Thorax Flashcards
1
Q
Where do intercostal veins drain into?
A
The azygous and internal thoracic veins
2
Q
What do the intercostal arteries branch into?
A
The thoracic aorta and internal thoracic arteries
3
Q
What are the intercostal nerves?
A
The anterior and ventral rami of the thoracic spinal nerves
4
Q
What innervates the diaphragm?
A
Phrenic nerve
5
Q
What does the phrenic nerve come off of?
A
Ventral Rami of C3, C4, C5
6
Q
What are the three main opening of the diaphragm?
A
The aortic hiatus, the esophageal hiatus, and the caval opening
7
Q
What spinal lev does the aortic hiatus occur?
A
T12
8
Q
Where is the aortic hiatus?
A
It is through the right and left crura of the diaphragm and marks the termination of the thoracic aorta/ beginning of the abdominal aorta, the thoracic duct and often the azygos vein.
9
Q
What is the esophageal hiatus?
A
It is within the muscular part of the diaphragm and transmits the esophagus and vagus nerves.
10
Q
What is the caval opening?
A
Located within the central tendon of the diaphragm and contains the inferior vena cava and sometimes the right phrenic nerve.
11
Q
What is the mediastinum?
A
The space that is sandwiched between the two pleural sacs and refers to all structures that lie between the lungs, extending from superior thoracic aperture to the diaphragm
12
Q
How is the mediastinum divided?
A
By a line drawn horizontally from the sternal angle to the lower border of T4 into the superior and inferior mediastinum.
13
Q
What is the inferior mediastinum subdivided into?
A
The anterior, middle, and posterior mediastinum
14
Q
What is the anterior mediastinum
A
It contains connective tissue, fat, and remnants of the thymus gland
15
Q
What does the middle mediastinum contain?
A
The heart and roots of the great vessels (superior vena cava, aorta, pulmonary trunk, pulmonary veins) enclosed in the pericardial sac as well as the phrenic nerves.
16
Q
What does the posterior mediastinum contain?
A
Descending aorta, azygous vein, thoracic duct, esophagus, trachea, and vagus nerves
17
Q
What is the lung encased in?
A
A pleural sac formed by a continuous serous membrane called the pleura.
18
Q
Where is the only point of attachment of the right and left lung?
A
At the root or hilum of the lung
19
Q
What is the part of serous membrane that covers the lung called?
A
The visceral pleura.
20
Q
What is the portion of the serous membrane that lines the thoracic cavity?
A
The parietal pleura.
21
Q
What is the space between the visceral and parietal pleura called
A
The pleural cavity
22
Q
What is pneumothorax
A
An accumulation of air in the pleural cavity, the lung collapses.
23
Q
What is costodiaphragmatic recess?
A
Pleural recesses formed by the reflection of the costal and diaphragmatic pleura.
24
Q
What is costomediastinal recesses?
A
Where the costal and mediastinal pleural meet.
25
What is pleural effusion?
Abnormal accumulation of fluid in the pleural space.
26
What is thoracentesis?
A procedure in which a needle in used to enter the pleural cavity and aspirate accumulated fluid.
27
Where is thorancentesis performed?
1-2 intercostal spaces below level of effusion, no lower than the 8th intercostal space.
28
What innervates the costal parietal pleura?
Intercostal nerves
29
What innervates both the mediastinal parietal pleura and diaphragmatic parietal pleura?
phrenic nerves.
30
What is visceral pleura innervated by?
Autonomic nerves
31
what is the pericardium?
Fibro-serous sac that encloses the heart and roots of the great vessels. It resides within the middle mediastinum.
32
What is the pericardial sac composed of?
Strong dense, fibrous layer (fibrous pericardium).
33
What does the serous pericardium consist of?
A parietal layer (parietal pericardium) that lines the inner surface of the fibrous pericardium and a visceral layer (visceral pericardium) that forms the outer layer of the hear (epicardium) and roots of the great vessels.
34
What is the pericardial cavity?
A potential space between the visceral pericardium and parietal pericardium.
35
Where is the transverse pericardial sinus?
Posterior to the ascending aorta and pulmonary trunk and anterior to the superior vena cava.
36
Where is the oblique sinus?
It is located behind the heart, surrounded by a reflection of serous pericardium around the right and left pulmonary veins.
37
How many chambers does the heart have
Four chambers- 2 atria and 2 ventricles.
38
Where are the atrioventricular valves located?
Between atria and ventricles.
39
Where are the semilunar valves?
Between the ventricles and great arteries.
40
Where is deoxygenated blood returned to the heart through?
The interior and superior vena cava into the right atrium and the right atrioventricular valve (tricuspid)
41
From the right atrium, where does the blood move?
To the right ventricle and is then ejected through the pulmonary semilunar valve into the pulmonary trunk, where it then travels to the lungs to become oxygenated.
42
How does oxygenated blood return from the lungs to the heart?
Through pulmonary veins, draining into the left atrium.
43
How does blood pass through the left atrium to the left ventricle.
The mitral or bicuspid
44
What do cardiac valves do?
They prevent backflow of blood
45
What are the two groups of the cardiac valves?
The semilunar valves and atrioventricular valves
46
How many cusps do the aortic and pulmonary valves have? What are they
3: the left, right, and anterior (pulmonary valve) or posterior (aortic valve)
47
Where are the openings for the left and right coronary arteries?
Adjacent to the left and right cusps.
48
What are the atrioventricular valves?
The mitral or bicuspid (2 cusps) on the left, the tricuspid on the right.
49
What does the cardiac skeleton do?
It maintains the intergrity of valve openings and provides points of attachments for the cusps. It electrically separates atrial from ventricular musculature.
50
What surfaces does the heart have?
Anterior (sternocostal), posterior (base) and inferior (diaphragmatic) surfaces
51
What does the anterior surface of the heart covered by?
The sternum and 3rd-6th costal cartilages
52
What mark the separation between the right and left ventricles and contain the coronary arteries and veins that supply the heart?
Anterior and posterior sulci
53
What marks the division between the atria and ventricles?
The coronary sulcus
54
What passes through the sternal angle on the anterior chest wall?
The T4-T5 vertebral level transverse plane
55
What does the sternal angle represent?
The superior medistastinum is separated from the inferior mediastinum.
The ascending aorta ends and arch of the aorta begins
The arch of the aorta ends and the thoracic aorta begins, and the trachea bifurcates
56
What is the upper limit of the heart?
3rd costal cartilage on right side of sternum and 2nd intercostal space on left side of sternum
57
Where do the left and right margin of heart extend from?
Left-descends laterally from 2nd intercostal space to apex located near the midclavicular line in 5th intercostal space
Right- extends from right 3rd costal to right 6th costal cartilage
58
Where does the lower margin of the heart extend from?
Sternal end of right 6th costal cartilage to the apex in the 5th intercostal space near midclavicular line.
59
Which ventricle is thicker? The right or left?
The left.
60
What are the muscular ridges of myocardium in the ventricles called?
Trabeculae carneae.
61
What is the septomarginal trabecula
A distinct band of the trabeculae carnea that forms a bridge between the interventricular septum and the base of the anterior papillary muscle of the right atrium.
62
What are papillary muscles?
Cone-shaped muscles that extend from the ventricular walls and septum, their apices are attached to chordae tendinae that extend and attach to the cusps of the atrioventricular valves.
63
What does contraction of paipillary muscles prevent?
It prevents the cusps of the atrioventricular valves from entering into the atrium during ventricular contraction. This prevents regurgitation of ventricular blood into the atrium.
64
What is the muscular portion ridges of the right atrium called?
Pectinate muscles.
65
What is the smooth portion of the atria called?
The sinus venarum.
66
What creates the boundary between muscular ridges and smooth portion of the atria?
The crista terminalis
67
How is coronary venous blood returned to circulation?
Through the coronary sinus which drains into the right atrium through the opening of the coronary sinus.
68
What does dominance of coronary blood supply refer to?
The artery that gives rise to the posterior interventricular artery.
69
What does the right coronary artery dominance mean?
The posterior interventricular artery is a branch of the right coronary artery (about 85% of the population)/
70
What does left coronary artery dominance mean?
The posterior interventricular artery is a branch of the left coronary artery (about 15% of the population).
71
What are the parasympathetic and sympathetic innervations of the heart?
Parasympathetic: vagus nerve
Sympathetic: T1-T4 levels of sympathetic trunk.
72
Where do the preganglionic fibers from the vagus nerve originate from?
Neurons in the brainstem.
73
What is referred pain?
Pain perceived at a location other than the site of the pain stimulus.
74
When does referred pain occur?
When visceral affterents converge with somatic afferent fibers at the level of the spinal cord.
75
Where can referred pain arise from?
Either the musculoskeletal/ connective tissue (referred somatic pain) or from the organs (referred visceral pain).
76
Where does referred somatic pain occur in the heart?
The fibrous pericardium, mediastinal pleura and diaphragm which are all innervated by phrenic nerves.
Pain from these areas is referred to shoulder of neck, which share C3, 4, 5 dermatomes.
77
Where does referred visceral pain from the heart occur?
T1-T4 spinal cord segments. The pain is felt as coming from the chest and medial arms as somatic afferents also share T1-T4 dermatomes.
78
How is the pain described in referred somatic pain?
Localized and sharp
79
How is the pain described in referred visceral pain?
Generally dull and diffuse
80
How are heart sounds produced?
By closure of the AV valves and semilunar valves.
81
What is regurgitation or backflow of blood?
Valve doesn't close tightly (leaky valve)
82
What is stenosis?
Valve does not fully open, limiting blood from through the valve (stenotic valve)
83
What is the root or hilum?
The point at which the pulmonary artery, vein, and bronchi enter and leave the lung
84
What does the trachea bifurcate into?
The right and left main (primary) bronchi at the level of the sternal angle.
85
Describe the right main bronchus when compared to the left main bronchus.
The right main bronchus is shorter, wider and more vertical than the left main bronchus.
86
Are more foreign bodies that enter the trachea lodged in the right or left side?
Ride
87
What is each branching of the tracheobronchial tree accompanied by?
By a branch of the pulmonary artery.
88
How many lobes does the right lung have?
3 lobes (superior, middle, inferior) separated by a horizontal and oblique fissures.
89
How many lobes does the left lung have?
Two lobes (superior and inferior) separated by an oblique fissure
90
What are bronchopulmonary segments?
Segmental bronchus and branch of the pulmonary artery that supply divisions within the lobes.
91
Where are the artery and bronchus located?
In the center of the bronchopulmonary segment while veins run at the periphery.
92
What innervates the lung?
Autonomic innervation from the vagus nerves and T1-T4 levels of the sympathetic trunk.
93
What is the function of the intercostal muscles?
They function in respiration by raising and lowering the ribs.
94
What is the costal grove?
the intercostal veins, arteries and nerves run along the interior margin of the rib in the costal grove, between the innermost and internal intercostal muscles
95
What is the pericardial sinuses?
When the visceral pericardium reflects back to become the parietal pericardium at the roots of the great vessels.
96
What structure can a seurgon pass their finger to in order to ligate between arteries and veins, stopping circulation?
The transverse pericardial sinus
97
Does the pulmonary valve have an anterior or posterior cusp?
Anterior
98
Does the aortic valve have an anterior or posterior cusp?
posterior
99
Does coronary flow during diastole?
Yes
100
What are the three main functions of cardiac skeleton?
Maintain integrity of valve openings
Attachment points for cusps
Electrically separates atrial from ventricular muscle
101
How does the trachea bifurcate and then branch?
It bifurcates into the right and left primary bronchi.
| Each primary bronchi branches into lobar bronchi, and the segmental bronchi.
102
Explain the differences in supply of the interventricular septum of a right and left dominant heart.
Right dominant: 2/3 interventricular septum is provided by the left anterior descending of left coronary artery
1/3 is provided by the descending artery of the right ventricle
Left dominant: whole interventricular septum is supplied by left coronary artery
103
What supplies blood to the airways themselves? Where do they arise from?
Through bronchial arteries that arise from the descending aorta.
104
What level does the esophageal hiatus occur
T10
105
What level does the caval opening occur
T8
106
Because the left atrium lies most posteriorly: if enlarged what problems can occur?
Dysphagia (difficulty swallowing) or hoarsness (due to compression of the left recurrent laryngeal nerve).
107
What is the crista terminalis?
The boundary between the pectinate and the smooth portion (sinus vernarum)
108
What comes off of the right coronary artery?
The posterior descending artery (posterior interventricular artery), the right marginal artery, the SA nodal artery, the AV nodal artery
109
What comes off the left coronary artery
The left anterior descending artery, the left marginal artery, and the circumflex artery
110
What is the distribution of blood flow of posterior descending artery?
1/3 septum, right atrium, right/left ventricle
111
What is the distribution of blood flow of the right marginal artery?
right ventricle
112
What is the distribution of blood flow of the SA nodal artery?
The SA node and the surrounding myocardium
113
What is the distribution of blood flow of the AV nodal artery?
The AV node and the surrounding myocardium
114
What is the distribution of blood flow of the left anterior descending artery?
right ventricle, left ventricle, 2/3 of the septum
115
What is the distribution of blood flow of the left marginal artery?
The left ventricle
116
What is the distribution of blood flow of the circumflex artery?
Posterior surface of the left ventricle.
117
What are the heart sounds produced by?
The first heart sound of S1 is the closure of the AV valves.
The second heart sound or S2 is the closure of the semilunar valves.
118
What is a segmentectomy:
removal of a segment of a lung
119
What is a lobectomy?
Removal of the lobe of the lung
120
What is the pneumonectomy?
removal of lung
