Thorax Flashcards
What is the discount code for Brainscape Pro?
MCPHS91BS
What is the rower’s muscle?
Serratus Anterior
What are the attachments of the Serratus Anterior and what function does it have?
Ribs and scapula. When contracts protracts scapula to reach forward. Rowers muscle.
Where did the embryo come together and fuse?
Linea alba
Linea Alba is where what came together and fused?
Embryo
Which dermatome is at the level of the umbilicus?
T10
Do veins, arteries, or nerves cross the midline?
Nope
Describe the midsternal line
Vertical line down middle of body through midsternum
Describe the midclavicular line (MCL)
Vertical line through body going down through middle of clavicle
Which rib attaches to the sternal angle?
Rib #2
Describe the three parts of the sternum
Manubrium, body, xiphoid process
Describe the subcostal plane
Horizontal line going under the combined cartilages of the bottom of the ribs
Where is the Xiphoid Process? Where is the sternal angle?
XP=Bottom of sternum, under the body. Angle is where the manubrium and body meet.
What goes in and out of the Superior Thoracic Aperture? What is it also called?
Trachea and esophagus go in, subclavian and carotid arteries go out. Some call thoracic outlet as. Aka thoracic inlet. Just go with aperture.
What are the “six pack” muscles?
Rectus abdominus
Describe the Costal Margin
Where lower ribs join costal cartilages to become costal margin
How many True Ribs, how many False Ribs, and how many Floating Ribs?
7 true, 3 false, 2 floating. 12 ribs total.
How many True Ribs and describe them
Have attachment on vertebra and attachment on costal cartilage and then sternum. 7 true ribs.
How many False Ribs and describe them
3 False Ribs. Don’t attach directly to sternum but instead to rib 7.
How many floating ribs and describe them?
Two floating ribs. Come from vertebra but don’t attach anteriorally.
Where is the Costotransverse Joint and describe it. Is it synovial?
Posterior thorax. Articulates with transverse process of vertebra. Synovial joint.
Where is the most curvature of the rib?
Costal angle has most curvature of rib. On back side of body. rest of rib is mostly flat.
Is the costal-sternal articulation of the ribs synovial or not?
Yes it is synovial
What does the head of the rib articulate with? Synovial?
Articulates with vetebral body above and below. Synovial.
What is inbetween the manubrium and body of the sternum?
Sternal angle
What are the three main parts of the sternum?
Manubrium, body, xiphoid process
Where are the jugular and clavicular notches?
Top part of the manubrium
What articulates with the costal notches? Synovial?
Cartilage of ribs
Which rib is the shortest and flattest?
Rib 1
Where are the limb and scapula held onto the trunk?
Sternoclavicular joint
Which part of the rib articulates with the transverse process of the vertebra?
Costal tubercle
Which part of the rib articulates with the vertebra?
Head of the rib
What is the job of the Anterior Scalene muscle and what runs in front of it?
Helps to anchor/hold up upper part of chest. Phrenic nerve runs on front of the anterior scalene.
Describe the phrenic nerve, including roots, function, and location
Phrenic nerve made of roots of C3, C4, and C5. Motor and sensory nerves (ventral primary rami) to diaphram. Runs on front part of Anterior Scalene.
Where are nerves that pick up pain from a pneumothorax?
Phrenic nerve on pleural side of diaphragm, intercostal nerve along chest wall
What do the innermost intercostals and internal intercostal muscles do?
They are used for forced exhalation which pull the ribs together resulting in smaller distance between ribs (pull rib down when contract)
What is the movement of the External Intercostals? Job?
When contract rib below gets pulled up and out. Inspiratory muscle
Shape of Transverse Thoracis and job?
Like star along ribs. Pulls ribs together. Exhalation. Very small muscle.
Subcostal muscles and ribs? Function? Attached to?
Some jump/skip ribs, others don’t. When contract pull up on rib below. Attached to some floating ribs.
Diaphragm is made out of what kind of muscle?
Skeletal
When diaphragm contracts what happens to pressure in thorax and abdominal cavities?
When contracts increases abdominal pressure but decreases thoracic pressure. During inhalation.
What is the “middle part” of the diaphragm called? Does it ever contract or expand?
Central tendon. Doesn’t ever contract or expand.
Where is Caval Aperture?
In diaphragm’s central tendon.
What goes through the Caval Aperture?
Opening for Inferior Vena Cava
Where is Esophageal Aperture?
On diaphragm’s muscular part
What goes through the Esophageal Aperture? Job?
Esophagus. Muscular part allows for sphincter action to prevent reflux from stomach.
Where is Aortic Apeture?
Behind/posterior diaphragm
What goes through Aortic Apeture?
Aorta
What does the Aorta sneak behind? Where?
Sneaks behind diaphragm very close to T12.
What is the innervation to the diaphgram?
Phrenic nerve. C3, C4, C5.
Internal thoracic artery AKA?
Internal Mammary Artery
Internal Thoracic Artery runs later to what?
Lateral to the sternum
Internal Thoracic Artery anastomoses with the Posterior Intercostal Artery via what?
Anterior Intercostal Artery. Provides collateral blood supply.
The Posterior Intercostal Artery comes off the aorta at every…?
At every segment
The Posterior Intercostal Artery hooks up with what other artery?
Anterior Intercostal arteries
Veinous blood in the thoracic wall goes into the SVC via which vein?
Azygous vein (except for anterior intercostals which go into internal thoracic veins)
Veinous blood in the Anterior Intercostal Arteries go to SVC via which vein?
Internal Thoracic Veins
The Interior Vena Cava travels through which part of the diaphragm?
Through Central Tendon of Diaphrahm
The Posterior Intercostal Veins drain into..?
Azygous vein, then SVC
Anterior Intercostal Veins drain into…?
Internal Thoracic Veins
Are there valves in the veins of the thorax?
No valves. Blood travels wherever pressure is lowest.
Which arteries supplies the diaphragm?
Musculophrenic Artery, Pericardicophrenic Artery
Where is the Parietal Pleura and what does it cover?
Outtermost pleura in thorax. On ribs and diaphragm.
What does the Parietal Pleura separate?
Separates the pleural cavity from the mediastinum
Which nerves innervate the Parietal Pleura?
Intercostal nerves and the phrenic nerve
What happens to the rib cage diameter during inspiration?
Diameter increases
What happens to the rib cage diameter during exhalation?
Diameter decreases
What does pleura secrete? What does this prevent?
Secrete fluid between lung and wall which prevents air space.
If the Parietal Pleura moves does the lung also move? Why?
Yes, because of the fluid the pleura secretes
Visceral Pleura is on what organ?
Lung
What goes through the Costal Groove?
Intercostal vein, artery, and nerve. Under the rib.
Where are the intercostal vein, arteries, and nerves?
Below the ribs. Safe to go above rib.
What happens at the Aortic Arch?
Aorta turns to go to body’s left side
How many lobes does right lung have? Names?
3 lobes. Superior Lobe, Middle Lobe, Inferior Lobe.
Which fissure separates the Superior and Middle Lobes of the right lung?
Horizontal fissure
Which lobe is exclusive to the right lung?
Middle lobe. Left lung has no middle lobe.
Which fissure separates Middle Lobe and Inferior Lobe or right lung?
Oblique fissure
What is the hilum?
Part of lung where the tubes are. Bronchi, pulmonary veins, pulmonary artery.
Does the left lung have a horizontal fissure?
NO. No middle lobe!!
What is most superior part of left hilum?
Branches of left pulmonary artery
What is the Tracheal Bifurcation?
Where the right main bronchus and left main bronchus separate from trachea
What is the shape difference between the Right Main Bronchus and Left Main Bronchus?
Right is more vertical, wider, and shorter. Easy for things to be inhaled in right. Left is more horizontal and more narrow than right.
Where is the largest percentage of pneumonia located?
Right lower lobe of lung
Pulmonary trunk goes to the
Pulmonary arteries then the lungs with deoxygenated blood
The hearts foramen ovale becomes the…?
Fossa ovalis, after born
The hearts ductus arteriousis becomes the…?
Ligamentum arteriousum
A patent ductus arteriousum connects what two things?
Aorta to pulmonary artery
Visceral pleura is found on
Organ
Parietal pleura is found on
Over visceral pleura
Space between visceral and parietal pleura is called
Potential space or cavity space
Two layers of pericardium of the heart?
Fibrous pericardium , Serosa pericardium
The visceral pericardium is also known as the
Epicardium
Auricles point to the…?
Pulmonary trunk
Which valves open and closed in ventricular systole?
Open=Semilunar valves; Closed=AV Valves
Which valves open and closed in ventricular diastole?
Open=AV Valves; Closed=Semilunar Valves
What is the job of the cardiac skeleton?
Mechanical stability, attachment point for the cardiac muscles and valve cusps, and electrical insulation
Which are the semilunar valves?
Aortic and Pulmonary valves
Which are the AV valves?
Bicuspid and Tricuspid valves
Where do you ascultate the aortic and pulmonary valves?
Aortic=right 2nd intercostal space; Pulmonary=left 2nd intercostal space
Where to ascultate the right and left AV valves?
Left=left 5th intercostal space at midclavicular line; Right=left 5th intercostal space at sternal margin
What are the three sources of blood to the heart?
SVC, IVC, coronary sinus
Coronary sinus drains into the…?
RIGHT ATRIUM
What great vessel behind Pulmonary Trunk?
Aorta
What is the most anterior valve?
Pulmonary trunk
First two vessels off aorta are
Right and Left Coronary Arteries
Which two veins form the Superior Vena Cava?
Right Brachiocephalic vein, Left Brachiocephalic vein
The pulmonary trunk gives off what two arteries?
Right and Left Pulmonary Arteries, bring deoxygenated blood to lungs
Why don’t we want blood to go to the lungs in an embryo?
Their lungs can’t handle the pressure
Vagus nerve goes behind or in front of root of lung?
Behind. Phrenic goes in front.
Recurrent laryngeal nerve comes off which cranial nerve?
Vagus nerve
The right recurrent nerve wraps about which artery?
Subclavian artery
What comes off the aorta in pairs?
Posterior Intercostal Arteries
Do the Posterior Intercostal Arteries come off the aorta in segments?
Yes
Phrenic nerve is from dorsal or ventral primary rami?
Ventral primary rami. All named nerves come from ventral primary rami.
Entire sympathetic trunk starts and ends at?
Lateral gray horn from T1 to L2
Lateral grey horn from T1 to T4 is sympathetic innervation for?
Heart/chest/lungs
Sympathetic innervation for the heart/lungs/chest is from where to where?
Lateral grey horn from T1 to T4
What are the three arteries coming off the aortic arch?
Left Subclavian, Left Common Carotid, Brachiocephalic Trunk
When take breath in diaphragm moves
DOWN
Left Vagus nerve goes anterior or posterior to esophagus?
Anterior
Right vagus nerve goes anterior or posterior to esophagus?
Posterior
Intercostal nerves are continuations of dorsal or ventral primary rami?
Ventral Primary Rami
Intercostal nerves are a continuation of ventral primary rami and supply which muscles?
Muscles in the chest wall.
The entire sympathetic trunk is made up of which spinal nerves?
T1 to L2
What is happening at the three esophogeal constrictor spots?
Other structures are pushing against the esophagus causing spots where food slows down. Cricoid cartilage, end of trachea, diaphragm.
What is an esophageal diverticulum?
Outcroppings in the esophagus. Locations of constriction and weakness in the esophagus muscle. Also place here most severe burns from ingested chemicals can happen.
What is the Esophageal Plexus?
A bundle of nerves that innervates the esophagus. Made of sympathetic and parasympathetic fibers.
Is the Esophageal Plexus made of both sympathetic and parasympathetic fibers?
Yes. Made of sympathetic and parasympathetic fibers.
The Left Vagus Nerve loops up and become the…?
Left Recurrent Laryngeal Nerve
When the Left Vagus Nerve loops up and becomes the Left Laryngeal Recurrent Nerve what does it loop around?
Around arch of aorta then back up
The Left Recurrent Laryngeal Nerve comes from which nerve?
Left Vagus Nerve
The Right Vagus Nerve loops up and becomes what?
The Right Recurrent Laryngeal Nerve
When the Right Vagus Nerve loops up what does it go around?
Loops around subclavian artery and behind root of hilum of lung and into esophageal plexus
The Right Vagus Nerve travels on which side of the esophagus?
Mostly behind/posterior esophagus
The Left Vagus Nerve travels on which side of the esophagus?
Runs on anterior surface of esophagus
Esophageal arteries come off of what main artery?
Aorta
The upper airways receive oxygenated blood from which arteries?
Left and Right Main Bronchus arteries. Not involved in gas exchange, just supply the muscles.
The Azygous vein is made of these veins and empties in this place
Made of posterior intercostal veins. Goes to superior vena cava.
What is the Lingula?
End of the superior lobe of the left lung. Lays over the heart and “licks the heart”.
The Recurrent Laryngeal Nerve provides motor innervation to what?
Larynx
Is the esophagus normally open or closed?
Always closed unless swallowing something. Nothing holds it open.
Is the trachea always open or closed?
Always open due to c-shaped cartillagenous rings.
The pulmonary trunk gives rise to what?
The pulmonary arteries. One going to each lung carrying deoxygenated blood.
Where do you “Cross Clamp” the aorta?
Transverse Pericardial Sinus. Where to clamp to stop blood flow out of heart. Transplant. behind pulm trunk and aorta.
Where are the three places deoxygenated blood returns to the heart?
Superior Vena Cava, Inferior Vena Cava, Coronary Sinus. All go into the right atrium.
What are the three main branches of the aorta?
Left Subclavian Artery, Left Common Carotid Artery, Brachiocephalic Trunk
What are the two layers of the Serous Pericardium?
Parietal Layer, Visceral Layer
What was the Ligamentum Arteriousum called during embryologic development?
Ductus arteosum
What does the Ligamentum Arteriosum do?
Attaches the aorta to the pulmonary artery
What is the job of the Pectinate Muscles? Where are they?
In auricle. Contraction.
What was the Fossa Ovalis? What did it allow?
Was a foramen that allowed flow between the atrium.
Where are the Cordae Tendineae and what do they do and prevent?
Attach cusps valves to papillary muscles. Attach papillary muscles to cusps. Prevents cusps from flapping too far out. Regurgitation happens when myocardium contracts but papillary muscles don’t keep valves closed and blood flows from ventricle to atrium.
Walls of the atrium are ___ compared to the walls of the ventricles?
Atrium is thin compared with the thick walls of the ventricles
Describe heart contraction
When heart contracts does so from apex to base in a spiral like motion.
What lines the ventricles?
Trabecular carneae. trabeculae= meart, carneae= beams meaty beam. line ventricles of heart preventing ventricles from putting suction on blood
Cardiac Skeleton made of what kind of tissue?
Connective tissue
Cardiac Skeleton causes the atrium and ventricles to contact in which directions?
Atria contract downward toward skeleton, ventricules contraction up toward cardiac skeleton. Atria contract down, ventricular contract up. Controlled by nerves.
What contracts during systole?
Ventricles
Which valves are open during systole?
Semilunar valves (pulmonary trunk, aorta)
Which valves open and closed during diastole?
AV Vales open, SLVs closed.
When do coronary arteries get their blood flow?
Diastole when coronary arteries get their blood flow!
Blood to the IVC, SVC, and coronary sinus flows during systole or diastole?
Diastole
What are the two main coronary arteries called? What do they supply?
Left Coronary Artery, Right Coronary Artery. Supply the heart itself (myocardium).
What are the two branches off the Left Coronary Artery?
Circumflex Artery, Left Anterior Descending
The Left Anterior Descending coronary artery runs along what groove and with that vein?
Anterior Interventricular Groove, along with Great Cardiac Vein
What groove does the Great Cardiac Vein run along? Where does it go to?
Anterior Interventricular Groove. From apex of heart, greatest distance to travel, joins coronary sinus, ends in RA.
The Right Coronary Artery branches into what and runs along what groove?
The Posterior Descending Artery, runs along Posterior Interventricular Groove/Septum along with Posterior Descending Vein
What is “Right Dominance”? How does it differ from “Left Dominance”?
Means the right coronary artery supplies the Posterior Descending Artery. Left Dominance is when the Left Circumflex Artery supplies the Posterior Descending Artery. Majority is Right Dominance.
Which coronary supplies a majority of blood to the left ventricle?
Left Anterior Descending coronary artery
Between Right Dominance and Left Dominance which is the majority?
Right Dominance is majority. This is when the right coronary artery supplies the Posterior Descending Artery of the heart.
What is the blood flow from the Vena Cava to Aorta?
VC->RA->TCV->RV->SLV->PT->PA->Lungs->PV->LA->BCV->LV->SLV->Aorta
In fetus what brings deoxygenated blood to the placenta?
Two umbilical arteries bring deoxygenated blood to placenta
In fetus where does the umbilical vein lead to?
Vena Cava
In fetus a patent foramen ovale allows blood to flow from right atrium into what other chamber ?
Left atrium then left ventricle
In a fetus a patent ductus artereosus allows blood to flow from where to where?
Patent ductus arterosus and shunts from pulmonary artery into aorta
What are the two types of pleura?
Parietal Pleura and Visceral Pleura
Where is Visceral Pleura found?
On an organ itself.
Where is Parietal Pleura found?
Parietal Pleura covers the boundaries of a cavity, such as the mediastinum has a mediastinal pleura.
What does pleura secrete and what is the function?
All pleura secretes serous fluid which prevents friction of organs as the organ moves within a cavity.
Are pleura continuous? What does this mean?
Means that a pleura can be both visceral in one location and in another parietal.
What does “reflection” mean with regards to pleura?
Means the pleura changed direction, usually going from visceral to parietal (or vice versa)
What is in the Hilum of the Lung?
Pulmonary Artery, Pulmonary Veins, Pulmonary Artery
Where does the bulk of gas exchange occur?
Alveoli of the lungs
What does Surfactant do?
Reduces surface tension fo water to make water thinner allowing easier exchange of gas in aveolus
What are the very first two arteries off the aorta?
Right and left coronary arteries
Is the sternocostral joint synovial?
Yes
Is the costocondral joint synovial?
No
What is the vein, artery, and nerve for the internal and external intercostal muscles?
Vein= Intercostal Vein; Artery=Intercostal Artery; Nerve=Intercostal Nerve
What is the function of the external intercostals?
Inhalation by increasing volume of thoracic cavity. Bends ribs to make thoracic cavity more open. When contract rib below gets pulled up and out.
What is the function of the internal intercostal muscles?
Exhalation by decreasing thoracic volume by bending ribs more closed. When contract pull rib below up and in during exhalation
What is the function of the innermost intercostal muscles?
Expiration by decreasing the thoracic cavity
The anterior intercostal arteries branch off of which artery?
Internal Thoracic Artery
The posterior intercostal arteries branch off of which two arteries?
Subclavian Artery for ribs 1 & 2; thoracic aorta for the rest
The Anterior Intercostal Veins drain into which vein?
Internal Thoracic Vein
How many Azygous Veins are there?
Just one. Runs vertically on right side of body to the SVC.
The Posterior Intercostal Veins drain into which vein?
Azugous vein, which goes into SVC
Which veins drain around the umbilicus?
Periumbillical veins
What are the nerves and artery for the diaphragm?
Nerves=C3, C4, C5 which makes the “phrenic nerve”; Artery=Musculophrenic artery and Pericardiophranic artery
What are the two layers of the Serous Pericardium?
Visceral Pericardium (aka Epicardium), Parietal Pericardium (fused to fibrous pericardium)
What does the Fibrous Pericardium do?
Anchors heart to surrounding chest wall. Also makes serous fluid to prevent friction.
Do the lungs ever completely fill their cavities?
No, their is always a little bit of room left unfilled
What are the two ways for sympathetic innervation to get to the thorax from T1-T4?
1) direct to the organ on splanchnic nerve, 2) follow the sympathetic trunk to Superior Cervical Ganglia then come off as a bundle of sympathetic nerves called “Cervical Splanchnic Nerves” then to heart or lungs (aka cervical cardiac nerves or cervical thoracic nerves) then come down the cervical splanchnic nerves along carotid artery down, or behind pharynx and in front of vertebra and make a plexus (like the esophageal plexus) until get to heart or lungs.
What is in Anterior Mediastinum?
Thymus and fat
What is in the Posterior Mediastinum?
Esophagus, azygous vein, hemiazygous vein
How many pulmonary arteries and pulmonary veins are there?
Two pulm arteries, four pulm veins
The Portal Vein brings blood into what organ and system?
Liver, portal system
What two arteries come off the brachiocephalic trunk? Which side is it on?
Right Common Carotid Artery, Right Subclavian Artery
Papillary Muscles attach what to what?
Attach myocardium to Cordae Tendineae
The Cordae Tendineae attach what to what?
Papillary Muscles to AV valve cusps
The bicuspid valve has how many cusps and what are their names?
Two cusps, Anterior Cusp and Posterior Cusp
Blood goes in from coronary sinus, IVC, SVC during which heart phase?
Diastole
Auscultating the pulmonary and aortic valves happen in which two places?
Aortic=2nd intercostal space on right; Pulmonary= 2nd intercostal space on left
Auscultate for right and left AV valves in which two locations?
5th intercostal space next to sternum for right, couple of fingers out left of sternum out for left
The Bundle of Hiss divides into what two things?
Divides into right and left bundle branches
The Posterior Descending Artery and Vein travel along what?
Interventricular Septum
Left recurrent laryngeal goes behind
Left recurrent laryngeal goes behind the ligamentum arteriosum (not the aorta)
Left vagus goes over the front of the
Left vagus goes over the front of the aortic arch
Which vagus nerve innervates anterior portion of esophagus
L/R vague nerve go over the aorta and under the lungs
Which vagus nerve innervates posterior portion of esophagus
Right vagus innervates posterior portion of esophagus
Which are the muscles of the posterior mediastinum?
Innermost intercostal muscles OR the subcostals muscles (if they are skipping ribs)
What is the sympathetic and parasympathetic innervation of the heart?
Sympathetic=T1-T4; Parasympathetic=vagus
What is the sympathetic and parasympathetic innervation of the esophagus?
Sympathetic=T2-T6; Parasympathetic=vagus
Where does the thoracic duct drain into?
Thoracic duct drains into the junction of the L subclavian vein and L internal jugular vein (DO NOT SAY BRACHIOCEPHALIC JUNCTION)
What is the function of the lympahatic ducts?
Carry lymph.
Where does lymph come from?
Interstitial cells/fluid
What drains into the Right Lymphatic Duct?
Right half of the head/neck, right chest, right upper limb. Goes to where Subclavian Vein and Jugular Vein join (aka origin of Right Brachiocephalic Vein).
How much of the body’s lymph drains into the Right Lymphatic Duct?
1/4th. Rest goes into Thoracic Duct.
Where goes Right Lymphatic Duct drain into?
Subclavian Vein and Jugular Vein join (aka origin of Right Brachiocephalic Vein).
What parts drain into the Thoracic Duct?
Everything below diaphragm, left side of chest, left neck, left head
Where does the Thoracic Duct drain into?
Drains into Left Brachiocephalic Vein
Where does the Right Lymphatic Duct drain into and where does the Thoracic Duct draiin into?
Right Duct=Origin of right brachiocephalic vein where subclavian and jugular join; Thoracic duct=Left Brachiocephalic Vein
What is the Cisterna Chyli?
Origin of the Thoracic Duct. Big collection of lymph from below diaphragm.
Where does the Cisterna Chyli flow into?
Thoracic Duct
Which are the Sympathetic NS nerves?
T1-L2. Aka “thoracolumbar”
Which are the Parasympathetic NS nerves?
CN 3, 7, 9, 10; Sacram nerves 2-4. “aka Cranial Sacral”
Parasympathetic cranial nerves only goes to what tissues?
Only goes to smooth muscles and glands
The Greater Splanchnic nerve is made up of which spinal nerves?
T5-T8
Where does the synapse for 1st and 2nd order sympathetic nerves occur?
Sympathetic ganglia, next to spinal column “para-aortic”
Where does the synapse for 1st and 2nd order parasympathetic nerves occur?
1st order parasympathetic can be very lengthy and synapse on the effector organ at the end order neuron
Where is the Coronary Sulcus and what two things run in the Coronary Sulus?
Posterior heart. Right Coronary Artery and Small Cardiac Vein
What does the Coronary Sulcus separate?
Atrium and Ventricle.
What two things run in the Anterior Interventricular Sulcus?
LAD and Great Cardiac Vein
I 8 10 Eggs At 12
IVC=T8, Esophagus =T10, Aorta=T12
What is the first site of gas exchange in the lungs?
Respiratory bronchiole
Respiratory bronchiole is the first site of what?
Gas exchange, but not much.
