Thorax Lec Flashcards

1
Q

3 compartments of the thorax

A

mediastinum (contains heart)

R and L pulmonary cavities

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2
Q

Spinal level of spine of scapula (root) and inferior angle

A

T3
T7

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3
Q

True, false and floating ribs

A

true - 1-7
false 8-10
floating 11, 12

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4
Q

Know where the rib tubercle and articular facets are

A

articular facet is part of the tubercle and its where it articulates with the vertebrae

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5
Q

Describe the articulations of the costovertebral and costotransverse joint

A

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

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6
Q

Describe the movement of the costotransverse joint in the mid-thoracic vs lower thoracic spine

A

mid thoracic - rotation
lower thoracic 0 glides

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7
Q

Know the location of the jugular notch and sternal angle

A

sternal angle - manubriosternal joint

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8
Q

Where are the sternal costal joints

A

first 7 ribs, synovial

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9
Q

What name change occurs at the first rib?

A

Subclavian artery and vein to axillary artery and vein

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10
Q

What muscles connects with the diaphragm

A

Quadratus Lumborum and Psoas Major

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11
Q

Diaphragm innervation

A

phrenic C3 C4 C5

keep you alive!

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12
Q

Attachments of the diaphragm

A

xiphoid process
costal margin of the thoracic wall
ribs 11 and 12
posterior abdominal wall ligaments
lumbar vertebrae

inserts on itself via central tendon

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13
Q

What three structures pass through the diaphragm and at what vertebral level?

Which is most posterior?

A

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

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14
Q

The sternal angle splits the mediastinum into superior and inferior portions at spinal level ____

A

T4/T5 disc
i45

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15
Q

What level does the aorta bifurcate into R and L common iliac arteries?

A

L3/L4

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16
Q

How many intercostal spaces are there? What is in each space?

A

11
(12 ribs, 1st space starts under 1st rib)
Intercostal vein, artery and nerve

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17
Q

Movement of rubs from lateral view and anterior view

A

lateral - pendulum (smaller movement)

anterior - bucket handle

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18
Q

review scapulohumeral rhythm

A

60 from ST joint
120 from GHJ
160 total
dont forget clavicle

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19
Q

Movement of the rib cage changes when breathing is ____

A

forced

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20
Q

What region is the thoracic spine most mobile? How many DOF does the thoracic spine have?

A

upper thoracic is most mobile but in general thoracic has all DoF

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21
Q

What aspects of the thoracic spine limits movements?

A

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

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22
Q

How many intercostal muscles are there and how are they innervated?

A

3
external, internal and innermost

Intercostal nerve T1-T11, segmentally

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23
Q

Action of external, internal and innermost intercostal muscles

A

external - draw ribs superiorly to explain rib cage during inhalation

internal - draw ribs inferiorly, decreasing space of thoracic cavity (exhalation)

innermost - assist internal muscles

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24
Q

What is the action/function of serratus posterior (superior and inferior)

A

forced breathing

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25
Q

What ribs does the transverse thoracic originate on, what’s its action?

A

3-6

depresses costal cartilages

literally skipped the slide in class

26
Q

subcostals

A

only for dissection pretty sure but they axist and may depress the ribs

27
Q

Levator costarum muscles do what

A

elevate tibs, assist respiration

“levator” elevate

28
Q

What muscle does the pec major (sternocostal head) also attach from?

A

external obliques

29
Q

When the pec minor is tight, what postural position results? What might this impinge?

A

anterior tilt (of scap)

impinge brachial plexus

30
Q

Pec major originates on coastal cartilage ____ while pec minor starts on ribs ___

A

1-6

3-5

31
Q

Serratus Anterior action

A

protracts and upwardly rotates scapula (punch)

holds scap against thoracic wall

32
Q

Where does serratus anterior originate and insert?

A

starts on lateral ribs 1-9

goes to medial border of scapula

33
Q

Arterial supply to the thoracic region is mostly segmental except for what?

A

internal thoracic arteries that come off subclavian artery

they go straight down on each side of the sternum

34
Q

The intercostal artery and nerve travel in the subcostal groove between which muscles?

A

internal and inner most intercostal

35
Q

Venous supply of thorax includes which major veins

A

superior vena cava, Azygos vein and internal thoracic vein

36
Q

Know how to identify the veins - which is more lateral, azygous or internal thoracic?

A

internal thoracic is lateral to azygos

37
Q

Dermatome levels are segmentary except __

What is at T2, T4,T6, T10?

A

except T1

T2 - armpit
T4 - nipple
T6 - xiphoid
T10 - umbilical

38
Q

The pleural cavities exist at what landmarks

What are the layers? What is between them?

A

just above rib 1 to just above costal margin

parietal and inner visceral, serous fluid in between

39
Q

Which layer of the pleural cavity is not innervated?

A

visceral

40
Q

Know how to identify the hilum, apex, base, of lungs

Also may have to differentiate between left and right

A
41
Q

The right lung has ___ fissure(s) and ___ lobes

A

2 fissures - oblique and horizontal

3 - superior middle and inferior lobe (know how to identify)

42
Q

The left lung has ___ fissure(s) and ___ lobes

A

1 fissure - oblique

2 lobes - superior an inferior

43
Q

Special feature of the left lung

A

lingula

44
Q

Contents of lung hila/hilum

A

right or left pulmonary artery

2 pulmonary veins

main bronchus

(bronchial vessels, nerves, lymphatics)

45
Q

Hilum vs root

A

root = collection of vessels

hilum = passageway

46
Q

Vertebral levels of the trachea

A

C6 to T4/5 where is bifurcates into R and L bronchus

47
Q

Describe the brachial tree divisions

A

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

48
Q

Pneumothorax

A

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

49
Q

Pulmonary arteries carry ______ blood to the ____

A

deoxygenated

lungs

50
Q

Pleural Reflection

A

reflects molding of surrounding structures

Know location for SVC, cardiac impression, IVC, azygog vein, esophagus

51
Q

What are recesses (list the 2)

A

spaces for the lungs to expand

costomediastinal recesses

costodiaphragmatic recesses

52
Q

What is more lateral, phrenic nerve or vagus nerve?

A

phrenic is slightly more lateral than vagus

53
Q

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?

A

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

54
Q

Which lung will have the plueral reflection for the aorta and which will have the IVC/SVC? Heart?

(on the medial surface)

A

aorta - left lung

IVC/SVC - right lung
heart - left lung

55
Q

External airways are outside the ____ and includes the ____ trachea

A

thorax

superior

56
Q

External airways must be stable against compression due to _____

A

atmospheric compression

57
Q

Epiglottis fxn

A

closes over trachea during swallowing to prevent aspiration of food or liquid

58
Q

Circoid cartilage marks what

A

marks start of trachea from laranyx

59
Q

T/F: the trachea has muscles

A

T: trachealis muscle

60
Q

What happens to the respiratory tract with COPD

A

airways and sacs lose their elasticity
destruction of air sac walls
airway walls become thick and inflamed
clogged airways with mucus

61
Q

2 most common COPD

A

chronic bronchitis
emphysema