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MSc Anatomy > Thorax > Flashcards

Thorax Flashcards

1. Discriminate the key landmarks of the thorax, including the borders of the pleura and heart 2. Describe in detail the anatomical regions of the ribs and vertebrae 3. Understand how the ribs and vertebrae articulate during breathing 4. Identify and describe the muscles of the anterior chest wall and associated nerve and blood supply 5. Compare and contrast the structure of the right and left lung 6. Discriminate the structures at the hilum of the lung and appreciate how their location relates

1
Q

What lies in the same plane as the sternal angle?

A
  1. 2nd Rib
  2. T4
  3. Carina at the bifurcation of the trachea
  4. Ligamentum arteriosum
  5. Division between superior and inferior mediastinum
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2
Q

How is the parietal pleura subdivided?

A

Based on region of the thorax it is in contact with:

  1. Cervical - projects superiorly above the clavicle by about 3cm and extends in to the neck
  2. Mediastinal - covers the lateral aspect of the mediastinum and runs down the sternum to the level of the 4th costal cartilage
  3. Costal pleura
  4. Diaphragmatic pleura
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3
Q

What are the costodiaphragmatic and costomediastinal recesses?

A

In quiet respiration the lungs do not completely fill the thoracic area available. The lower border of the lung is about 5cm above the lower border of the pleura - this is the costodiaphragmatic recess which lies between the 8th and 10th rib in the mid-axillary line.
Free spaces around the mediastinum designed for lungs to expand in to during forced inspiration - costomediastinal recess

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4
Q

At what level does the inferior vena cava pass through the diaphragm?

A

T8 - through the central tendon to enter the right side of the mediastinum

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5
Q

At what level does the oesophagus pass through the diaphragm?

A

T10 - just left of the midline through the muscular part of the diaphragm

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6
Q

At what level does the aorta enter the abdomen?

A

T12 - passes posteriorly to the diaphragm in the midline

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7
Q

Describe the blood supply to the anteromedial breast

A

Branches from the internal thoracic artery perforate the anterior chest wall - branches associated with 2nd to 4th intercostal spaces

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8
Q

Describe the lymphatic drainage of the breast

A

Medial part of the breast lymph drainage accompanies the perforating arteries and drain in to the parasternal nodes on the deep surface of the thoracic wall
Lateral breast lymph is drained in to the axillary region of the upper limb
Approximately 75% drains into axillary nodes

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9
Q

What is the cutaneous innervation of the breast?

A

Lateral and anterior branches of the 2nd to 6th intercostal nerves carry general sensation from the skin of the breasts

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10
Q

What is the main nerve root contribution to the phrenic nerve?

A

C4

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11
Q

What is the origin of pectoralis major?

A

Medial half of the clavicle, sternum and related costal cartilages (first 7), aponeurosis of external oblique

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12
Q

What is the insertion of pectoralis major?

A

Lateral lip of the intertubercular groove of the humerus

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13
Q

What is the action of pectoralis major?

A

Adducts, flexes and medially rotates the arm

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14
Q

What is the origin of subclavius?

A

Rib 1 at the junction between rib and costal cartilage

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15
Q

What is the insertion of subclavius?

A

Groove on the inferior surface of the middle third of the clavicle

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16
Q

What is the innervation of subclavius?

A

Nerve to subclavius - which originates from the upper trunk of the brachial plexus (C5, C6)

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17
Q

What is the action of subclavius?

A

Pulls clavicle medially to stabilise the sternoclavicular joint

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18
Q

What is the innervation of pectoralis major?

A

Medial and lateral pectoral nerves which are branches of medial and lateral cords of the brachial plexus respectively

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19
Q

What is the origin of pectoralis minor?

A

Ribs 3-5 and deep fascia overlying the related intercostal spaces

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20
Q

What is the insertion of pectoralis minor?

A

Coracoid process

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21
Q

What is the innervation of pectoralis minor?

A

Medial pectoral nerve

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22
Q

What is the action of pectoralis minor?

A

Depresses tip of the shoulder and protracts the scapular

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23
Q

What are the true and false ribs?

A

True - Ribs 1-7

False - Ribs 8-12

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24
Q

What are the typical and atypical ribs?

A

Typical - Ribs 3-9

Atypical - Ribs 1, 2, 10, 11 and 12

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25
Q

What makes Rib 1 an atypical rib?

A
  • Flat in the horizontal plane
  • One articular surface on the head for articulation with T1
  • Scalene tubercle
  • Posterior groove for subclavian artery
  • Anterior groove for subclavian vein
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26
Q

What makes Rib 2 an atypical rib?

A
  • Like Rib 1, flat but twice as long
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27
Q

What makes Rib 10 an atypical rib?

A

The head has a single facet for articulation with its own vertebra

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28
Q

How many facets/demifacets does the entire sternum have?

A

6 facets for articulation with clavicle and Ribs 1, 3, 4, 5, 6
4 Demifacets for articulation with Rib 2 and Rib 7

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29
Q

Describe a typical costovertebral joint?

A

Two facets on the head of the rib articulate with the superior facet on the body of its own vertebra and with the inferior facet on the body of the vertebra above

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30
Q

Where is it unsafe to insert a chest drain in to an intercostal space?

A

Inferior border of a rib since the costal groove is at the inferior border of a rib. Vein, Artery, Nerve from superior to inferior.

31
Q

What is the function of the external intercostal muscles?

A

Most active during inspiration, supports the intercostal space and moves ribs superiorly

32
Q

What is the function of the internal intercostal muscles?

A

Most active during expiration, supports intercostal space and moves ribs inferiorly

33
Q

Where is the endothoracic fascia located?

A

Between innermost intercostal muscles/ribs and parietal pleura

34
Q

In which layer do the intercostal vessels and nerves run?

A

Between internal intercostal muscles and innermost intercostal muscles

35
Q

What lies between the deltoid muscle and the pectoralis major muscle?

A

Deltopectoral groove

36
Q

What structure runs in the deltopectoral groove?

A

Cephalic vein

37
Q

What are the attachments of transversus thoracis?

A

Internal surfaces of costal cartilages of ribs 2-6 and inferior aspect of deep surface of sternum, xiphoid process and costal cartilages of ribs 3-6

38
Q

Where do the first two posterior intercostal arteries arise from?

A

First two arise from the supreme intercostal artery which descends in to the thorax as a branch of the costocervical trunk (a posterior branch of the subclavian artery)

39
Q

Where do the inferior 9 pairs of posterior intercostal arteries arise from?

A

Posterior surface of the thoracic aorta

40
Q

What does the internal thoracic artery branch in to?

A

Musculophrenic artery and Superior epigastric artery

41
Q

At what level does the internal thoracic artery branch?

A

Approximately the level of the 6th intercostal space

42
Q

Where do anterior intercostal arteries arise from?

A

Internal thoracic artery or musclophrenic artery (below 6th intercostal space)

43
Q

Describe the lymphatic drainage of the thoracic wall

A

Lymphatic vessels of the thoracic wall drain mainly in to lymph nodes associated with the internal thoracic arteries (parasternal nodes), with the heads and necks of ribs (intercostal nodes), and with the diaphragm (diaphragmatic nodes).

44
Q

Where do parasternal nodes drain in to?

A

Bronchomediastinal trunks

45
Q

What are the branches of a typical intercostal nerve?

A

Lateral cutaneous branch (divides in to an anterior and a posterior branch) and its terminal branch, the anterior cutaneous branch (divides in to a medial and a lateral branch)

46
Q

What is different about the second intercostal nerve?

A

The lateral cutaneous branch is called the intercostobrachial nerve which contributes to cutaneous innervation of the medial surface of the upper arm (hence T2 dermatome) - it doesn’t subdivide

47
Q

What information do the intercostal nerves carry?

A

Somatic motor innervation to the muscles of the thoracic wall, somatic sensory innervation from the skin and parietal pleura and postganglionic sympathetic fibres to the periphery

48
Q

What are the surface markings for the inferior border of the pleura?

A

Rib 8, Rib 10 and T12 (from anterior to posterior)

49
Q

What are the surface markings for the inferior border of the lung?

A

Rib 6, Rib 8 and T10 (from anterior to posterior)

50
Q

What is the pulmonary ligament?

A

A thin bade-like fold of pleura that projects inferiorly from the root of the lung and extends from the hilum to the mediastinum

51
Q

What is the function of the pulmonary ligament?

A

It may stabilise the position of the inferior lobe and may also accommodate the down-and-up translocation of structures in the root during breathing

52
Q

Where do the vagus/phrenic nerves pass in relation to the roots of the lungs?

A

Vagus nerves pass posterior to the root and Phrenic nerves pass anterior to the root

53
Q

What is the difference between the hilum of the right lung and the hilum of the left lung?

A

On the left side, the pulmonary artery is superior, pulmonary veins are inferior and the bronchi are posterior.
On the right side, the lobar bronchus to the superior lobe branches from the main bronchus in the root so is therefore superior to the pulmonary artery

54
Q

What are the surface markings of the oblique fissure?

A

Curved line that starts at the spinous process of T4, crosses the 5th intercostal space laterally, and then follows the contour of rib 6 anteriorly.

55
Q

What is a bronchopulmonary segment?

A

An area of lung supplied by a segmental bronchus and its accompanying pulmonary artery branch. It is the smallest, functionally independent region of a lung.

56
Q

How many bronchopulmonary segments are there?

A

10 in each lung, some are fused in the left lung.

57
Q

Where does the right bronchial artery arise from?

A

A single artery usually arises from the third posterior intercostal artery (but occasionally, it originates from the upper left bronchial artery)

58
Q

Where do the left bronchial arteries arise from?

A

Directly from the anterior surface of the thoracic aorta - the superior one arises at T5 and the inferior one inferior to the left bronchus.

59
Q

Describe the visceral innervation of the lung

A

Anterior and posterior pulmonary plexuses are interconnected and lie anterior and posterior to the tracheal bifurcation. The anterior plexus is much smaller than the posterior. The plexus is made from contributions from the sympathetic trunks and the vagus nerve. Visceral efferents from the vagus nerve constrict the bronchioles and visceral efferents from the sympathetic system dilate the bronchioles.

60
Q

What is the origin of serratus anterior?

A

Lateral surfaces of upper 9 ribs in the mid-clavicular line

61
Q

What is the insertion of serratus anterior?

A

Costal surface of medial border of scapula

62
Q

What is the action of serratus anterior?

A

Protraction and rotation of the scapula also keeps medial border and inferior angle of scapula opposed to thoracic wall

63
Q

What is the innervation of serratus anterior?

A

The long thoracic nerve (C5, C6, C7)

64
Q

What are the main differences between the right and left lung?

A

Right: 3 lobes, 2 fissures
Left: 2 Lobes, 1 fissure, aortic impression, cardiac impression, lingula

65
Q

What are the surface markings of the horizontal fissure?

A

Follows the fourth intercostal space from the sternum until it meets the oblique fissure as it crosses rib 5

66
Q

Describe the structure of the bronchial tree

A

Trachea (C-shaped cartilage, smooth muscle posteriorly), divides in to left and right main bronchi (right main bronchi wider and more vertical), each main bronchi divides in to lobar bronchi within the lung, lobar bronchi divide in to segmental bronchi (or tertiary bronchi)

67
Q

Where is the superior border of the left atrium?

A

Lower border of the 2nd left costal cartilage, 2.5cm laterally from the edge of the sternum

68
Q

Where is the superior border of the right atrium?

A

Upper border of the 3rd right costal cartilage, 1cm laterally from the edge of the sternum

69
Q

Where is the inferior border of the right atrium?

A

Upper border of the 6th costal cartilage, 1cm laterally from the edge of the sternum

70
Q

Where is the apex of the heart?

A

5th left intercostal space, mid-clavicular line

71
Q

What are the features of a typical cervical vertebra?

A 
Vertebral body is short in height and square shaped
Spinous process is short and bifid
The vertebral foramen is triangular
Foramen transversarium (for vertebral artery)
72
Q

What are the features of a thoracic vertebra?

A

Two partial facets on each side (superior and inferior costal facets
Transverse costal facet (for articulation with tubercle of its own rib)
Heart shaped vertebral body
Circular vertebral foramen

73
Q

What are the features of a lumbar vertebra?

A

Large
Lack facets for articulation with ribs
Transverse processes are thin and long (except LV)
Triangular and large vertebral foramen

74
Q

How do adjacent vertebrae articulate?

A

Superior and inferior articular processes that project from where the pedicles join the laminae
Symphyses between vertebral bodies

MSc Anatomy (6 decks)

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