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SPOM > Thorax > Flashcards

Thorax Flashcards

1
Q

Clinical significance of superficial fascia of abdomen and thorax?

A
  • continuity of fascia
  • superficial veins anastomose with larger vessels
  • if blockage of vena cava, veins will hypertrophy and serve as alternate path back to heart
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2
Q

Thorax functions?

A
  1. Protection of important cardiac and respiratory structures
  2. Respiration framework offers stabilization during inhalation and exhalation
  3. Attachment and support for muscles of upper limbs, neck, abdomen
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3
Q

3 major spaces of thorax?

A
  1. Central compartment (mediastinum)
    - thoracic organs except lungs
  2. Right and left pulmonary cavities
    - lungs
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4
Q

Specific features of thoracic vertebrae?

A
  • long spinous processes
  • facets on body for head of ribs
  • facets on transverse processes for tubercle of rib
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5
Q

Which thoracic vertebrae are closely related to the Aorta?

A

T5-T8

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6
Q

Lower rib fracture clinical significance?

A
  • could puncture liver or spleen

- huge cardiac output going here

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7
Q

Location of bone marrow biopsies?

A
  • Ilium used most often

- Sternum can also be used, but risk of puncturing heart

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8
Q

Manubrium?

A
  • widest
  • thickest
  • Jugular notch: level of T3 posterior
  • clavicular notches
  • Sternal angle: level of T4 posterior (junction of 2nd rib)
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9
Q

Body of sternum? clinical significance?

A
  • joined to manubrium by Fibrocartilage
  • transverse lines
  • bone marrow found here
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10
Q

Xiphoid process? clinical significance?

A
  • smallest
  • variable in size and shape
  • hyaline cartilage surrounding bone, ossified
  • Epigastric mass from xiphoid
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11
Q

True ribs?

A
  • 1st 7 ribs
  • articulate with sternum through their own costal cartilage
  • vertebrosternal
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12
Q

False ribs?

A
  • ribs 8, 9, 10
  • articulate to sternum via costal cartilage #7
  • vertebrochondral
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13
Q

Floating ribs?

A
  • ribs 11 and 12
  • do not articulate with sternum
  • muscles of posterior abdomen attach here
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14
Q

Supernumerary ribs?

A
  • common
  • more common in cervical than lumbar
  • extra ribs
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15
Q

Typical ribs?

A
  • Ribs 3-9

- head, neck, and shaft

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16
Q

Angle of rib? Clinical significance?

A
  • where ribs extends anterolaterally at same level of spinous process
  • shaft turns medially and down
  • most common fracture is anterior to angle
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17
Q

Costal groove? clinical significance?

A
  • inferior groove of rib
  • protects intercostal artery, vein, and nerve
  • Pleural effusion: fluid accumulation in chest (CHF, pneumonia, cancer), compresses lungs
  • require pleurocentesis (stick needle to remove fluid), needle must be stuck superior to rib to not puncture neurovascular bundle
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18
Q

First rib? Clinical significance?

A
  • highest, broadest, strongest, flattest, most curved, shortest
  • closely associated with brachial plexus, Axillary artery and vein (subclavian vessels pass over 1st rib)
  • Anterior scalene muscles attach to scalene tubercle
  • Phrenic nerve lies on anterior surface of scalene
  • axillary artery/vein is anterior
  • brachial plexus is posterior
  • closely related to apex of lung, if broken may cause pneumothorax
  • tumor on lung could grow and disrupt neurovascular structures
  • Horner’s syndrome: tumor grows posterior into sympathetic trunk to affect autonomic NS
19
Q

Importance of 2nd rib?

A
  • twice as long as first

- tuberosity for Serratus Anterior muscle

20
Q

Costal cartilages? Clinical significance?

A
  • bars of hyaline cartilage
  • progressively ossify
  • costal margin: costal cartilage of ribs 8, 9, 10
  • Clinical: ossification and osteoporosis with age, ribs fracture easier, hurts to cough, greater risk of pneumonia, can be fatal
  • Clinical: joints are synovial, can become fibrous over time becoming irritated or inflamed (costochondritis), pain can be mistaken for heart issue
21
Q

External intercostal muscles attachments?

A
  • lower margin of 1st 11 ribs
  • from tubercles of ribs behind to cartilages of ribs in front
  • give way to external intercostal membrane
22
Q

External intercostal muscles function?

A

elevate ribs and muscle of inspiration

23
Q

Anterior vs posterior arteries and veins in intercostal grooves?

A
  • anterior: from internal thoracic vessels

- posterior: from Aorta

24
Q

Levator Costarum attachments?

A
  • transverse process of 7th cervical to 11th thoracic vertebrae
  • insert into lower adjacent rib between tubercle and angel
25
Q

Levator costarum function and innervation?

A
  • function: elevate ribs for inspiration

- innervation: dorsal rami

26
Q

Internal intercostal attachments?

A
  • lower margin of rib and costal cartilage
  • fibers pass down and back to upper margin of lower ribs and cartilage
  • from medial ends of intercostal spaces to angle of ribs
  • give way to intercostal membrane
27
Q

Internal intercostal function?

A

expiration

28
Q

Innermost intercostals?

A
  • part of internal intercostals separated by intercostal vessels and nerves
  • not well developed
  • subcostal: variable in number, arise form ribs near angles and insert 2-3 ribs below
  • sternocostalis: sternum to costal cartilage
29
Q

Transversus thoracis?

A
  • attaches on posterior side of sternum and goes up and lateral to ribs
  • innervated by anterior rami
  • function in expiration
30
Q

Diaphragm attachments?

A
  • most important muscle of respiration (increases volume of thorax)
  • no bony attachments
  • inserts on central tendon (attaches to pericardium)
  • divided into halves and has three parts (sternal, costal, lumbar)
31
Q

Sternal part of diaphragm?

A
  • fibers arise from back of diploid and descend to central tendon
  • sternocostal triangle: transmits the superior epigastric vessels (branch of internal thoracic artery)
32
Q

Costal part of diaphragm?

A

arise from inner surfaces of lower 6 costal cartilages and lower 4 ribs

33
Q

Lumbar part of diaphragm?

A
  • arise from two fibrous arches and bodies of L1 and L2
  • medial and lateral arcuate ligament
  • part of diaphragm arises from lumbar vertebrae
  • forms two muscular crura that ascend to central tendon
  • forms aortic opening
34
Q

Medial arcuate ligament location?

A

over Psoas major muscle

35
Q

Lateral arcuate ligament location?

A

over Quadratus lumborum

36
Q

Action of diaphragm?

A
  • central tendon descends when it contracts, increase volume of thorax and air rushes in
  • facilitates return of blood to heart through vena cava
  • each half separates nerve supply
  • hiccups are spasmodic contraction of diaphragm
  • no one can voluntarily hold breath to point of asphyxiation
37
Q

Innervation and blood supply of diaphragm?

A
  • Phrenic nerve (C3, 4, 5)
  • supplies from underneath blood vessels
  • rich sensory response (peritoneum, pericardium, pleura)
  • each half has separate nerve supply
38
Q

Shoulder pain related to diaphragm?

A
  • shoulder pain over trapezius
  • epigastric pain, xray shows free air under diaphragm
  • perforated abdominal organ, ruptured posterior gastric ulcer
  • continuous with inferior aspect of diaphragm
  • referred pain to neck
39
Q

Internal thoracic artery and branches?

A
  • first branch of Subclavian Artery
  • passes down through thorax behind costal cartilages
  • ends at 6th intercostal space by dividing into terminal branches:
  • Superior Epigastric (pierces diaphragm)
  • Musculophrenic
40
Q

Sternocostal triangle?

A

space for passage of Superior epigastric vessels (branch of internal thoracic artery)

41
Q

Thoracic nerves?

A
  • meningeal branches
  • dorsal rami
  • ventral rami
  • first, second, third intercostal nerves supply the arm and thorax
42
Q

Joints of thorax?

A
  • Costovertebral
  • Costotransverse (synovial- motion)
  • Costochondral (hyaline-no motion)
  • Sternocostal (starts as synovial but fibrous over time, 2-7)
43
Q

Movements of thoracic cage?

A
  • movements change volume of rib cage, creates vacuum for air to rush in
  • inhalation (ribs rise and move laterally)
  • intercostal muscles especially external

SPOM (17 decks)

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