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Anatomy - Modules 3 & 4 > Thorax & Back > Flashcards

Thorax & Back Flashcards

1
Q

What are the typical vertebrae?

A

C3 - L5

  • body
  • verterbral arch (pedicles & lamina)
  • spinous process (attachment for spinal mm)
  • transverse process (attachment lever for spinal musc)
  • articular proc (sup. & inf. - form facet joints b/t vertebrae)
  • vertibral notches (sup. & inf.)
  • intervertebral foramen
  • vertebral foramen
  • vertebral canal
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1
Q

Identify and describe the function of the fibrous skeleton

A
  1. four fibrous rings surround the orifices of the valves
  2. provides attachments for myocardium of atria and ventricles
  3. provide attachment for cardiac valves
  4. provide electrical insulation b/t atria and ventricles
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2
Q

Latissimus dorsi

(superficial back)

A

A: extends, adducts, and medially rotates humerus

O (proximal): SPs T7-L5, thoracolumbar fascia, iliac crest, and last 3 ribs.

I (distal): humerus

Innerv: thoracodorsal nerve

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2
Q

Aortic valve

A

Located b/t left ventricle and the aorta

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3
Q

Name the joints of the posterior thorax

A
  1. Costovertebral
  2. Costotransverse
  3. Intervertebral (IV) joints of the thoracic spine (discs and facets)
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4
Q

Trapezius

(superficial back)

A

Action: elevates, rotates, and retracts scapula; lower fibers depress scap.

O: superior luchal line, external occipital protuberance, nuchal ligament, SPs of C7-T12

I: lateral third of clavicle, acromion, spine of scapula

Innerv: CN 11

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4
Q

Rhomboid major

(superficial back)

A

Major:

A: fixes scap to thoracic wall & retracts and rotates it to depress glenoid cavity.

O: SPs T2-T5 vertebrae

I: medial border of scap below base of spine of scapula

Innerv: dorsal scapular nerve

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4
Q

Serratus Posterior Inferior

(intermediate back)

A

A: depresses ribs

O: SPs of T11-12

I: inferior aspect of tibs 9-12

Innerv: ventral rami of lower thoracic ribs

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4
Q

Costal angle

A

The end of the ribs on either side, the upside down V with xiphoid process in the middle

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5
Q

Name the joints of the vertebral column

A
  1. facet joints
  2. intervertebral discs
  3. uncovertebral (joints of Luschka)
  4. atlanto-axial joint
  5. atlanto-occipital joint
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5
Q

What is thoracic outlet syndrome?

A

When emerging structures from the thoracic inlet are affected by obstructions of the superior thoracic apperature, like arteries and T1 spinal nerves.

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6
Q

Meningocele

A

condition in which the meninges protrude through bony defect of vertebral arch

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8
Q

Identify landmarks of the lower quadrant

A
  1. CVA
  2. T12
  3. lower trapezius
  4. lumbar paraspinal muscles
  5. iliac crest
  6. L4
  7. posterior superior iliac spine
  8. sacrum
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9
Q

Thoracic vertebrae

A

Body - heart shaped, costal facets

Circular, small vertebral foramen

Transverse processes are long and have facets for articulation with the ribs

Long spinous processes that extend inferiorly to the segment below.

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9
Q

What landmarks are in the sternal angle?

A

bifurcation of the trachea (carina)

beginning and ending of the aortic arch

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10
Q

Facet joints

A

synovial joints b/t superior and inf. facets of articular process

  • enhance or limit movement depending on motion
  • some weight bearing function in C & L regions

Prone to degenerative changes - limited movement & pain

excessive bone spurs can cause stenosis of intervetebral foramen

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10
Q

Anterior intercostals

A

Pass between internal and innermost intercostal muscles

comes from internal thoracic and musculophrenic arteries

Supply anterior 1st - 9th intercostal spaces

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11
Q

muscles used during expiration

A

rest: elastic recoil
exercise: internal intercostals, abs (rectus abdominus, int/ext oblique)

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12
Q

Which ligaments are unique to the cervical spine?

A
  1. Anterior atlanto-occipital membrane
  2. Tectorial membrane (cont. of PLL)
  3. Posterior atlanto-occipital membrane
  4. Nuchal ligament (cont. of supraspinous lig. EOP to C7, acts as septum separating muscles of R/L posterior neck)
  5. Crucitate ligament (stabilizes dens against anterior arch of C1) Contains transverse, superior, and inferior bands)
  6. Alar ligament (extends from sides of dens to lateral margin of foramen mangum - limit exc. rotation)
  7. Apical ligament (apex of dens for FM)
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12
Q

Name the joints of the anterior thorax

A
  1. Costochondral joints
  2. Sternocostal joints
  3. Sternoclavicular (SC) joints
  4. interchondral joints - articulation b/t costal cartilages of lower ribs
  5. Manubriosternal (sternal angle)
  6. Xiphodsternal joint
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12
Q

Superior VC

A

returns blood back to the right atrium from area superior to diaphragm (but not heart and lungs)

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12
Q

Coronary sinus

A

most of the cardiac veins drain into this

coronary sinus drains directly into the right atrium

great, middle, and small cardiac veins and oblique vein of the left atrium all empty into coronary sinus

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13
Q

Rhomboid Minor

(superficial back)

A

A: fixes scapula to thoacic wall and retracts & rotates it to depress glenoid cavity.

O: ligamentum nuchae, spines of C7 and T1 vertebrae

I: medial border of scapula at spine of scap

Innerv: dorsal scap nerve

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14
Q

Right coronary artery

A

Supplies:

right atrium

most of the right ventricle

diaphragmatic surface of the left ventricle

SA and AV nodes

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15
Q

Posterior intercostals

A

Pass between internal and innermost intercostal muscles. Overly intercostal muscles, and parietal pleura.

Comes from superior intercostal artery and throacic aorta

Supply all of the 10th and 11th intercostal spaces

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16
Q

Myelomeninocele

A

condition in which both the spinal cord and meninges protrude through a defect in the vertebral arch

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17
Q

What is the primary curve?

A

Kyphotic (“hump”)

thoracic and sacral

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17
Q

endocardium

A

thin, smooth lining layer of the heart chambers (outermost layer)

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18
Q

Which muscles form the intermediate layer of the back?

A
  1. Serratus posterior superior
  2. Serratus posterior inferior
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19
Q

Tricuspid valve

A

Located b/t right atrium and right ventricle.

Chordae tendineae and papillary muscles anchor the cusps

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20
Q

What structures are located in the middle mediastinum?

A

Region in throacic cavity WITHIN THE PERICARDIUM

  1. pericardium
  2. heart
  3. root of great vessels
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21
Q

What are the structures of the sternum?

A
  1. manubrium
  2. sternum
  3. xiphoid
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22
Q

What is the developmental curve?

A

Birth - 1 degree only

Infant: hold head up - develop 2 in cervical

begin to walk - develop 2 in lumbar

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24
Q

What are the atypical vertebrae?

A

Atlas (C1) & Axis (C2)

anterior and posterior arch and tubercle

  1. Lateral Mass - superior facets articulate w/occiput
    * flexion & extension movement
  2. Inferior facets articulate w/ C2 for rotation movement

DENS (C2)

forms the pivot for rotation b/w C1 and C2

forms synovial joint with anterior arch of C1

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25
Q

Cauda equina

A

Dangling roots at the end of the spinal cord that resemble a horse’s tail.

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26
Q

What are the landmarks of the left atrium

A
  1. foramen ovale
  2. 4 openings of the pulmonary veins
  3. bicuspid valve
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26
Q

What structures are in the superior aperature?

A

esophagus

trachea

spinal nerves

blood vessles that support head, neck, and UE

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28
Q

Identify the movements of the spine

A
  1. flexion
  2. extension
  3. lateral flexion
  4. rotation
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29
Q

Obliquus Capitis

(inferior and superior)

A

Superior:

A: extends and bend head laterally

O: TP of atlas

I: occipital bone

Inferior:

A: rotates atlas to turn face to SAME SIDE

O: spine of axis

I: TP of atlas

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31
Q

Describe lordosis

A

Occurs in lumbar region - excessive anterior curve

seen in orthopedic anomalies, postural habits, pregnancy. (think “butt sticking out”)

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32
Q

Muscles of the thoracic wall

A
  1. external intercostals - INSPIRATION
  2. internal intercostals - EXPIRATION
  3. innermost intercostals - ELEVATE
  4. transverse thoracis - EXPIRATION, DEPRESS
  5. subcostal - INSPIRATION, ELEVATE
  6. levator costarum - INSPIRATION, ELEVATE
  7. serratus posterior superior/inferior - INSP/EXP respec.
  8. diaphragm - PHRENIC NERVE - INSPIRATION
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33
Q

What is the function of the fibrous skeleton?

A
  1. four fibrous rings, surround the orifices of the valves
  2. provides attachments for myocardium of atria and ventricles
  3. provides attachment for cardiac valves
  4. provide electrical insulation b/t atria and ventricles
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34
Q

Ribs 8 - 10 are classified as what?

A

False ribs. They attach “indirectly” to the sternum.

36
Q

Describe intervetebral joint structure

(source of herniation)

A

Disc - acts as shock absorber, influences motion

composed of water, collagen fibers, proteoglycans

NO DISC b/t occiput and C1 - C2

Annulus fibrosis - concentric layers composed of collagen fibers.

anchor disc to bone or cartilaginous end plate

outside layer blends w/ ALL and PLL

Nucleus pulposus - polyglycans attract H2O to this portion of the disc (aging :(

39
Q

Describe uncovertebral (joints of Luschka)

A

Formed by uncinate process of C3 to C7

“pseudo joint”

prone to bone spur formation

joint looks similar to a synovial joint

40
Q

Identify landmarks of the upper quadrant

A
  1. C7
  2. medial scapula border
  3. spine of scapula
  4. inferior angle of scapula
  5. upper trapezius
41
Q

What muscles are used during normal ventilation?

A

Inspiration:

rest - diaphragm

exercise - diaphragm + external intercostals

extreme exercise - above, plus accessory muscles (SCM and scalenes)

Expiration:

rest - elastic recoil

exercise - recruit the internal intercostals + abdom. muscles

43
Q

Levator Scapula

(superficial back)

A

A: elevates scapula medially, inferiorly rotates glenoid cavity. Ipsilateral flexion - rotates to the same side.

O: posterior tubercles of transverse processes of C1-C4

I: medial border of scap from superior angle to spine

Innerv: ventral rami of C3-C4 and dorsal scap nerve

43
Q

Describe the superior aperature

A

Contains the:

  1. esophagus
  2. trachea
  3. nerves & blood vessels that supply the head, neck and UE
43
Q

Left coronary artery

A

Supplies:

left atrium

most of the left ventricle

part of the right ventricle

most of the IVS

44
Q

Anterior and posterior radicular arteries

A

Course along most nerve roots and supply blood to the dorsal and ventral roots of the spinal nerves.

45
Q

Inferior aperature

A

esophagus

IVC

aorta to pass inferiorly to the abdominal cavity

46
Q

What structures are located in the anterior mediastinum?

A

Region in the throacic cavity ANTERIOR TO THE PERICARDIUM

  1. internal thoracic vessels’
  2. fat
  3. few lymph nodes
48
Q

Lumbar vertebrae

A

Kidney shaped body

Triangular shaped vertebral forament ( larger than T, smaller than C)

Sturdy, hatched shaped spinous processes

accessory process located at the base of spinous processes

mammillary process located on superior articular pillar

49
Q

Semispinalis

(deep layer of deep back)

A

A: extends head, neck, & thorax and rotates them to OPPOSITE SIDE

O: TP of C4-T12

I: SP of cervical and thoracic regions

INnerv: dorsal rami of spinal nerves

50
Q

What structures are located in the posterior mediastinum?

A

Region in the thoracic cavity POSTERIOR TO THE PERICARDIUM

  1. esophagus
  2. decending thoracic aorta
  3. thoracic duct
  4. lymph nodes
51
Q

Multifidi and Rotators

(deep layer of deep back)

A

A: stabilizes spine

O: sacrum, ilium, TP of T1-T12, and articular proc. of C4-C7

I: SPs of vertebrae above, spanning two to four segments

Rotators stabilize and rotate spine

52
Q

Intercostal nerves

A

Run along the extent of the intercostal spaces.

Anterior and posterior intercostal nerves.

54
Q

Identify the ligaments of the vertebral column

A
  1. Anterior longitudinal ligament (ALL)
  2. Posterior longitudinal ligament (PLL)
  3. Ligamentum flavum - connects the lamina b/t each vertebrae. High elastin content. Restores neutral position of the spine.
  4. Interspinous ligaments - connect adjacent SPs
  5. Supraspinous ligaments - connect adjacent SPs (C7-sacrum)
55
Q

What structures are in the superior mediastinum

A

Region in thoracic cavity SUPERIOR TO THE PERICARDIUM

  1. thymus (children)
  2. arch of aorta/great vessels
  3. trachea
  4. esophagus
57
Q

What is the secondary curve?

A

cervical and lumbar

Lordotic (curving forwards)

57
Q

Pulmonary trunk

A

sends unOX blood from the right ventricle to lungs

58
Q

Identify landmarks of the sacrum

A

Apex - inferior end of sacrum (just above coccyx)

Base - superior portion of S1 (the large top, actually)

Promontory - prominent anterior edge of 1st vertebra (round part at base)

Ala - sup/lateral portion of sacrum (wing!)

Median sacral crest - midline, formed by fused SPs (seen only from the back)

Sacral hiatus - formed by failure of lamina of S5 to fuse

Sacral cornu - formed by pedicles of S5 (either side of hiatus)

Sacral canal - (base) contain nerve roots of cauda equina

58
Q

What are the landmarks of the right atrium

A
  1. SVC/IVC openings
  2. opening to the coronary sinus’
  3. fossa ovalis
  4. tricuspid valve
60
Q

Describe the inferior aperature

A

Allows the esophagus, IVC, and aorta to pass inferior to abdominal cavity.

61
Q

Which muscles form the superficial layer of the back?

A
  1. Trapezius
  2. Latissimus dorsi
  3. Rhomboid major/minor
  4. Levator scapula
62
Q

There are two enlargements on the spinal cord. Where are they?

A

Cervical enlargement

Lumbar englargement

63
Q

Vertebral structures that may refer to the back

A
  1. vertebrae (bone)
  2. intervertebral disc
  3. facet joints
  4. ligaments of spine
  5. nerve roots
64
Q

The transverse dimension of the thorax increases slightly when the intercostal muscles contract, raising the middle (lateral-most parts) of the ribs (especially the lower ones. This is called the:

A

Bucket -handle movement

65
Q

Dentate (denticulate) ligaments

A

act as anchors to the spine - formed by pia matter.

most intimate layer.

PIA filament comes down (just one) from that

66
Q

Conus medullaris

A

The tail end of the spinal cord

67
Q

Vasculature of the thoracic wall

A

Thoracic aorta - through the posterior intercostal and subcostal arteries

Subclavian artery - through the intercostal throacic and supreme intercostal arteries.

Axillary artery- through superior and lateral thoracic arteries

68
Q

Spina Bifida Occulta

A

failure of vertebral arch to fuse, no spinous process developed. Just bone/bone with a space in between.

68
Q

What are the landmarks of the right ventricle

A
  1. tricuspid valve
  2. papillary muscle/chordae tendineae
  3. pulmonary valve
70
Q

Which are the floating ribs?

A

11 and 12. They do not attach to the sternum at all.

71
Q

Anterior and posterior segmental medullary arteries

A

Derived from the spinal branches of the acending cervical, deep cervical, postior intercostal, and lumbar arteries. Located at cervical and lumbar enlargements - where there is a lot of blood flow.

73
Q

The AP dimension of the thorax increases considerably when the intercostal muscles contract. Movement at the ribs (2nd - 6th) at the costovertebral joints around an axis passing through the necks of the ribs causes the anterior ends of the ribs to rise. This is called the:

A

Pump-handle movement

75
Q

What are the landmarks of a typical rib?

A
  1. Head - have facets that articulate w/ transverse process
  2. neck
  3. tubercle - articulates w/ transverse process
  4. shaft - thin, flat curves
  • common site of rib fracture, weakest point of the rib

Ribs 3-9 are “typical”

76
Q

Which muscles form the deep layers of the back?

A

Superficial deep:

  1. Splenis capitis/cervicis

Intermediate deep:

  1. Erector spinae (3)

Deep deep:

  1. Semispinalis
  2. Multifudi
  3. Rotators
77
Q

Transverse thoracis

A

Depresses ribs - expiration

Located on internal anterior thoracic cage

78
Q

Anterior spinal artery

A

Supplies the anterior portion of the spinal cord. Arises from the branches of the vertebral arteries.

79
Q

Erector Spinae

(intermediate deep layer)

A
  1. Iliocostalis
  2. Longissimus
  3. Spinalis

A: extends and laterally bends vertebral column and head

O: posterior sacrum, iliac crest, sacrospinus lig, SPs of lower lumbar &m sacral vertebrae.

Innerv: dorsal rami of each region

80
Q

What are the landmarks of the left ventricle

A
  1. bicuspid valve
  2. papillary muscle/chordae tendineae
  3. aortic valve
81
Q

Describe kyphosis

A

Occurs in T spine - excessive posterior curve

old age, posture, compression fx

82
Q

Describe the atlanto-occipital joint structure

A

synovial joints b/t C1 facet and occipital condyles

provides flexion/extension movement of the head/neck

83
Q

Which muscles form the sub-occipital region?

A
  1. rectus capitis posterior major
  2. rectus capitis posterior minor
  3. obliquus capitis inferior
  4. obliquus capitis superior
84
Q

Describe scoliosis

A

Lateral deviation w/ rotary component of the spine

curve named for convexity

85
Q

Muscles used during inspiration

A

rest: diaphragm
exercise: diaphragm + intercostals

heavy exercise: above, plus accessory muscles (SCM and scalenes) maybe pecs

86
Q

Rectus Capitis Posterior

(major and minor)

A

Major: extends and rotates head to the SAME SIDE

O: spine of axis

I: inferior nuchal line

Minor:

A: entends head

O: tubercle of posterior arch of atlas

I: median inferior nuchal line

87
Q

Pericardium

A

Double walled, fibroserous sac

Outside sac: fibrous pericardium. Attached to diaphragm via pericardiacophrenic ligament. Also attaches to sternum via sternopericardial ligament.

Inside sac: serous pericardium. Two layers - parietal and visceral

88
Q

Describe atlanto-axial joint structure

A

Comprised of facet joints C1 and C2 AND dens and anterior arch.

Provides rotation of the head/neck

89
Q

Inferior VC

A

returns blood back to the right atrium from areas inferior to the diaphragm

90
Q

Azygos Vein

A

Most posterior intercostal veins drain into this, semi-azygos and to SVC

92
Q

Ribs 1- 7 are classified as what?

A

True ribs. They attach “directly” to the sternum.

92
Q

Pulmonary valve

A

located b/t the right ventricle and pulmonary trunk

auscultate along left 2nd intercostal space

93
Q

Aorta

A

sends blood to body from left ventricle, branches of the aortic arch are:

Bracheocephalic trunk gives rise to RCC and R subclavian artery

LCC

L subclavian artery

95
Q

What structures are located in the sub-occipital triangle?

A

BORDERS ARE:

rectus capitis posterior major DOES NOT INCLUDE RC CAP MINOR

obliquus capitis inferior and superior

AND INCLUDES:

  1. vertebral artery
  2. sub-occipital nerve (C1)
97
Q

Bicuspic valve

A

Located b/t atrium and left ventricle

Chordae tendinae and papillary muscles anchor

98
Q

epicardium

A

blends into visceral layer of serous pericardium

99
Q

Splenius Capitis/Cervicis

(superficial deep layer)

A

Capitis:

A: bilaterally - extend head

unilaterally - laterally bends and rotate face to SAME SIDE

O: nuchal ligament, SP C7-T3

I: mastoid process

Innerv: dorsal rami of middle cervical nerves

Cervicis:

A: bilaterally - extends neck (cap does head) unilaterally - bends and rotates neck toward SAME SIDE

O: SP T3-T6

I: transverse process C1-C3

100
Q

Anterior auscultation landmarks

A
  1. R/L 2nd intercostal space
  2. Erb’s point - left 3rd ICS
  3. left sternal border - 4th or 5th
    ICS
  4. left 5th ICS - midclavicular
102
Q

Identify the curves of the spine

A

KYPHOTIC (primary curves)

  1. thoracic
  2. sacral
  3. birth primary curve only

LORDOTIC (secondary curves)

  1. cervical (hold head/sit upright)
  2. lumbar (stand/walk)
103
Q

myocardium

A

cardiac muscle

104
Q

Serratus Posterior Superior

(Intermediate back)

A

A: elevates ribs

O: ligamentum nuchae, SPs of C7-T3

I: superior aspect of ribs 2-4

Innerv: ventral rami of upper thoracic nerves

105
Q

R/L pulmonary veins

A

returns OX blood back to the left atrium from the lungs

106
Q

Cervical vertebrae

A

TYPICAL - C3 - L5

Body is small, wider side to side

Large triangular vertebral foramen

Vertebral artery ascends through C1 - C6 via transverse foramen

Spinous process

  • bifid C3 - 5
  • C7 - most prominent
107
Q

Internal thoracic artery

A

Origin: subclavian artery

passes inferiorly and lateral to sternum b/t costal cartilages and transverse throacic muscle to divide into superior epigastric and musculophrenic arteries

Anatomy - Modules 3 & 4 (1 decks)

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