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HHP > thorax > Flashcards

thorax Flashcards

1
Q

how many pairs of ribs do we have

A

12

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2
Q

what types of ribs do we have

A

7 pairs of true ribs (1-7)
3 pairs of false ribs (8-10)
2 pairs of floating ribs (11 + 12)

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3
Q

what do true ribs connect to

A

sternum via their own costal cartilage

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4
Q

how do false ribs attach to the sternum

A

by merging together and attaching to the costal cartilage of rib 7 (forms the costal margin)
so indirect connection with the costal cartilage

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5
Q

how do floating ribs connect to the sternum

A

DO NOT as they do not have costal cartilage

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6
Q

what do all ribs attach to

A

thoracic vertebrae of spine (in thoracic region of the spine) posteriorly

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7
Q

so what is the ribcage formed by

A

rib bone becoming costal cartilage (costal bc in region of the lungs) which then attaches to sternum itself

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8
Q

what is located between the rib and where it becomes costal cartilage

A

costo-chondral junction

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9
Q

what level does the
a) 1st rib
b) 2nd rib
attach

A

a) T1 vertebra = to manubrium portion of sternum

b) T12 vertebra

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10
Q

what is the space between each of the ribs called

A

intercostal space

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11
Q

what 3 parts make up the sternum from top to bottom

A

1) manubrium
2) body of the sternum
3) xiphoid process

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12
Q

what bone attaches to the scapular on the posterior aspect of the ribcage

A

clavicle

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13
Q

which 2 openings allow structures to enter and leave the rib cage

A

1) superior thoracic aperture = structures pass from h&n or upper limb into thoracic region
2) inferior thoracic aperture = pass from thoracic region to abdominal region

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14
Q

what 3 functions does the ribcage serve, explain these

A

1) protection = for vital organs (heart, lungs) + upper abdominal organs (liver sits high up on rhs and pushes up into the diaphragm) + spleen on lhs
2) support = all bones have muscles attached to them, ribcage provides stable point of attachment for lots of muscles in thoracic region + muscles that help control movement of upper limb (eg pecks, a few muscles in top of arms / shoulders)
3) respiratory movements = breathing in + out changes thoracic vol (essential for pressure change and air to be drawn in / forced out)

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15
Q

what is the diaphragm

A

high spongy sheet of thin, strong muscle that separates thorax from the abdominal region and covers the entire inferior thoracic outlet

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16
Q

how does the diaphragm sit

A

domes superiorly into rib cage when relaxed

higher on rhs bc of liver

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17
Q

what does the diaphragm do during

a) inspiration
b) expiration

A

a) contracts so muscle fibres pulled tight causing muscle to be pulled down flat (more space inside rib cage for lungs to expand and take in as much O2 as possible)
b) relaxes

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18
Q

what allows passage of structures through the between thorax and abdomen

A

apertures in its posterior

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19
Q

what level does the inferior vena cava pass through the diaphragm at

A

T8 (thoracic vertebra 8)

  • remember - vena cava has 8 letters so T8!
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20
Q

what level does the inferior oesophagus pass through the diaphragm at

A

T10

  • and oesophagus has 10 letters
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21
Q

what level does the inferior / descending aorta pass through the diaphragm at

A

T12

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22
Q

which nerves supply the diaphragm and what are they made up of

A

PHRENIC NERVES (r+l one)

made up of contributions from cervical spinal nerves 3, 4, 5
C3, C4, C5 keeps the diaphragm alive!

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23
Q

what are the 3 layers of intercostal muscle

A

external (also have an external intercostal membrane - lies medial to external muscle, v thin and see through)
internal (fibre directions lay perpendicular to external)
innermost

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24
Q

explain the innermost intercostal muscles

A
  • v thin layer of muscle, follows same fibre direction as internal
  • only used when forcing air out of lungs - accessory muscle of respiration
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25
Q

how do external intercostal muscles run and what does this mean when we breathe in

A

downward direction
from upper rib and latch onto rib below
external contract pulling inferior rib upwards

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26
Q

how do internal intercostal muscles run and what does this mean when we breathe out

A

upward direction
from lower rib and latch onto rib above
internal contract pulling ribs down to dec space in thoracic cavity so we’re forcing air out through lungs

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27
Q

which three vessels correspond to the intercostal spaces
what is there role
where are these found

A

intercostal vein (posterior intercostal veins drain into azygous vein - hemiazygous and accessory azygous veins)

intercostal artery (posterior intercostal artery arise from descending aorta)

intercostal nerve (sympathetic contributions from sympathetic chain)

supply intercostal muscle / take blood away

found under the costal groove (on lower portion of inner surface of each of rib) + protects the structures

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28
Q

what is the structure of the intercostal space

A

1) external intercostal muscle most superficial
2) then internal
3) then the neurovascular bundle (ALWAYS runs vein, artery, nerve top to bottom VAN)
4) deep to this is innermost

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29
Q

how do intercostal muscles help to move the position of the ribcage

A
  • ribcage moved up + out of sternum when external intercostal in upper ribs pull to move ribs up in inspiration which increases anteroposterior diameter making more room for lungs to expand
  • when external intercostal contract, lower ribs move up + out increasing diameter across entire ribcage (transverse diameter) in inspiration
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30
Q

what are the 2 divisions of the thoracic cavity

A 
superior mediastinum
inferior mediastinum (made up of anterior, middle + posterior portions)

mediastinum encloses / contains heart, major vessels + nerves, trachea (carrying air to lungs) + oesophagus

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31
Q

what happens to the trachea once in the thoracic region

A

divides into 2 primary bronchi

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32
Q

what is present either side of the mediastinum

A

pleural cavities consisting of 2 pleural sacs which cover the lungs

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33
Q

what is the name of the point where the manubrium meets the sternum and what does it allow us to do

A

STERNAL ANGLE

  • know what separates superior mediastinum (run above it) from the inferior (below it)
  • 2nd rib attaches at level of it
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34
Q

what level would the sternal angle cut through

A

T4/5 vertebral disc

so superior mediastinum above level of T4/5 and inferior below

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35
Q

what structures are contained in the superior mediastinum

A 
thymus 
trachea
oesophagus
vagus nerves
phrenic nerves
left recurrent laryngeal branch of the vagus nerve
thoracic duct
great vessels (aorta, superior vena cava, pulmonary trunk - artery + vein)
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36
Q

what structures are contained in the inferior mediastinum

A

anterior = area between posterior aspect of sternal body + anterior aspect of pericardium. contains ligaments binding fibrous pericardium to posterior aspect of the sternum with 1/2 lymph nodes + small vessels

middle = heart which is surrounded by 1 fibrous pericardium layer (tough sac) externally
2 serous pericardium layers (secrete serous pericardial fluid = facilitates movements associated w beating of heart) underneath between which is the pericardial cavity (parietal layer on inner surface of fibrous flips to make continuous visceral layer)
Serous pericardium extends around aorta + pulmonary trunk as they pass through fibrous pericardium and surrounds superior + inferior venae cavae + 4 pulmonary veins near their terminations
the visceral serous pericardium (epicardium) forms part of heart wall
also pulmonary trunk, the two bronchi, the ascending aorta and the terminal part of the superior vena cava

posterior = oesophagus, descending aorta, thoracic duct, azygous + hemiazygous vein, sympathetic chain, lymph nodes, thoracic splanchnic nerves

37
Q

what is the function of the

a) sympathetic chain
b) the thoracic duct

A

a) helps control nervous impulses to heart and lungs - chain of sympathetic nerves, run paravertebrally down through thoracic region to abdomen, only receive contributions in thoracic region, contain different ganglia (cell bodies)
b) v deep between aorta and azygous vein, biggest lymph vessel in body, takes lymph back from body back to venous system so it can be recirculated

38
Q

what is the function of the azygous vein

A

takes blood back to inferior vena cava from lower portions of body
drains digestive tract and posterior intercostal veins

39
Q

describe the aorta

A

ascending aorta comes out of heart, the arch of the aorta gives off branches to the h+n then loops downwards becoming the descending aorta which supplies blood to the rest of the trunk (abdomen, pelvis, lower limbs)

40
Q

what are the 3 branches coming directly off of the aorta

A

1) brachiocephalic trunk = first branch of aorta
2) left common carotid artery = supplies left of h+n
3) left subclavian artery = supplies left upper limb

41
Q

what does the braciocephalic trunk split into

A

right subclavian artery = supplies right upper limb

right common carotid artery = supplies left of h+n

42
Q

what veins drain into the heart

A

right internal jugular vein and right subclavian vein combine to form the right braciocephalic vein

same 2 veins combine to form braciocephalic vein on the left

the 2 braciocephalic veins combine to form the superior vena cava which drains into right atrium

43
Q

what are the 3 branches of the thoracic aorta

A

1) paired, segmental branches to the body wall = ie intercostal arteries
2) paired arteries to paired internal organs = ie bronchial arteries (go to bronchi)
3) ventral, unpaired arteries to to GIT = ie oesophageal arteries

44
Q

explain the intercostal arteries given off by the aorta

A

12 sets of posterior intercostal arteries given off directly from the aorta on both sides (12 sets so 1 for each intercostal space)

45
Q

what surrounds the lungs and what is it

A

PLEURA
membraneous sac enclosing the pleural cavity
lung pushes its way into the sac until the 2 layers of the pleura are against each other

46
Q

what are the 2 layers of pleura

A

1) visceral pleura = at front, inner membranous layer of tissue directly on / covering the lung and adjoining structures
2) parietal pleura = at back, outer layer of tissue against / covers inside of thoracic wall

47
Q

what is in between the 2 layers of pleura and what does it aid with

A

PLEURAL CAVITY

  • thin layer in middle
  • contains thin film of serous fluid
  • helps maintain lubrication so lungs can expand and contract wout friction
  • creates surface tension between parietal and visceral layers to aid inspiration (when ribcage moves up + out parietal pleura is pulled with it creating tension between the 2 layers so visceral layer is pulled outwards to help lungs expand + take air in)
48
Q

name the structures entering the lungs from largest to smallest

A

1) trachea = descends as a single tube through the superior mediastinum
2) r+l primary bronchi = trachea divides into these at level of T4, this bifurcation point is called the carina
3) secondary bronchi + bronchioles = bronchi pass through their hilum before dividing into these
4) alveoli

49
Q

what are the structures of the lungs

A

1) apex = the top of the lungs
2) superior lobe
3) middle lobe (right only)
4) inferior lobe
5) oblique fissure
6) transverse / horizontal fissure (right only)

50
Q

what does the oblique fissure do

A

separates superior and inferior lobes

on both sides

51
Q

what does the horizontal fissure do

A

separates the superior and middle lobes

on right side

52
Q

what does the left lung have that the right does not

A

LINGULA

tongue like projection of its superior lobe

53
Q

how do structures enter and leave the lung

A

HILUM OF THE LUNG

  • medial aspect of lung next to the heart
  • corresponds to 4-5th costal cartilages
  • corresponds to T5/7 poseriorly
  • left lung hilum = pulmonary artery superiorly, primary / main bronchus dividing into 2 secondary bronchus, 2 pulmonary veins inferiorly, pulmonary ligament (pleura gathers together from each side to form it)
  • right lung hilum = same but 2 pulmonary arteries anteriorly, bronchus has thick wall (3 secondary bronchi) + lies posteriorly, 3 pulmonary veins in inferior

1 secondary bronchi for each lobe

54
Q

what two impressions do the lungs have (bc lungs are soft)

A

1) cardiac impression = made by heart, deeper on left lung as heart points heavily towards lhs of thorax
2) aortic impression = made by arch of aorta as it arches and descends near posterior border of left lung / over top of hilum of left lung
3) azygous vein impression = posterior to hilum + over top of it in right lung
4) rib impressions = costal (lateral) surfaces of both lie alongside ribs so bear impressions from the ribs on this surface

55
Q

what are the
a) right
b) left
AV valves called

A

a) tricuspid valve (has 3 cusps)

b) mitral / bicuspid valve (2 cusps)

56
Q

what are the
a) right
b) left
semilunar valves called

A

a) pulmonary

b) aortic

57
Q

what are the cusps of the AV valves attached to

A

papillary muscles (in wall of ventricle) which has chordae tendineae (tendinous strands referred to as heart strings) coming off it

58
Q

how do the papillary muscles prevent backflow

A
  • when heart contracts they become tight and contract
  • chordae tendineae become taute
  • cusps of valves are forced closed
  • bc chordae tendineae are pulled tight the valve cannot invert on itself so blood is forced out through aorta / pulmonary artery
59
Q

how does heart contract, what does this allow

A
  • contractions in heart sent down through middle causing heart to contract from bottom upwards
  • allow blood flow from atria to ventricle
60
Q

which blood vessels supply the heart muscle

A

coronary arteries

- right and left coronary arteries

61
Q

what are the branches of the right coronary artery

A

it emerges from aorta
curves around heart in a groove (coronary sulcus - coronal = crown) to the posterior aspect
then gives off
1) right posterior descending / intraventricular
2) right marginal branch = runs along inferior border of heart

62
Q

what do branches of the right coronary artery supply

A
  • conducting centres of the heart (SAN + AVN)

- these control impulses through atria down towards ventricle to enable heart to contract

63
Q

what are the branches of the left coronary artery

A

emerges from aorta

1) left anterior descending artery
2) circumflex artery (curves posteriorly on heart)

64
Q

what do branches of the left coronary artery supply

A

mainly left ventricle

65
Q

how is deoxygenated blood carried away from heart muscle and back to heart

A

CORONARY VEINS
great cardiac vein collects 2/3 blood from heart muscle
it drains into the coronary sinus which empties into right atrium
sits in coronary sulcus
anterior cardiac veins (3–4) open directly into right atrium

66
Q

what are the pec muscles

A

pec major
pec minor
surround the thoracic cage

67
Q

what does the vagus nerve do in the thorax

A

goes from brain down TO the colon

gives of recurrent larangeal nerve which supplies the larynx

68
Q

how do interior intercostal arteries arise

A

internal thoracic artery (branch of right subclavian artery) gives rise to them
it also gives of musculophrenic artery

69
Q

how does the trachea maintain its structure

A

rings of cartilage

70
Q

describe the

a) posterior
b) anterior border of lungs

A

a) much wider than anterior, smooth

b) much thinner, not smooth

71
Q

what is visible on costal (back) surface of lung

A

ridges where ribs cause an indent

72
Q

what heart structure is used in development, what does it become in adults

A

ductus arteriosis = shunts oxygenated blood from pulmonary trunk (oxy blood carried into body by umbilical vein) into aorta so it can go through descending aorta

becomes ligamentum arteriosum
not used as adult

73
Q

describe internal features of the right atrium

A
  • muscular inner wall (pectinate muscle)
  • smooth muscle = crysta terminalis
  • 2 above help distinguish right atria
  • 3 cusps of av valve
  • fossa ovalis = indentation in adult heart (during development = hole shunting blood flow from right to left atrium) called foramen ovali in development
  • left atrium similar
74
Q

describe internal features of the right ventricle

A
  • inner surface = trabeculae carneae muscle (to which cords are attached + extensions of these muscles are the papillary muscles)
  • deep to trabeculae carneae = papillary muscles project out into ventricular lumen (attached to chordae tendineae)
  • tricuspid valve = papillary muscle to chordae tendineae to tricuspid valve
  • papillary muscle + chordae tendineae prevent inversion of cuspid valve when ventricle contract
  • moderator band comes off septum, helps slow speed of conduction through ventricles so they contract AFT atria have contracted
  • 3 cusps of SL (2 anteriorly, 1 posteriorly) valves in pulmonary trunk (pulmonary valves)
75
Q

describe internal features of the left ventricle

A
  • trabeculae carneae
  • thicker papillary muscle and walls
  • chordae tendineae go up to inferior portion of heart toward a cusp of av valve
76
Q

give the names and location of pleura covering the lungs (as pleura changes name depending on where it is)

A
  • visceral plural = tightly directly stuck to lung
  • folds on itself to become parieral pleura
  • cervical pleura = if take deep breath lungs come up into clavicle / cervical region
  • costal pleura = directly in contact w ribs
  • diaphragmatic parietal pleura = on top of diapraghm
  • in between the pleuras (space between them)
    parietal pleura have mediastinal, costal, diaphragmatic pleura cervical parietel pleura
77
Q

function of costal cartilage

A

expansion of the thorax and extension of the ribs

contributes to elasticity of walls of thorax

78
Q

what distinguishing features do thoracic vertebrae have

A

(superior and inferior) facets on the sides of the vertebral bodies for articulation with the heads of the ribs, and facets on the transverse processes of all (except 11th and 12th) for articulation with rib tubercles
demifacet for rib head

79
Q

how do adjacent vertebrae articulate

A

upper surfaces of lamina

80
Q

where are visceral and parietal layers of pleura continuous

A

at hilum of lung

81
Q

a) function of the thymus in children

b) how thymus structure changes with age

A

a) production and maturation of T-lymphocytes or T cells

b) shrinks rapidly with age from puberty(older individuals at greater risk for life-threatening infections)

82
Q

what is the posterior mediastinum is bounded by

a) anteriorly
b) posteriorly
c) laterally

A

a) posterior aspect of fibrous pericardium
b) anterior surface of thoracic vertebral bodies T4- T12
c) mediastinal parietal pleura

83
Q

function of

a) hemiazygos
b) accessory hemiazygos veins

A

a) drain left mediastinum and left lower esophagus

b) with azygous = drain most posterior intercostal veins on lhs of body

84
Q

what could cause “mediastinal shift” what are the consequences in the thoracic cavity

A

volume expansion or loss on one side of thorax

compression of lung on unaffected side
life-threatening = pressure on great vessels causes dec in venous return, reduced CO, decreased BP and hypoxia = lead to shock

85
Q

what stage of the cardiac cycle does blood flow into the coronary arteries

A

peaks during ventricular diastole

86
Q

consequence of a blockage in the anterior interventricular (left anterior descending) artery?

A

myocardial infarction

high fatality risk

87
Q

what separates the rough and a smooth portion of relatively thin wall of the right atrium

A

ridge = the crista terminalis internally
smaller rough area = auricular appendage, w elevations (pectinate muscles)
smooth walled portion (sinus venarum) receives openings of superior and inferior venae cavae and coronary sinus

88
Q

describe internal features of the left atrium

A
  • thin walled
  • smooth and roughened portion
  • roughened portion = auricular appendage
  • smooth walled portion is formed by incorporation of the 4 pulmonary veins during development

HHP (10 decks)

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