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
1
Q
Identify and describe the function of the fibrous skeleton
A
- four fibrous rings surround the orifices of the valves
- provides attachments for myocardium of atria and ventricles
- provide attachment for cardiac valves
- provide electrical insulation b/t atria and ventricles
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
2
Q
Aortic valve
A
Located b/t left ventricle and the aorta
3
Q
Name the joints of the posterior thorax
A
- Costovertebral
- Costotransverse
- Intervertebral (IV) joints of the thoracic spine (discs and facets)
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
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
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
4
Q
Costal angle
A
The end of the ribs on either side, the upside down V with xiphoid process in the middle
5
Q
Name the joints of the vertebral column
A
- facet joints
- intervertebral discs
- uncovertebral (joints of Luschka)
- atlanto-axial joint
- atlanto-occipital joint
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.
6
Q
Meningocele
A
condition in which the meninges protrude through bony defect of vertebral arch
8
Q
Identify landmarks of the lower quadrant
A
- CVA
- T12
- lower trapezius
- lumbar paraspinal muscles
- iliac crest
- L4
- posterior superior iliac spine
- sacrum
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.
9
Q
What landmarks are in the sternal angle?
A
bifurcation of the trachea (carina)
beginning and ending of the aortic arch
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
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
11
Q
muscles used during expiration
A
rest: elastic recoil
exercise: internal intercostals, abs (rectus abdominus, int/ext oblique)
12
Q
Which ligaments are unique to the cervical spine?
A
- Anterior atlanto-occipital membrane
- Tectorial membrane (cont. of PLL)
- Posterior atlanto-occipital membrane
- Nuchal ligament (cont. of supraspinous lig. EOP to C7, acts as septum separating muscles of R/L posterior neck)
- Crucitate ligament (stabilizes dens against anterior arch of C1) Contains transverse, superior, and inferior bands)
- Alar ligament (extends from sides of dens to lateral margin of foramen mangum - limit exc. rotation)
- Apical ligament (apex of dens for FM)
12
Q
Name the joints of the anterior thorax
A
- Costochondral joints
- Sternocostal joints
- Sternoclavicular (SC) joints
- interchondral joints - articulation b/t costal cartilages of lower ribs
- Manubriosternal (sternal angle)
- Xiphodsternal joint
12
Q
Superior VC
A
returns blood back to the right atrium from area superior to diaphragm (but not heart and lungs)
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
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
14
Q
Right coronary artery
A
Supplies:
right atrium
most of the right ventricle
diaphragmatic surface of the left ventricle
SA and AV nodes
15
Posterior intercostals
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
16
Myelomeninocele
condition in which both the spinal cord and meninges protrude through a defect in the vertebral arch
17
What is the primary curve?
Kyphotic ("hump")
thoracic and sacral
17
endocardium
thin, smooth lining layer of the heart chambers (outermost layer)
18
Which muscles form the intermediate layer of the back?
1. Serratus posterior superior
2. Serratus posterior inferior
19
Tricuspid valve
Located b/t right atrium and right ventricle.
Chordae tendineae and papillary muscles anchor the cusps
20
What structures are located in the middle mediastinum?
Region in throacic cavity WITHIN THE PERICARDIUM
1. pericardium
2. heart
3. root of great vessels
21
What are the structures of the sternum?
1. manubrium
2. sternum
3. xiphoid
22
What is the developmental curve?
Birth - 1 degree only
Infant: hold head up - develop 2 in cervical
begin to walk - develop 2 in lumbar
24
What are the atypical vertebrae?
Atlas (C1) & Axis (C2)
anterior and posterior arch and tubercle
1. Lateral Mass - superior facets articulate w/occiput
* flexion & extension movement
1. 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
25
Cauda equina
Dangling roots at the end of the spinal cord that resemble a horse's tail.
26
What are the landmarks of the left atrium
1. foramen ovale
2. 4 openings of the pulmonary veins
3. bicuspid valve
26
What structures are in the superior aperature?
esophagus
trachea
spinal nerves
blood vessles that support head, neck, and UE
28
Identify the movements of the spine
1. flexion
2. extension
3. lateral flexion
4. rotation
29
Obliquus Capitis
| (inferior and superior)
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
31
Describe lordosis
Occurs in lumbar region - excessive anterior curve
seen in orthopedic anomalies, postural habits, pregnancy. (think "butt sticking out")
32
Muscles of the thoracic wall
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
33
What is the function of the fibrous skeleton?
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
34
Ribs 8 - 10 are classified as what?
False ribs. They attach "indirectly" to the sternum.
36
Describe intervetebral joint structure
| (source of herniation)
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
Describe uncovertebral (joints of Luschka)
Formed by uncinate process of C3 to C7
"pseudo joint"
prone to bone spur formation
joint looks similar to a synovial joint
40
Identify landmarks of the upper quadrant
1. C7
2. medial scapula border
3. spine of scapula
4. inferior angle of scapula
5. upper trapezius
41
What muscles are used during normal ventilation?
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
Levator Scapula
| (superficial back)
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
Describe the superior aperature
Contains the:
1. esophagus
2. trachea
3. nerves & blood vessels that supply the head, neck and UE
43
Left coronary artery
Supplies:
left atrium
most of the left ventricle
part of the right ventricle
most of the IVS
44
Anterior and posterior radicular arteries
Course along most nerve roots and supply blood to the dorsal and ventral roots of the spinal nerves.
45
Inferior aperature
esophagus
IVC
aorta to pass inferiorly to the abdominal cavity
46
What structures are located in the anterior mediastinum?
Region in the throacic cavity ANTERIOR TO THE PERICARDIUM
1. internal thoracic vessels'
2. fat
3. few lymph nodes
48
Lumbar vertebrae
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
Semispinalis
| (deep layer of deep back)
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
What structures are located in the posterior mediastinum?
Region in the thoracic cavity POSTERIOR TO THE PERICARDIUM
1. esophagus
2. decending thoracic aorta
3. thoracic duct
4. lymph nodes
51
Multifidi and Rotators
| (deep layer of deep back)
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
Intercostal nerves
Run along the extent of the intercostal spaces.
Anterior and posterior intercostal nerves.
54
Identify the ligaments of the vertebral column
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
What structures are in the superior mediastinum
Region in thoracic cavity SUPERIOR TO THE PERICARDIUM
1. thymus (children)
2. arch of aorta/great vessels
3. trachea
4. esophagus
57
What is the secondary curve?
cervical and lumbar
Lordotic (curving forwards)
57
Pulmonary trunk
sends unOX blood from the right ventricle to lungs
58
Identify landmarks of the sacrum
**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
What are the landmarks of the right atrium
1. SVC/IVC openings
2. opening to the coronary sinus'
3. fossa ovalis
4. tricuspid valve
60
Describe the inferior aperature
Allows the esophagus, IVC, and aorta to pass inferior to abdominal cavity.
61
Which muscles form the superficial layer of the back?
1. Trapezius
2. Latissimus dorsi
3. Rhomboid major/minor
4. Levator scapula
62
There are two enlargements on the spinal cord. Where are they?
Cervical enlargement
Lumbar englargement
63
Vertebral structures that may refer to the back
1. vertebrae (bone)
2. intervertebral disc
3. facet joints
4. ligaments of spine
5. nerve roots
64
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:
Bucket -handle movement
65
Dentate (denticulate) ligaments
act as anchors to the spine - formed by pia matter.
most intimate layer.
PIA filament comes down (just one) from that
66
Conus medullaris
The tail end of the spinal cord
67
Vasculature of the thoracic wall
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
Spina Bifida Occulta
failure of vertebral arch to fuse, no spinous process developed. Just bone/bone with a space in between.
68
What are the landmarks of the right ventricle
1. tricuspid valve
2. papillary muscle/chordae tendineae
3. pulmonary valve
70
Which are the floating ribs?
11 and 12. They do not attach to the sternum at all.
71
Anterior and posterior segmental medullary arteries
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
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:
Pump-handle movement
75
What are the landmarks of a typical rib?
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
Which muscles form the deep layers of the back?
Superficial deep:
1. Splenis capitis/cervicis
Intermediate deep:
1. Erector spinae (3)
Deep deep:
1. Semispinalis
2. Multifudi
3. Rotators
77
Transverse thoracis
Depresses ribs - expiration
Located on internal anterior thoracic cage
78
Anterior spinal artery
Supplies the anterior portion of the spinal cord. Arises from the branches of the vertebral arteries.
79
Erector Spinae
| (intermediate deep layer)
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
What are the landmarks of the left ventricle
1. bicuspid valve
2. papillary muscle/chordae tendineae
3. aortic valve
81
Describe kyphosis
Occurs in T spine - excessive posterior curve
old age, posture, compression fx
82
Describe the atlanto-occipital joint structure
synovial joints b/t C1 facet and occipital condyles
provides flexion/extension movement of the head/neck
83
Which muscles form the sub-occipital region?
1. rectus capitis posterior major
2. rectus capitis posterior minor
3. obliquus capitis inferior
4. obliquus capitis superior
84
Describe scoliosis
Lateral deviation w/ rotary component of the spine
curve named for convexity
85
Muscles used during inspiration
rest: diaphragm
exercise: diaphragm + intercostals
heavy exercise: above, plus accessory muscles (SCM and scalenes) maybe pecs
86
Rectus Capitis Posterior
| (major and minor)
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
Pericardium
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
Describe atlanto-axial joint structure
Comprised of facet joints C1 and C2 AND dens and anterior arch.
Provides rotation of the head/neck
89
Inferior VC
returns blood back to the right atrium from areas inferior to the diaphragm
90
Azygos Vein
Most posterior intercostal veins drain into this, semi-azygos and to SVC
92
Ribs 1- 7 are classified as what?
True ribs. They attach "directly" to the sternum.
92
Pulmonary valve
located b/t the right ventricle and pulmonary trunk
auscultate along left 2nd intercostal space
93
Aorta
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
What structures are located in the sub-occipital triangle?
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
Bicuspic valve
Located b/t atrium and left ventricle
Chordae tendinae and papillary muscles anchor
98
epicardium
blends into visceral layer of serous pericardium
99
Splenius Capitis/Cervicis
| (superficial deep layer)
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
Anterior auscultation landmarks
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
Identify the curves of the spine
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
myocardium
cardiac muscle
104
Serratus Posterior Superior
| (Intermediate back)
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
R/L pulmonary veins
returns OX blood back to the left atrium from the lungs
106
Cervical vertebrae
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
Internal thoracic artery
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
