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Anatomy of thorax > Thorax > Flashcards

Thorax Flashcards

1
Q

Which vertebra does the suprasternal plane correspond to

A

T2 posteriorly

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2
Q

Which vertebra does the sternal angle plane correspond to

A

T4/5 posteriorly

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3
Q

Which vertebra does the xiphisternal plane correspond to

A

T9 posteriorly

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4
Q

What are intercostal muscles innervated by

A

Intercostal nerves

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5
Q

What type of joint are intervertebral joints

A

Symphysis joints

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6
Q

What type of joint are costovertebral joints

A

Synovial joints

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7
Q

What type of joint are sternocostal joints

A

1st- primary cartilaginous

2-7- synovial plan joints

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8
Q

What type of joint is a sternoclavicular joint

A

Synovial

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9
Q

What type of joint is the costochondrial joint

A

Primary cartilaginous joint

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10
Q

What type of joint is an interchondral joint (adjacent border of 6-7, 7-8, 8+9 costal cartilage)

A

Synovial joint

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11
Q

Where does the phrenic nerve arise from

A

C3,4,5 (C345 keeps the diaphragm alive)

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12
Q

What is the course of the right phrenic nerve

A

Wall of SVC

Along side of fibrous pericardium over right atrium

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13
Q

What is the course of the left phrenic nerve

A

Over the arch of the aorta and pulmonary trunk

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14
Q

What does the phrenic nerve innervate

A

Diaphragm, pleura of mediastinum and pericardium

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15
Q

What symptoms does neurogenic thoracic outlet syndrome present with

A

Pain

Weakness and loss of muscle at base of thumb

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16
Q

What symptoms does venous thoracic outlet syndrome present with

A

Swelling, pain and blueness of light

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17
Q

What symptoms does arterial thoracic outlet syndrome present with

A

Pain, coldness and paleness of the arm

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18
Q

Where do internal thoracic arteries run and where does it arise from

A

Subclavian artery and runs along the anterior side of the ribcage (either side of the sternum)

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19
Q

What does the internal thoracic artery supply

A

Intercostal muscles in spaces 1-6

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20
Q

What does the internal thoracic artery divide into and what do these supply and run

A

Superior epigastric artery

Musculophrenic artery (supplies ics 7-9 and lower part of pericardium; also splits into anterior intercostals and pass between internal and innermost intercostal muscles to supply the intercostals, overlying skin, and parietal pleura)

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21
Q

How can you tell if the diaphragm is paralysed and why does this happen

A

One side is risen up because the R and L phrenic nerves supply different sides of the diaphragm. If the RHS is paralysed, then when the left contracts, the contents of abdomen push up against the diaphragm

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22
Q

What arteries does the subclavian artery give rise to that supply the thoracic wall and what do they supply

A 
Internal thoracic (ics1-6)
Supreme intercostal arteries (gives rise to the first and second posterior intercostal arteries, which supply blood to their corresponding intercostal space)
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23
Q

What arteries does the axillary artery give rise to that supply the contents of the thorax and what do they supply

A

Superior thoracic artery (supplies Serratus anterior)

Lateral thoracic artery (supplies Serratus anterior and breast)

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24
Q

What arteries supply the breast and where do they arise from

A

Internal thoracic artery (from subclavian)

Lateral thoracic artery and thoracoacromial arteries (from axillary artery)

Lateral mammary branches (from posterior intercostal arteries)

Mammary branch (from anterior intercostal artery)

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25
Q

Where do the veins of the breast drain into

A

Axillary and internal thoracic veins

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26
Q

Where does the vagus nerve appear from

A

Between the common carotid artery and internal jugular vein

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27
Q

Course of the right vagus nerve

A

Runs anterior to beginning of subclavian artery
[gives off right recurrent laryngeal nerve at origin of subclavian artery]
Then forms oesophageal plexus

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28
Q

Course of left vagus nerve

A

Runs along lateral wall of common carotid artery
Passes between the descending aorta and left pulmonary trunk
[left recurrent laryngeal nerve branches off and loops around the arch of the aorta]
Joins the right vagus nerve to make plexus

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29
Q

Which vagus nerve passes between the descending aorta and left pulmonary trunk

A

Left

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30
Q

Which vagus nerve gives off a laryngeal nerve which loops around the arch of the aorta

A

Left

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31
Q

Which vagus nerve runs anterior to the beginning of subclavian artery

A

Right

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32
Q

Which vagus nerve forms the oesophageal plexus

A

Both

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33
Q

Why is long lasting hoarseness sometimes a sign of lung cancer

A

Because laryngeal nerves innervate laryngeal muscles so if there’s a lung tumour there can be pressure on laryngeal nerves causing hoarseness

34
Q

What does the thoracic duct drain

A

lower extremities, pelvis, abdomen, left side of the thorax, left upper extremity, and left side of the head and neck

35
Q

Where does the thoracic duct drain into (terminate)

A

junction of the left subclavian and left internal jugular veins

36
Q

How does the thoracic duct enter the abdomen

A

through the aortic hiatus

37
Q

Which structures pass through the diaphragm at level T8

A

Vena cava

R Phrenic

38
Q

Which structures pass through the diaphragm at level T10

A

Oesophagus
Left phrenic
Vagus nerve

39
Q

Which structures pass through the diaphragm at level T12

A

Thoracic duct
Aortic Hiatus
Azygos system

40
Q

What’s the diaphragm attached to anteriorly

A

Inferior 6 ribs and their costal margins and the xiphoid process

41
Q

What is the supply of the diaphragm

A

Phrenic arteries

42
Q

What is the origin of the pec minor muscle

A

3rd-5th ribs near costal cartilage

43
Q

Where does the pec minor muscle insert

A

Medial border and superior surface of coracoid process

44
Q

What is the action of the pec minor

A

Stabilise scapula by drawing it in inferably and anteriorly against the thoracic wall

45
Q

What is the innervation of the pec minor

A

Medial pectoral nerves

46
Q

What is the artery that supplies the pec minor

A

Thoracoacromial artery

47
Q

Where is the origin of the pec major muscle

A

Anterior sternal half of clavicle
Manubrium and sternum up to 6 costal cartilages
Aponeurosis of abdominal external oblique

48
Q

Where does the pec major insert

A

Bicipital groove of the humerus

49
Q

What is the action of the pec major

A

Humerus flexion (lifting arm up)
Humerus adduction (bringing arm towards body)
Rotate humerus medially
Keep arm attached to trunk

50
Q

What is the innervation of the clavicular head of the pec major

A

C5,6 (lateral pectoral nerve)

51
Q

What is the innervation of the sternocostal head of the pec major

A

C7, C8, T1 (medial pectoral nerve)

52
Q

What are some of the structures that run through the superior thoracic aperture

A 
Trachea
Oesophagus
Lung apex
Thoracic duct
L&R common carotids and subclavian aa
Brachiocephalic and internal jugular vv
Vagus and phrenic nerves
53
Q

What are some of the structures that run through the inferior thoracic aperture

A

OSeophagus
Thoracic duct
Abdominal aorta
Inferior vena cava

54
Q

What is the origin of the Serratus anterior mm

A

Superior 8 or 9 ribs

55
Q

What is the insertion of the serratus anterior mm

A

Vertebral border and inferior angle of scapula

56
Q

What is the action of the serratus anterior mm

A

Abduction and rotate scapula upwards

Elevate ribs when scapula stabilised

57
Q

What is the nerve supply of the serratus anterior mm and its roots

A

Long thoracic nerve (C5-7)

58
Q

What is the blood supply of the serratus anterior mm

A

Lateral thoracic artery (from the axillary artery)

59
Q

In the RHS of the body, where do all the posterior intercostal veins drain into (except the first) and in turn where does this drain into

A

Azygos vein -> Right superior vena cava

60
Q

Where does the azygos vein drain into

A

Right superior vena cava

61
Q

In the LHS of the body, where do all the intercostal veins drain into (except upper 3 accessory hemiazygos veins)

A

Hemiazygos vein

62
Q

Where do the upper 3 accessory hemi-azygos veins drain into (these are only found on the LHS)

A

Left brachiocephalic vein

63
Q

Where do the anterior intercostal veins drain into and where does this drain into in turn

A

Internal thoracic vein -> Brachiocephalic vein

64
Q

What are the accessory inspiratory muscles

A

Scalene muscles
Infra-hyoid muscles
Erector Spinae muscles
Quadratus lamborum

65
Q

What is the role of the scalene muscles in inspiration

A

Stabilise first ribs so when intercostal muscles contract, ribs are moved up to first rib

66
Q

What is the role of the quadrates labour during inspiration

A

Stabilises 12th ribs so when diaphragm, contracts, ribs are moved away from 12th

67
Q

How are external intercostals positioned

A

Inferiomedially

68
Q

How are internal intercostals positioned

A

Inferolaterally

69
Q

How are innermost intercostals positioned

A

Inferolaterally

70
Q

What is thoracocentesis used for

A

Obtain sample for histology or to treat primary tension pneumothorax

71
Q

where is the needle inserted in thoracocentesis

A

Inferior half of ics in;

  • 4th/5th midaxillary line
  • or 2nd ics in midaxillary line
72
Q

What does the needle pass through in thoracocentesis

A

Intercostal muscles and parietal pleura

73
Q

When is intercostal nerve block used

A

When there is pain due to shingles or localised chest wall pain

74
Q

Where does the lateral thoracic artery come from and what does it supply

A

Axillary artery and supplies the

  • Serratus anterior
  • Breast
75
Q

What is the origin of the lateral pectoral nerve (including the root values) and what does it supply

A

C5,6,7 –> Lateral cord of brachial plexus –> Lateral pectoral nerve –> Pec major

76
Q

What is the origin of the medial pectoral nerve (including the root values) and what does it supply

A

C8+T1 –> Medial cord of brachial plexus –> Medial pectoral nerve –>Pec minor and major

77
Q

What do the intercostal nerves supply

A 
IC muscles
Transverse thoracic muscle
Subcostal muscle
Levator costarum muscle
Serratus posterior muscles
Abs
Thoracic and abd. skin
Pleura
78
Q

Where are the sites of oesophageal constriction

A

ABCD=

  • Cricoid cartilage (C6)
  • Arch of Aorta
  • Bronchus (LMB T4/5)
  • Diaphragm (oesophageal hiatus T11)
79
Q

Why are the sites of oesophageal constriction important

A

Where foreign objects/food are most likely to become stuck and cause choking

80
Q

What’s winging of the scapula a sign of

A

Paralysis of the long thoracic nerve (C5-C7) which innervates serratus anterior

Anatomy of thorax (7 decks)

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