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Regional Anatomy > Thorax > Flashcards

Thorax Flashcards

1
Q

What are the gross functions of the throax

A

Protects vital organs lungs heart and great vessels

Its musculature acts as the bellows that allow for the inflation and deflation of the lungs

Site of attachment of the upper limbs to the axial skeleton

Its a conduit of major viscera between the pharynx and abdomen

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2
Q

What are the two standard Xrays of the thoracic cavity?

A

PA X ray (xrays fired from posterior to anterior) Used more commonly heart is on the right side of the image as you look at it

AP Anterior to posterior
Viewed the same way less clear images

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3
Q

What is the superior boundary of the thoracic cavity

A

Superior thoracic aperture

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4
Q

What is the inferior boundary of the thoracic cavity

A

The diaphragm

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5
Q

What forms the anterior-latero-Posterior boundary of the thoracic cavity

A

The ribs

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6
Q

What forms the posterior boundary of the thoracic cavity

A

The thoracic vertebrae T1-T12

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7
Q

What forms the anterior boundary of the thoracic cavity

A

manubrium of sternum
Body of sternum
Xiphoid porcess

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8
Q

What is the structure of the superior thoracic inlet/ aperture?

A

Superior margin of manubrium level with intervertebral disc between TII-TIII

First rib slopes inferiorly to its attachment on the manubrium from TI

As a result superior thoracic aperture is at an oblique angle facing slightly anteriorly

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9
Q

What is the structure fo the inferior thoraracic aperture in terms of its shape and the skeletal boundaries?

A

Determined by the sites of attachment of the diaphragm
domed shaped due to attachment of diaphragm

skeletal boundaries include TXII posteriorly,

Rib XII and rib XI posteriolaterally

Distal cartilaginous end of ribs VII to X which untie to from the coastal margin anterolaterally

Xiphoid process anteriorly

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10
Q

What vertebral level is the aortic hiatus located in the diaphragm? What passes through here?

A

TXII
Descending aorta
Azygous vein
Thoracic duct

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11
Q

What vertebral level is the oesophageal hiatus located in the diaphragm? What passes through here?

A

TX
Oesophagus
right and left vagus nerves

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12
Q

Where is the caval hiatus located in the diaphragm? what passes through here?

A

TVIII

IVC

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13
Q

What is the angle of louis? What vertebral plane does this occur?

A

transverse plane through the interveterbral disc between TIV and TV

Is where the manubrium and body of sternum fuse

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14
Q

Why is the TIV-TV verebral plane clinically singinficant?

A

Passes through the sternal angle where the manubrium and the sternum fuse

used to identity position of rib II as rib I not palpable because of overlying clavicle

Marks where the arch of the aorta begins and ends

Separates the mediastinum into superior and inferior parts

level at which the trachea bifurcates into right and left bronchi

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15
Q

What are the ten layers of tissue from superficial to deep of the anterior thoracic wall?

A

Skin

Superficial fascia

Pectoral fascia

Pectoralis major

Clavipectoral fascia

pectoralis minor

external intercostal muscle

internal intercostal muscle (ribs embedded in this layer)

innermost intercostal muscle

endothoracic fascia

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16
Q

What is the fascia pectoralis?

What are the functions of the layers?

A

Colelctive term for the pectoral fascia and clavipectoral fascia

Pectoral fascia covers the pectoralis major and separates it from breast tissue

Clavipectoral fascia sperates pectoralis minor from pectoralis major

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17
Q

What is the endothroacic fascia where is it located what does it seperate?

A

Deepest layer of the thoracic wall
loos connective tissue it separates the innermost intercostal muscle and ribs from the parietal pericardium and pleura of the viscera

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18
Q

What is the characteristics of a typical thoracic vetebra?

A

heart shaped vertebral body
long spinous process posteriorly
circular vertebral foramen
superior articular processes are flat and face posteriorly
inferior articular processes with facets facing anteriorly
transverse process projecting laterally
2 pairs one superior and one inferior coastal demifacets (superior articulates with respective rib inferior with the head of the rib below)

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19
Q

What are the typical articulation points between the ribs and the thoracic vertebra?

A

Three sites for articulation:

Two demifacets located on superior and inferior aspects of corresponding vertebral bodies (superior and inferior demifacets)

Oval facet on transverse process articulates with tubercules on its own rib

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20
Q

What are the notable exceptions to the standard articulation of the ribs?

A

Rib I superior coastal facet is complete on TI therefore rib I does no interact with the inferior aspect of CVII

Vertebra TX ( TIX sometimes) articulate only with its own ribs therefore lacks inferior demifacets on the body

Vertebra of TXI and TXII articulate only with the head of there own ribs and don’t posses transverse coastal facets

NB remember rib 2 is atypical but articulates normally just is longer

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21
Q

What are the true ribs what does it mean to be a true rib?

A

Ribs I-VII

Must have a direct relationship between rib and coastal cartilage that binds the rib to the manubrium/sternum via synovial gliding joint
(rib I does have a coastal cartilage therefore is a true rib but has a fibrous joint)

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22
Q

What are the false ribs?

Why are they called false ribs?

A

Ribs VIII-X
coastal cartilages join to the coastal cartilage of the overlying rib an have no direct relationship to the sternum

Ribs XI XII have no contract with ribs above then or the sternum therefore are often called floating ribs

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23
Q

What is the shape/ components of a typically rib?

A

Curve shaft
anterior end continuous with coastal cartilage

posterior end articulates with vertebral column and therefore has a head: articulates with demifacets, a neck (separation point), and tubercule that articulates with oval facet.

Also has a coastal groove where the intercostal vein, artery and nerve run (VAN)

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24
Q

What are the atypical ribs

A

Ribs 1, 2, 10, 11, 12

25
Q

Why is Rib I atypical?

A

Rib I head articulates only with vertebrae of TI

slopes inferiorly to attachment on manubrium.

Has two distinct grooves formed from the subclavian vein and subclavian artery

26
Q

Why are ribs XI-XII atypical

A

Only articulate with head bodies of there corresponding vertebrae

have no attachment to the sternum are floating ribs

27
Q

What is the structure of the manubrium?

A

Juglar notch superior aspect important clinical landmark (T2-T3)

either side of juglar notch are oval fossa for articulation with clavicles

laterally are facets for attachment of the coastal cartilage of Rib I

inferior lateral end there is a small demifacet for attachment to coastal cartilage of Rib II

Fuses with the body of sternum between TIV-TV vertebra

28
Q

What is the structure of the body of sternum?

A

Flat bone

most superiolateral facet is a demifacet for articulation with coastal cartilage of rib II

Four full facets for articulation with coastal cartilages of ribs III-VI

Demifacet at located at the most inferior lateral end for articulation with coastal cartilage of rib VII

29
Q

Xiphoid process structure?

A

joined to the body of sternum by a cartilaginous attachment that is eventually ossified with age Xiphisternal joint is at the T9 vertebral level

Has one demifacet located superolateraly for articulation with the coastal cartilage of rib VII

30
Q

What are the three layers of intercostal muscle?

What is significant about there arrangement?

A

external intercostal muscles
internal intercostal muscles
innermost intercostal muscles

Grains of each muscle fibres run against each other:

External muscle fibres run inferomedially

Internal intercostal run at 90 degrees to that

Innermost run inferomedially too

Ribs located in the internal intercostal muscle with intercostal vein artery and nerve running in the intercostal groove on the inferior aspect of each rib (VAN)

31
Q

What is the outmost covering of the lungs?

What is the function of this layer?

A

Parietal pleura outmost and visceral pleura in contact with the surface of the lungs
Between these tow layers is the pleura cavity which is filled with a thin film of pleura fluid that allow the lungs to expand without friction between thoracic wall

32
Q

What is pleura effusion

A

Excess fluid accumulates in the pleura space that may cause the underlying lung to collapse

33
Q

Where is a chest drain inserted?

A

At the level of the 5th intercostal space on the lower border of the axilla

Drain inserted above the rib to avoid artery and vein in intercostal groove

34
Q

How many lobes make up the right and the left lung?

What are the names of the fissures?

A

Right 3 lobes oblique fissure separating inferior and superior lobe and horizontal fissure separates middle and superior lobe

Left 2 lobe separated by oblique fissure

35
Q

What are bronchopulmonary segments and how many are there in each lung?

A

Bronchopulmonary segments are divisions of the lugn based on air supply

Right has 10
Left has 8

36
Q

Where do blood vessles and air enter the lung

A

On the medial surface in an area known as the hilum

37
Q

What is the mediastinum?

A

Central cavity between the two plural cavities lined by an outer layer of tough fibrous pericardium

38
Q

What is the membranous layer that forms the boundaries of the mediastinum?

A

Outer tough fibrous pericardium
inner serous pericardium that has two layers:
parietal pericardium lines the inner surface of fibrous pericardium
Visceral pericardium that adheres to the surface of the heart

In between the two layers is a thin layer of serous fluid that reduces friction and allows the heart to contract

39
Q

What is significant about the serous and partietal layers of serous pericardium?

A

They are continuous with one another around the roots of the great vessels creating reflection of serous pericardium

40
Q

What are the names of the two reflections of serous pericardium and what is there clinical significance?

A

Transverse pericardial sinus lies posterior to ascending aorta and pulmonary trunk and anterior to the superior vena cava.

Oblique pericardial sinus around the superior vena cava and the pulmonary veins

Transverse pericardial sinus can pass a ligature all the way through the sinus posterior to the aorta and pulmonary trunk allowing surgeons to stop the flow of blood in these vessels and put the person on bypass why they operate on the heart

41
Q

What are the layers of tissue making up the heart

A

Serous pericardium that comprises of parietal layer serous fluid visceral layer (aka epicardium)
Myocardium
Endocardium lining inside of heart

42
Q

Where does the mediastinum start and end

A

T1 to TXII

43
Q

What is the angle of louis and what segments does it divide the mediastinum into? What are the names of

A

imaginary transverse plane between manubriosternal join between TIV-TV levels

Devides mediastinum into superior and inferior parts

Inferior mediastinum divisible into three further parts:
Anterior mediastinum space infant of the pericardial sac
Posterior mediastinum space posterior to the pericardial sac and in front of the vertebra
middle mediastinum is the pericardial sac and its contents

44
Q

What is pectus excavatum?

A

Anterior chest wall deformity sternum is sunken so chest looks caved in
Doesn’t cause any developmental issues but makes breathing more difficult especially when exercising

45
Q

Wat is pectus carinatum?

A

Pigeon chest
malformation of ribcage where sternum and ribs are protruded
Doesn’t cause any developmental issues just causes issues when trying to exercise as breathing is harder

46
Q

What is an intercostal nerve bock? When is it used?

A

VAN layout
local anaesthetic can be applied around the intercostal neves
Commonly used when inserting a chest drain or doing thoracoscopy

47
Q

What is mediastinoscopy?

A

Endoscope inserted at a small incision at the root of the neck superior to jugular notch into the potential space anterior to the trachea and then down into the mediastinum allowing surgeons to see the mediastinum and tak biopsies

48
Q

Where is the breast located where does it span from and to?

A

On anterior thoracic wall

Anterior to the pec major and pec minor

Seratus anterior located inferiorly and laterally

Extends to the lateral border of the sternum to the mid axially line via the axillary process

Spans from the anterioly from the 2nd to the 6th ribs

49
Q

What are the mammary glands

A

well developed in females

are modified sweat glands consisting of a series of lobules drained by lactiferous ducts that all converge at the nipple

50
Q

What surround the nipple

A

Areola

51
Q

What form of connective tissue is the breast made up of ?

A

Mainly adipose tissue

and the glandular tissue that forms the mammary glands

52
Q

What are some specialised tissues found within the breast?

A

fibrous connective tissue forms the ligaments of cooper that attach and secure the breast to the dermis and pectoral fascia as well as separating secretory lobules

loose connective tissue layer between pectoral fascia and breasts tissue called the retromammary space allows degree of movement of breast over pec major and is used in reconstructive surgery

53
Q

What is the arterial supply to the breast?

4

A

Internal thoracic artery and its perforating branches (medial supply)

Lateral supply:
lateral thoracic artery
thoracoacromial artery

Lateral mammary arteries that stem from the lateral cutaneous branches of the intercostal arteries

54
Q

What is the venous drainage?

A

Axillary vein majority

some into internal thoracic vein

55
Q

What is the lymphatic drainage?

A

Axillary lymph node majority

some into parasternal lymph nodes too

56
Q

What is the nervous innervation?

A

Anterior and lateral cutaneous branches of 4th 5th 6th intercostal nerves

57
Q

What is breast cancer?

A

Can occur in both men and females
Carcinomas malignant tumours that metastasise and speed through lymph vessels
interference with lymphatic drainage by cancer can cause lymphodema which results in dimples/ puffy skin

58
Q

mesectomy clinical correlation?

A

Simple removal of the breast down to the retromammary space –> implants can be place in between pectoralis fascia and retromammary space

Radical mesecotomys involve removal of all breast and then the pectoral muscles fat and fascia and as many lymph nodes as possible from around axillary region

Lumpectomies more commonly performed removal of cancerous tissue locally and neighbouring lymph vessels

Regional Anatomy (2 decks)

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