directly posterior to T4/T5 IV disc

18
Q

Name the hierarchy of pulmonary divisions

A
  1. Trachea (1)
  2. primary bronchi (2) - right catches foreign objects)
  3. Lobar bronchi (secondary)
  4. Segmental bronchi (tertiary)
19
Q

Describe the innervation of the lungs

A
  • PNS
    • Vagus N.
    • Bronchoconstriction
    • Vasodilation
    • Increase glandular secretion
  • SNS
    • Bronchodilation
    • Vasoconstriction
    • Decrease glandular secretions
20
Q

What is the difference between the superficial lymphatic plexus and the deep lymphatic plexus?

What anomaly exists in lymphatic drainage that is clinically relevant?

A

The superficial lymphatic plexus drains lung parenchyma and visceral pleura into bronchopulmonary LN

Deep lymphatic plexus drains the submucosa of bronchi and adjacent CT

Bronchopulmonary nodes to tracheobronchial LN to bronchomediastinal Lymphatic trunks

Lower left lobe crosses midline and drains through right lymphatic ducts

21
Q

Anterior Mediastinum contents

A

Located anterior to pericardial cavity

Mostly fat and lymphatic tissue

Lymphatic vessels and nodes

Transverse Thoracis Muscle

22
Q

Middle mediastinum contents

A

InsidePericardial Cavity ITSELF

  1. Heart
  2. Great Vessels
    1. Ascending Aorta
    2. Pulmonary Vessels
23
Q

Posterior Mediastinum contents

A

Location: posterior to pericardial cavity

Thoracic (descending) aorta

Trachea and bronchi

Esophagus

Esophageal plexus

Thoracic duct

Posterior mediastinal lymph nodes

Azygos and hemiazygos veins

Vagus nerves

Thoracic sympathetic trunks

Thoracic splanchnic nerves

Lymph nodes

24
Q

Superior Mediastinum Border and contents

A

Border: T1 to transverse thoracic plane

  1. Thymus
  2. Brachiocephalic veins
  3. SVC
  4. Aortic Arch
25
Q

Mediastinum

A

Sup and Inf MS divided by transverse thoracic plane (T4/T5 IV disc to angle of louie)

Inferior MS goes from Transverse Thoracic plane to diaphragm

26
Q

What is costoclavicular syndrome? How do the symptoms differ from cervical rib syndrome?

A

Compression of subclavian artery located btw anterior and middle scalene muscles

Cervical rib syndrome can compress BOTH subclavian artery and the inferior trunk of the BP (C8 and T1). Costoclavicular syndrome compresses more JUST the SCA

27
Q

What are the landmarks of the chest wall to outline the heart?

A
  1. 3rd RCC to 2nd LCC
  2. 6th RCC to 5th LIS
28
Q

What are the 3 branches off of the aortic trunk?

A
  1. Right Brachiocephalic A.
    1. Branches into Right Subclavian and Right Common Carotid
  2. Left Common Carotid A.
  3. Left Subclavian A.
29
Q

What is the position of the Phrenic and Vagus N, relative to each other?

A

Phrenic - lateral and and anterior to hilum of the lung

Vagus - medial and posterior to hilum of lung

30
Q

Describe the pericardial layers and its blood supply

A

Blood supply to pericardium: Pericardiophrenic arteries and veins

Fibrous pericardium - outer, tough layer that keeps heart confined while beating

  • Serous Pericardium = serous + parietal
    • Serous - glued to heart wall
    • Parietal - glued to fibrous
  • Pericardial space is space btw serous and parietal
31
Q

Describe the 2 important cardiac sinuses and their origin

A
  • Transverse Pericardial Sinus
    • area between outflow (aorta and PSLV) and inflow tracts (PV and SVC)
    • Can put finger in btw
  • Oblique Pericardial Sinus
    • space in posterior pericardium formed by reflection of serous pericardium at the inferior of pulmonary veins
32
Q

What are the 5 important features of the Right Atrium?

A
  1. Pectinate m.
  2. sinus venarum
  3. crista terminalis - separation btw pectinate and smooth sinus venarum (internal aspect of RA)
  4. fossa ovalis
  5. sulcus terminalis - marks separation of pectinate from smooth sinus venarum (externally)
33
Q

What is heart dominancy determined by?

A

which CA gives off the posterior IV branch

34
Q

The majority of the time, what are the branches of the RCA?

A
  1. SA nodal branch
    1. 60%
  2. Right Marginal branch
  3. Atrioventricula nodal branch
    1. 80%
  4. posterior IV branch (67% of the time)
35
Q

What are the branches off the LCA?

A
  1. Anterior IV branch (LAD)
  2. Anterior branch (diagonal)
    1. btw LAD and circumflex (in some patients)
  3. Circumflex branch
  4. Left marginal branch

**gives off SA nodal branch 40% of the time

36
Q

What artery does the great cardiac vein travel with and where does it drain?

A

Travels along the anterior IV groove with LAD, then along the coronary sulcus until it drains into the coronary sinus, draining into the right atrium

37
Q

Describe the basic order of events for an electrical impulse in the cardiac cycle?

A
  1. SA node creates impulse
  2. Atrial muscles contract
  3. Impulse travels to AV node
  4. AV bundle of His
  5. R and L branchcees go down the IV septum
  6. Impulse terminates at subendocardial branches (Purkinje fibers)
  7. Ventricles Contract
38
Q

What 3 types of nerve fibers does the cardiac plexus contain?

A
  1. Post G SNS
    1. Fibers from the upper thoracic spinal cord segments (T1 - T5/T6)
  2. Pre G PNS
    1. Vagus
  3. GVAs
    1. Return of GVA fibers from heart to T1 - T5/T6 dorsal horns (thus resulting in referred pain to those dermatomes)
39
Q

Describe the 2 different pathways for SNS and PNS innervation of the heart

A
  • SNS
    • Originate from T1 - T5/T6 IMLLCC (preG cell body)
    • Travel along sympathetic chain to synapse with PostG cell bodies in cervical and T1 - T5/T6 paravertebral ganglia
    • PostG fibers travel along cardiac plexus to heart
  • PNS
    • PreG cell bodies in Dorsal Motor Nucleus of Vagus (CN X)
    • Vagus travels and PostG cell bodies are actually located in the heart
40
Q

What is the effect of the SNS on the heart? WHat about the PNS? (3 physiological responses)

A
  1. SNS
    1. Increase HR
    2. CA vasodilation
    3. Increase heart’s contractile force
  2. PNS
    1. Decerase HR
    2. CA vasoconstriction
    3. Decrease heart’s contractile force
41
Q
A

Gross Anatomy_JM (10 decks)

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