thorax-major slide powerpoint Flashcards
where is the thorax located
superior part of the trunk between the neck and abdomen
what is the floor of the thoracic cavity (diaphragm) deeply invaginated inferiorly by
viscera of the abdominal cavity
what does the central compartment of the thorax/mediastinum house
the conducting structures that make up the thoracic viscera (except the lungs)
what is the majority of the thoracic cavity occupied by
the lungs
how do nutrients/food traverse the thoracic cavity
via the esophagus
what is the most important symptoms of cardiac disease
chest pain
how do people who have had a heart attack usually describe the associated pain
as a severe sub-sternal pain (deep to the sternum) that does not disappear with rest
where do the mammary glands of the breast lie
within the subcutaneous tissue of the thoracic wall
where are intercostal spaces widest
anterolaterally
what can be injured if the first rib is broken
brachial plexus of nerves and subclavian vessels
which ribs are most commonly fractured
middle ribs
what do rib fractures usually result from
blows or from severe injures
what part of the rib is weakest
just anterior to its angle
what happens to then wall during flail chest
it moves paradoxically (inward on inspiration and outward on expiration)
define thoracotomy
the surgical creation of an opening through the thoracic wall to enter a pleural cavity
what is the most common location for a posterior thoracotomy incision
posterolateral aspects of the 5th-7th intercostal spaces
what do cervical ribs interfere with
neuromuscular structures exiting the superior thoracic aperture
what is the most accurate description for the type of bone of the manubrium
roughly trapezoidal bone
according to Dr ray what level does the xiphoid process lay
T10
what is the xiphoid process a marker for
midline marker for the superior limit of the liver, the central tendon of the diaphragm, and the inferior border of the heart
what type of fracture typically occurs when there is a fracture of the sternal body
comminuted fracture (the sternum is broken into several pieces)
where is the most common site of sternal fracture
sternal angle
what is the mortality rate associated with sternal fractures
24-45%
what is the superior thoracic aperture/anatomical thoracic inlet bounded by
posteriorly by vertebra T1, laterally by 1st pair of ribs and costal cartilage, and anteriorly by the manubrium
what structures pass through the superior thoracic aperture
trachea, esophagus, nerves and vessels that drain the head, neck and upper limbs
how does the superior thoracic aperture slope
anteroinferiorly
what is the inferior thoracic aperture/anatomical thoracic outlet bound by
12th thoracic vertebrae, 11th and 12 pairs of ribs, costal margins and xiphisternal joint
when are external intercostals most active
during inspiration (elevate ribs during forced inspiration0
what are the inferior internal intercostals continuous with
internal oblique muscles in anterolateral abdominal wall
when are internal intercostals most active
during expiration: maintain or increase bonus of intercostal space
what does the interosseous portion of the internal intercostals do during forced respiration
depress ribs
what does the interchondral portion of the internal intercostals duo during active inspiration
works with external intercostals to elevate the ribs
what costal cartilages do the transverse thoracic muscles attach to
2nd-6th costal cartilages
what are the transverse thoracic muscles continuous with inferiorly
transverse abdominal muscles in the anterolateral body wall
what is the main thing the transverse thoracic muscles do
provide proprioceptive information
what is the primary muscle of inspiration
diaphragm
what fascia covers the breasts
2/3 by pectoral fascia and the other third by fascia covering the serrates anterior
what is the space between the breast and the pectoral fascia called
retromammary space/bursa
where is the lactiferous sinus located
deep to the areola
what is the name for the creamy white to yellowish pre milk fluid that may secrete from the nipples during the last trimester of pregnancy and during initial episodes of nursing
colostrum
what is colostrum believed to be especially rich in
protein, immune agents, and a growth factor affecting the infant’s intestines
what is the arterial supply of the breast derived from
medial mammary branches of perforating branches , anterior intercostal branches of internal thoracic artery, lateral thoracic and thoracoacromial arteries, posterior intercostal arteries
what is the main venous drainage of the breast
axillary vein
describe the lymph passage of the breast
from nipple, areola and lobules of the gland to the subareolar lymphatic plexus
where does most lymph of the breast drain to
axillary lymph nodes (but initially to anterior or pectoral nodes)
where may the lymph of the inferior quadrants pass to
deeply to abdominal lymph nodes
where does lymph from the skin of the breast drain
ipsilateral axillary, inferior deep cervical and infraclavicular lymph nodes (and also into parasternal lymph nodes)
where does the lymph from the axillary nodes drain
into clavicular lymph nodes and from them into the subclavian lymphatic trunk
where does lymph from the parasternal nodes drain
the bronchomediastinal lymphatic trunk
what pleura directly surrounds the lungs
visceral pleura
where is the visceral pleura continuous with the parietal pleura
hilum of the lung
what are the 4 parts of the parietal pleura
costal part, mediastinal part, diaphragmatic part, cervical pleura
what does the costal part of the parietal pleura cover
the internal surfaces of the thoracic wall
how is the costal part of the parietal pleura separated from the internal surface of the thoracic wall
endothoracic fascia
what fascia connects the diaphragmatic pleura with the muscular fibers of the diaphragm
phrenicopleural fascia
what is the superior continuation of the costal and mediastinal parts of the parietal pleura
cervical pleura
what pleura covers the apex of the lungs
cervical pleura
what is the fibrous extension of the endothoracic fascia that reinforces the cervical pleura
supra pleural membrane (sibson fascia)
at what age is the cervical pleura especially vulnerable to injury
the first few years after birth (due to short necks at young age)
when does hemothorax most commonly occur
from injury to a major intercostal or internal thoracic vessel (more than from laceration of a lung)
what is acute pleuritic marked by
sharp, stabbing pain, especially on exertion, such as climbing stairs, when the rate and depth of respiration may be increased even slightly
what separates the 2 lungs
mediastinum
where is the pulmonary artery generally located
superior most on left (superior lobar bronchus may be superior most on right)
which lung is longer
left
which lung is heaver
right
describe the anterior border of the right lung compared to left
right is relative straight and left as a deep cardiac notch
is the mediastinal surface of the lung convex or concave?
concave
which surface of the lung includes the hilum
mediastinal surface
is the diaphragmatic surface of the lung concave or convex?
concave
what color are the lungs of healthy non-smokers
pink
lung cancer involving what nerve can result in paralysis of the hemidiaphragm
phrenic nerve
what nerve may be involved in apical lung cancers due to its relationship with the apex of the lung
recurrent laryngeal nerves
what nerve supplies all but one of the laryngeal muscles
recurrent laryngeal nerve
what airway constitutes the tracheobronchial tree
sub-laryngeal airway
where does the trachea bifurcate (at what level)
the level of the transverse thoracic plane (sternal angle)
what does the right main bronchus pass direct to
hilum
what is the passage of the left main bronchus to the hilum
passes inferolatearlly, inferior to the arch of the aorta and anterior to the esophagus and thoracic aorta to get to the hilum
what is the arterial supply of the bronchopulmonary segments
supplied independently by a segmental bronchus and a tertiary branch of the pulmonary artery
what is the basic structural unit of gas exchange in the lung
pulmonary alveolus
where do the veins from the visceral pleura drain
pulmonary veins
where do the veins of the parietal pleura drain
they join the systemic veins in adjacent parts of the thoracic wall
where do the 2 left bronchial arteries usually arise from
directly from the thoracic aorta
how does the right bronchial artery typically arise
indirectly either by the proximal part of one of the upper intercostal arteries (usually the 3rd posterior intercostal artery) or from a common trunk with the left superior bronchial artery
where does the right bronchial vein drain
into azygos vein
where does the left bronchial vein drain
into the accessory hemiazygos vein or the left superior intercostal vein
what is the immediate result of pulmonary embolism
partial or complete obstruction of blood flow to the lung
where is pain from the parietal pleura referred
to the cutaneous distribution of the intercostal nerves to the thoracic wall, or in the case of inferior nerves, to the anterior abdominal wall
which lymph nodes commonly enlarge with bronchogenic carcinoma
supraclavicular lymph nodes
what is another name for the supraclaviculr lymph nodes
sentinel lymph nodes
what is the tough external layer of the pericardium (fibrous) continuous with
central tendon of diaphragm
what is the serous pericardium mostly composed of
mesothelium
what is the fibrous pericardium continuous with superiorly
tunica adventitia of the great vessels entering and leaving the heart and with the pre tracheal layer of deep cervical fascia
what attaches the fibrous pericardium to the posterior surface of the sternum
sternopericardial ligaments
what pericardium protects the heart against sudden overfilling
fibrous pericardium
what is the main arterial supply of the pericardium
pericardiacophrenic artery (brach of internal thoracic)
what is the nerve supply to the pericardium
phrenic nerve, vagus nerve sympathetic trunk
why is the transverse pericardial sinus important to cardiac surgeons
inserting a clamp into this space can stop large artery blood flow during surgery
define pericardial effusion
passage of fluid from pericardial capillaries into the pericardial cavity or an accumulation of pus
what occurs when there is extensive pericardial effusion and the volume of the sac does not allow full expansion of the heart
cardiac tamponade
what is a common way to reach the pericardiac sac
by entering the infrasternal angle and passing the needle superoposteriorly
when does the lub sound of the heart occur
as the blood is transferred (sucked) from the atria into the ventricles
when is the dub sound of the heart heard
as the ventricles expel blood from the heart
what s the apex of the heart formed by
inferolatearl part of the left ventricle
what intercostal space is the apex posterior to in adults
left 5th intercostal space
where is the sound of mitral valve closure maximal
apex
what mainly forms the base of the heart
left atrium
what mainly forms the anterior (sternocostal) surface of the heart
right ventricle
what mainly forms the diaphragmatic (inferior) surface of the heart
left ventricle and partly by the right ventricle; it is related mainly to the central tendon of the diaphragm
what mainly forms the right pulmonary surface
right atrium
what is the arterial continuation of the right ventricle
pulmonary trunk
what disorder occurs when the apex of the heart is directly to the right
dextrocardia
what is the ear-like conical muscular pouch that projects from the right atrium that increases the capacity of the atrium as it overlaps the ascending aorta
auricle
what is the vertical ridge of the heart (internal)
crista terminalis
what is the vertical groove/terminal groove of the heart (external)
sulcus terminalis
at what level does the SVC open into the superior part of the right atrium
3rd costal cartilage
what level does the IVC open into the inferior part of the right atrium
5th costal cartilage
where is the coronary sinus
in between the right atrioventricular orifice and the IVC orifice
what is the adult remnant of the foramen ovale
fossa ovalis
what is the primordial atrium represented by in the adult
right auricle
what is the coronary sinus a derivative of
venous sinus
where is the SA node located
in the border between the primordial atrium and sinus venosus
what separates the ridged muscular wall of the inflow part of the chamber from the smooth wall part of the conus arteriosus
supra ventricular crest
what does the anterior papillary muscle arise from
anterior wall of right ventricle
what does the posterior papillary muscle arise from
inferior wall of the right ventricle
what does the septal papillary muscle arise from
inter ventricular septum
what is the curved muscular bundle that traverses the right ventricular chamber from the inferior part of the IVC to the base of the anterior papillary muscle
septomarginal trabecula
what is listed first for all cardiac defects
VSDs
is arterial pressure higher in systemic or pulmonary circulation
systemic
what level is the mitral valve at
4th costal cartilage
what is the first branch of the aorta
coronary arteries
what do the coronary arteries supply
myocardium and epicardium
what is the main vein of the heart
coronary sinus
what does the coronary sinus receive at his left end
great cardiac vein
what does the coronary sinus receive at its right end
middle cardiac vein and small cardiac veins
what does pulmonary valve incompetence ultimately lead to
backlash of blood under high pressure into the right ventricle during diastole
what it the most frequent valve abnormality
aortic valve stenosis
what is the most common site of coronary artery occlusion
anterior inter ventricular branch of the left coronary artery
what is the most common cause of ischemic heart disease
coronary artery insufficiency resulting from atherosclerosis
what is another way to describe pain that originate in the heart
angina pectoris
what are pain receptors in muscles stimulated by
lactic acid
