Thorax Lec Flashcards
3 compartments of the thorax
mediastinum (contains heart)
R and L pulmonary cavities
Spinal level of spine of scapula (root) and inferior angle
T3
T7
True, false and floating ribs
true - 1-7
false 8-10
floating 11, 12
Know where the rib tubercle and articular facets are
articular facet is part of the tubercle and its where it articulates with the vertebrae
Describe the articulations of the costovertebral and costotransverse joint
costovertebral - head of rib (crest) with demi facets of vertebral body
costotransverse - transverse process of vertebrae with rib tubercle
rib 7 with vertebrae 6 and 7
Describe the movement of the costotransverse joint in the mid-thoracic vs lower thoracic spine
mid thoracic - rotation
lower thoracic 0 glides
Know the location of the jugular notch and sternal angle
sternal angle - manubriosternal joint
Where are the sternal costal joints
first 7 ribs, synovial
What name change occurs at the first rib?
Subclavian artery and vein to axillary artery and vein
What muscles connects with the diaphragm
Quadratus Lumborum and Psoas Major
Diaphragm innervation
phrenic C3 C4 C5
keep you alive!
Attachments of the diaphragm
xiphoid process
costal margin of the thoracic wall
ribs 11 and 12
posterior abdominal wall ligaments
lumbar vertebrae
inserts on itself via central tendon
What three structures pass through the diaphragm and at what vertebral level?
Which is most posterior?
IVC T8
Esophagus and vagus nerve T10
Aorta and thoracic duct T12
I 8 10 eggs at 12
Posterior to anterior is Aorta, Esophagus, IVC
The sternal angle splits the mediastinum into superior and inferior portions at spinal level ____
T4/T5 disc
i45
What level does the aorta bifurcate into R and L common iliac arteries?
L3/L4
How many intercostal spaces are there? What is in each space?
11
(12 ribs, 1st space starts under 1st rib)
Intercostal vein, artery and nerve
Movement of rubs from lateral view and anterior view
lateral - pendulum (smaller movement)
anterior - bucket handle
review scapulohumeral rhythm
60 from ST joint
120 from GHJ
160 total
dont forget clavicle
Movement of the rib cage changes when breathing is ____
forced
What region is the thoracic spine most mobile? How many DOF does the thoracic spine have?
upper thoracic is most mobile but in general thoracic has all DoF
What aspects of the thoracic spine limits movements?
Long SP limits spinal extension
TP limit side bending
Facets oriented in frontal plane (stop signs) - allow more rotation and side bending over flex/ext
How many intercostal muscles are there and how are they innervated?
3
external, internal and innermost
Intercostal nerve T1-T11, segmentally
Action of external, internal and innermost intercostal muscles
external - draw ribs superiorly to explain rib cage during inhalation
internal - draw ribs inferiorly, decreasing space of thoracic cavity (exhalation)
innermost - assist internal muscles
What is the action/function of serratus posterior (superior and inferior)
forced breathing
What ribs does the transverse thoracic originate on, what’s its action?
3-6
depresses costal cartilages
literally skipped the slide in class
subcostals
only for dissection pretty sure but they axist and may depress the ribs
Levator costarum muscles do what
elevate tibs, assist respiration
“levator” elevate
What muscle does the pec major (sternocostal head) also attach from?
external obliques
When the pec minor is tight, what postural position results? What might this impinge?
anterior tilt (of scap)
impinge brachial plexus
Pec major originates on coastal cartilage ____ while pec minor starts on ribs ___
1-6
3-5
Serratus Anterior action
protracts and upwardly rotates scapula (punch)
holds scap against thoracic wall
Where does serratus anterior originate and insert?
starts on lateral ribs 1-9
goes to medial border of scapula
Arterial supply to the thoracic region is mostly segmental except for what?
internal thoracic arteries that come off subclavian artery
they go straight down on each side of the sternum
The intercostal artery and nerve travel in the subcostal groove between which muscles?
internal and inner most intercostal
Venous supply of thorax includes which major veins
superior vena cava, Azygos vein and internal thoracic vein
Know how to identify the veins - which is more lateral, azygous or internal thoracic?
internal thoracic is lateral to azygos
Dermatome levels are segmentary except __
What is at T2, T4,T6, T10?
except T1
T2 - armpit
T4 - nipple
T6 - xiphoid
T10 - umbilical
The pleural cavities exist at what landmarks
What are the layers? What is between them?
just above rib 1 to just above costal margin
parietal and inner visceral, serous fluid in between
Which layer of the pleural cavity is not innervated?
visceral
Know how to identify the hilum, apex, base, of lungs
Also may have to differentiate between left and right
The right lung has ___ fissure(s) and ___ lobes
2 fissures - oblique and horizontal
3 - superior middle and inferior lobe (know how to identify)
The left lung has ___ fissure(s) and ___ lobes
1 fissure - oblique
2 lobes - superior an inferior
Special feature of the left lung
lingula
Contents of lung hila/hilum
right or left pulmonary artery
2 pulmonary veins
main bronchus
(bronchial vessels, nerves, lymphatics)
Hilum vs root
root = collection of vessels
hilum = passageway
Vertebral levels of the trachea
C6 to T4/5 where is bifurcates into R and L bronchus
Describe the brachial tree divisions
trachea (C6-T4/5)
R and L main bronchus
lobar bronchi (secondary bronchi, different on R and L*)
segmental bronchi
conduction
terminal
respiratory
alveolar sacs
Pneumothorax
collapsed lung
puncture of the thoracic wall lets in atmospheric air to the pleural cavity, disrupting the negative air pressure typically inside that keeps the lung inflated
Pulmonary arteries carry ______ blood to the ____
deoxygenated
lungs
Pleural Reflection
reflects molding of surrounding structures
Know location for SVC, cardiac impression, IVC, azygog vein, esophagus
What are recesses (list the 2)
spaces for the lungs to expand
costomediastinal recesses
costodiaphragmatic recesses
What is more lateral, phrenic nerve or vagus nerve?
phrenic is slightly more lateral than vagus
Describe the phrenic nerve course - where does it exit, it goes on what side of the heart? anterior or posterior to vagus nerve? innervates what?
nerve roots C3-C5
exits neck between anterior and middle scalene
travels behind great veins
travels lateral to each side of heart
anterior to vagus nerve
innervates each half og the diaphragm
Which lung will have the plueral reflection for the aorta and which will have the IVC/SVC? Heart?
(on the medial surface)
aorta - left lung
IVC/SVC - right lung
heart - left lung
External airways are outside the ____ and includes the ____ trachea
thorax
superior
External airways must be stable against compression due to _____
atmospheric compression
Epiglottis fxn
closes over trachea during swallowing to prevent aspiration of food or liquid
Circoid cartilage marks what
marks start of trachea from laranyx
T/F: the trachea has muscles
T: trachealis muscle
What happens to the respiratory tract with COPD
airways and sacs lose their elasticity
destruction of air sac walls
airway walls become thick and inflamed
clogged airways with mucus
2 most common COPD
chronic bronchitis
emphysema
