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Clinical Anatomy > Thorax > Flashcards

Thorax Flashcards

0
Q

bony landmarks of the posterior thorax

A

spinous processes of thoracic vertebrae 1-12

costovertebral angle CVA

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1
Q

bony landmarks of the anterior thorax

A 
jugular notch
sternal angle
2nd rib
ICS intercostal space
costal margin
costal angle
interspaces 2-6
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2
Q

Identify the vertical lines of thorax (anterior, lateral, posterior) and describe location

A 
anterior: 
anterior median (midsternal) line- thru sternum in midsagittal place
midclavicular line (MCL)- thru midpoint of clavicle

lateral:
anterior axillary line-along anterior axillary fold formed by pec major
mid axillary line- thru apex of armpit
posterior axillar line - thru posterior axillary fold formed by latissimus dorsi and teres major

posterior:
posterior median (midspinal.midvertebral) line-thru spinous process in midsagital plane
scapular lines- thru inferior angles of scapula

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3
Q

Landmarks of auscultation posterior and anterior

A

posterior: auscultation alley (either side of posterior median)
anterior:
1. R 2nd ICS (aortic valve)
2. L 2nd ICS (Pulmonary valve)
3. Erb’s point (L 3rd ICS)
4. Left sternal border/4/5th ICS (Tricuspid valve)
5. Midclavicular apex Left 5th ICS (mitral valve)

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4
Q

bones of thoracic wall

A

ribs, thoracic vertebrae, sternum

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5
Q

function of thoracic wall

A

protect thoracic content: heart lungs BVs esophagus etc

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6
Q

Main structures of sternum:

A

manubrium
sternum
xiphoid

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7
Q

sub divisions of the ribs

A

true (1-7) attach directly to sternum
false(8-10) attach indirectly to sternum
floating(11-12) do not attach to sternum

typical ribs = 3-9
atypical ribs = 1,2,10,11,12

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8
Q

land marks on a typical rib

A 
rib 3-9: head with two facets
neck
tubercle 
shaft
costal angle
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9
Q

what makes the atypical ribs different?

A

1 and 2 have scalenes attached

10 11 12 articulate with the spine differently

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10
Q

common site for rib fracture

A

shaft

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11
Q

the head articulates with.. the tubercle articulates with..

A

two vertebrae: costal facets inferior and superior on vertebral bodies (except bottom 4 vertebrae)

transverse costal facets on the transverse process of spine (except 11 and 12 vertebral bodies)

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12
Q

landmarks of thoracic vertebrae

A

spinous process
transverse process (articulate by synovial joint to form rib)
costal facets (T1-8 have superior and inferior, T 9 -12 have only 1)
transverse costal facets (not found on T 11 or T 12)

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13
Q

describe the two apertures of the thorax

A

superior: esophagus, trachea, nerves and BVS that supply head neck and UE
inferior: allows esophagus, IVC, and aorta to pass inferior to abdominal cavity

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14
Q

Name and describe the joints of the posterior thorax

A

costovertebral (rib and vertebrae body)
costotransverse (rib and transverse process)
intervertebral joints of thoracic spine (disc and facets)

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15
Q

name and describe the joints of the anterior thorax

A

costochondral (rib and chondral cartilage)
sternocostal (costal cartilage and sternum)
sternoclavicular (sternum and clavicle) -only true synovial joint for UE

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16
Q

name and describe joints of anterior thorax

A 
interchondral (articulation btwn costal cartilages of lower ribs (9to10 and 8 to 9)
manubriosternal / sternal angle (manubrium to sternum)
xiphosternal joint (xiphoid to sternum)
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17
Q

normal movement of inspiration:

A

up, out, and diaphragm down ward

increase AP and lateral diameter d/t “buckethandle” motion of ribs
increase superior and inferior length

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18
Q

muscles of inspiration at rest, exercise, intense exercise

A

rest = diaphragm
exercise = diaphragm and external intercostals
extreme exercise = diaphragm, external intercostals, scm, scalenes, pecs

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19
Q

muscles of expiration at rest and exercise

A 
rest = none. - elastic recoil of lungs
exercise = internal intercostals and abdominal muscles rectus abdominis, int/ext obliques
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20
Q

abnormal movement patterns of ventilation

A
  1. accessory pattern - shrug in COPD

2. asymmetry - pneumothorax or scoliosis (trauma to one lung)

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21
Q

list muscles of the thoracic wall

A

external intercostals
internal intercostals
innermost intercostals

transversus thoracis
subcostal muscles
levator costarum
serratus posterior superior
serratus posterior inferior
diaphragm - central tendon and sternal region, costal region, lumbar region
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22
Q

describe actions of thoracic wall muscles

A

external intercostals-inspiration
internal intercostals-expiration
innermost intercostals-elevate (BV and nerves run btwn this and internal)

transversus thoracis - expiration(internal anterior thoracic cage)
subcostal muscles-inspiration (internal posterior thoracic cage)
levator costarum-inspiration (external posterior of thoracic cage attach to ribs and TP)
serratus posterior superior-inspiration
serratus posterior inferior-expiration
diaphragm - central tendon and sternal region, costal region, lumbar region -phrenic nerve C3-5 motor and sensory- INSPIRATION!! flattens diaphragm and pulls air into lungs

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23
Q

pathway of intercostal nerves

A

all 12 spinal nerves exit spinal intravertebral foramen (IVF) and branch into poterior and anterior rami
(anterior supplies the intercostal spaces with VAN = vein artery and nerve bundle)

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24
Q

what supplies the ICS ?

A

VAN of anterior rami thoracic spinal nerve

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25
Q

describe herpes zoster/shingles

A

dormant virus in single segmental nerve is activated
painful red vesicular lesions in dermatome pattern
common in thoracic region but will be seen in other regions too including face head and LE

26
Q

Describe the artery system of thorax wall starting with 3 major sources of circulation

A
  1. thoracic aorta-
    a. posterior intercostal artery -3-11 ICS-POSTERIOR and 10+11 ALL
    b. subcostal artery-12th rib ALL (from inferior)
  2. axillary artery
  3. subclavian artery
    a. costocervicle trunk-> superior thoracic artery -ICS 1+2
    b. internal thoracic artery->anterior intercostal artery -1-9 ICS-ANTERIOR
27
Q

Describe venous drainage of thorax

A

intercostal spaces->intercostal veins-> anterior or posterior:

if anterior: ->internal thoracic vein->SVC (?)
if posterior: azygos system -> SVC
L: T1-4 skip azygos system and go to brachiocephalic L trunk vein ->SVC
L: T5-12 ->hemi or accessory hemi azygos-> Azygos vein->SVC
R:right side intercostals and hemi/accessory->azygos vein-> SVC

28
Q

function of breast

A

reproductive role in female

29
Q

landmarks of male breast and female breast

A

male = nipple
near 4th intercostal space
the apex of the heart is just inferior/medial to it

female= circular base (sternum to mid axillary line ribs 2-6)
axillary tail (extends along inferior border of pec towards axilla)
quadrants (for clinical documentation of cysts or tumors)
-clock-3 6 9 12 upper outer upper inner lower outer lower inner
-right and left have the same “clock” 3 on R (middle inner) is 9 on L (middle inner)

30
Q

lymphatic drainage of breast

A

75% of lymph node (usually lateral) drain to axillary lymph nodes then on to the brachiocephalic system
the rest drains medially via the parasternal lymphnodes

important clinically for exam (palpate axillary region) and post surgical lymphedema

31
Q

ID and describe the tracheobronchial tree

A

trachea begins inferior to larynx (cricoid cartilage)
D shaped cross section (incomplete C shaped rings of cartilage with membranous flat back - trachealis muscle

carina-bifurcates into r/l bronchi at sternal angle
r/l primary bronchi-lobar bronchi (3 R 2 L) - segmental bronchi (10 segments)-intersegmental bronchi (20-25 more)-bronchioles (Cartilage begins to disappear) -terminal bronchiole-respiratory bronchioles (gas exchange)- acinus: (one terminal bronchiole supplies whole acinus-many respiratory bronchioles-many alveolar ducts/sacs-alveoli)

32
Q

ID and describe the 3 pulmonary pleurae

A
  1. visceral pleura- invests lungs
  2. parietal pleura- lines thoracic wall and diaphragm
  3. pleural cavity - space btwn two layers lubricated by serous pleural fluid
33
Q

ID and describe the pleural recesses

A
  1. costodiaphragmatic recess- large, located in posterolateral region (back of lung)
  2. costomediastinal recess- small, located anterolateral region (front lateral of lung behind sternum)
34
Q

what is thoracentesis?

A

removal of fluid in pleural cavity using hypodermic needle inserted thru intercostal space (its hard to breath because fluid is in the way)

35
Q

ID and describe regions of the lungs

A

apex- superior
base- inferior sits on diaphragm
hilum/root- site where the lung becomes covered by visceral pleura!!
-contains: primary bronchus, pul veins, pul artery, bronchial vessels, pul nerves, lymph vessels

36
Q

ID describe RIGHT lung

A

superior middle inferior lobes
horizontal fissure and oblique fissure
superior (3) middle (2) inferior (5) segments

37
Q

ID and describe the LEFT lung

A 
superior and inferior lobe
oblique fissure
Lingula where middle lobe would be
cardiac notch in superior lobe
5 segments per lobe
38
Q

ID and describe layers of heart wall

A

endocardium- inner layer of THIN smooth lining heart chamber
myocardium - cardiac muscle middle layer
epicardium - outer later blends into the visceral layer of serous pericardium

39
Q

ID and describe pericardium

A

double wall fibroserous sac*

Outside sce=fibrous pericardium

  • attaches to diaphragm via pericardiacophrenic ligamet
  • attaches to sternum bia sternopericardial ligament

Inside sac=serous pericardium

  • parietal layer is the outer layer that blends with fibrous pericardium
  • visceral layer is the inner layer that blends with the epicardium

pericardial cavity is between the parietal serous and visceral serous pericardiums –has smooth serous fluid to allow heart to move freely within the pericardial sac

40
Q

land marks of the R atrium

A 
SVC
IVC
opening coronary sinus
fossa ovalis
tricuspid valve
41
Q

landmarks of L atrium

A

foamen ovale
4 openings of pul veins
bicuspid valve

42
Q

lndmarks of R ventricle

A

tricuspid valve
papillary muscle/chordae tendineae
pulmonary valve

43
Q

landmarks of L ventricle

A

bicuspid valve
papillary muscle/chordae tendineae
aortic valve

44
Q

ID and describe the fibrous skeleton

A

four fibrous raised rings around the surface of the orifices of the valves

  1. provides attachmnt for myocardium of atria and ventricles
  2. provides attachment for cardiac valves
  3. electrical insulation btwn atria and ventricles

pulmonary semilunar
aortic semilunar
L coronary artery bicuspid-tricuspid R coronary artery

45
Q

ID and describe the tricuspid valve

A

R atria/ R ventricle
chordae tendineae and papillary muscles anchor cusps of the valves
auscultat along left sternal border 5th ICS

46
Q

ID and describe Bicuspid valve

A

L atria/Lventricle
chrodae tenindeae and papillary muscles anchor cusps of the valve
auscultate along APEX (left 5th ICS)

47
Q

ID and describe the pulmonary valve

A

R ventricle and Pulmonary trunk

auscultate along left 2nd ICS

48
Q

ID and describe the aortic valve

A

L ventricle and Aorta

auscultate along right 2nd ICS

49
Q

4 great vessels of the heart

A 
SVC (returns blood to right atrium from areas above diaphragm except the heart and lungs)
IVC (returns blood to the right atrium from areas below the diaphragm)
Pulmonary trunk (sends unoxygenated blood from R ventricle to lungs)
Pulmonary Veins R/L (returns oxygenated blood back to the left atrium from the lungs)
Aorta (sends blood to body from L ventricle)
50
Q

what is the origin and associated pressure gradient of the coronary arteries?

A

R/L coronary arteries originate in BASE OF THE AORTA
-aortic pressure causes back flow from early diastole/isovolumetric relaxation- blood goes into R/L coronary arteries not back into heart

51
Q

Pathway of R and L coronary branches

A

R:

  1. nodal branches (supply SA/AV nodes)
  2. marginal branch (supplies R ventricle)
  3. posterior interventricular artery/right posterior descending (supplies R ventricle back)

L:

  1. anterior interventricular arterty/left anterior descending(major site of occlusion supplies septum and left ventricle)
  2. circumflex artery (supplies left atrium and left ventricle)
  3. marginal branch (supplies L ventricle)
52
Q

pathways of coronary veins

A

most cardiac veins (great, middle small, oblique) drain into coronary sinus -> R atrium

anterior cardiac and smallest cardiac veins -> R atrium (not the coronary sinus)

53
Q

describe conducting pathway of heart

A

SA node (sinoatrial)-> AV node (atrioventricular -1/10 sec delay for atrial contraction)-> AV bundle of His->L/R bundle branches-> purkinje fibers

54
Q

describe the surfaces of the heart

A
  1. sternocostal/anterior surface
    (mostly right ventricle)
  2. diaphragmatic / inferior surface
    (mostly L ventricle and some of R ventricle)
  3. Pulmonary / left surface on the lung side
    (mostly L ventricle)
  4. APEX - tip -5th ICS at MCL (PMI point of maximal impact- “apical impulse”
  5. base- back of the heart mainly the L atrium nad some of the right
55
Q

describe mediastium

A

region btwn r/l pleurae in thoracic cavity
3 ? regions: 1. superior, 2. middle (anterior middle posterior)
described in relation to the pericardium

56
Q

content of the superior mediastinum

A 
superior to the perocardium
thymus
arch of aorta
great vessels
trachea
esophagus
57
Q

content of anterior mediastinum

A

anterior to pericardium
internal thoracic vessels
fat
few lymphnodes

58
Q

content of middle mediastinum

A

within in the pericardium
pericardium
heart
roots of great vessels

59
Q

content of posterior mediastinum

A

posterior to pericardium
esophagus (descending thoracic aorta)
thoracic duct
lymphnodes

60
Q

positions of the CXR

A

PA, lateral, lateral decubitus

TAKEN DURING INSPIRATION**

61
Q

difference in heart shadow btwn pa and ap views

A

heart shadow is distorted/widened

62
Q

landmarks of PA CXR

A 
aortic arch
l ventricle
apex of heart
l diaphragm
right diaphragm
right atrium
ascending aorta
trachea shadow
right bronchi
r/l hilum
hilar points
costophrenic recess/angle/costodiaphragmatic recess
63
Q

lateral CXR landmarks

A 
sternal angle
heart shadow
anterior mediastnum
m mediastinum
p mediastinum
costophrenic recess r vs l diaphragm
r is higher from liver under it!

Clinical Anatomy (7 decks)

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