Thorax Outcomes Flashcards
P, D, A, I External Intercostals
P & D: rib to rib, fascicles oriented superior- lateral to inferior-medial (Down & in)
A: elevates ribs
I: intercostal nn. (Segmental)
P, D, A, I Internal & Innermost Intercostals
P & D: rib to rib, superior-medial to inferior-lateral (down & out)
A: depression of ribs
I: intercostals n. (Segmental)
P, D, A, I Transverse thoracis
P: posterior sternum
D: costal cartilages
A: depresses ribs
I: intercostal n. (Segmental)
P, D, A, I Transverse thoracis
P: posterior sternum
D: costal cartilages
A: depresses ribs
I: intercostal n. (Segmental)
P, D, A, I: Diaphragm
P: xiphoid process, inner surface of lower ribs & costal cartilages, & lumbar vertebrae via the cura
D: central tendon
A: inspiration (negative thoracic pressure by inferior displacement)
I: phrenic n. (C3-5)
What are the boundaries, contents and compartments of the thoracic cavity?
Posterior boundary: spine
Anterior boundary: sternum
Inferior boundary: diaphragm
Superior boundary: superiorthoracic aperture
Contents: organs of respiratory & cardiovascular systems
Pleural Cavity & Mediastinum
What are the components of the thoracic wall?
Skin
Subcutaneus tissue
Ribs
Intercostal mm.
What are the three functions of the thoracic wall
Protection
Respiration
Muscle attachments
Describe a true rib
Direct cartilagenous attachments at the sternum
Ribs 1-7
Describe a false rib
Indirectly attach at the sternum
Ribs 8-10
What ribs are floating ribs?
RIbs 11-12
What are the 3 rib joints?
Costovertebral
Costotransverse
Sternocostal
Describe the costovertebral joint
head of rib to vertebral body
Describe the costotransverse joint
costal tubercle to transverse process
Describe the sternocostal joint
sternum to cartilage
What is the synovial classification of all rib joints?
Plane/gliding
Describe the bony landmarks of the first rib
Scalene tubercle for scalene muscle located between the grooves (ant to subclav a)
2 grooves for sublavian a. and subclavian v.
Describe the bony landmarks of the sternum
Manubrium: jugular notch & clavicular notch
Body: sternal angle, costal notches
Xiphoid
What is the segmental innervation of the diaphragm
C3-5
What is the peripheral nerve innervation the diaphragm?
Phrenic n.
What does the bucket handle analogy relate to?
Describes the rib elevation/depression for the medial/lateral rib shafts
*Inspiration: ribs elevate & move middle of shaft laterally
Expiration: ribs depress & move middle of shaft medially
What does the pump handle analogy relate to?
Describes the anterior/posterior dimensional movement of ribs
*Inspiration: ribs elevate & move sternum upward & forward
Expiration: ribs depress & move sternum downward & backward
What are the intercostal nn. (T1-12) also known as?
Ventral rami of thoracic spinal nn.
What are intercostal nn. T1-6 named?
Upper intercostal nn.
What are intercostal nn. T7-11 named?
Thoracoabdominal nn. & lower intercostal nn.
What is intercostal nn. T12 and below named?
Subcostal nn.
What are the major landmarks of innervation of the thoracic wall?
T4: includes nipple
T6: skin over xiphoid process
T10: includes umbilicus
What are the external features of the right lung?
Apex
3 Lobes
Fissures
What are the external features of the left lung?
Apex 2 Lobes
Fissures
Lingula
Describe the bronchial tree
Trachea to primary bronchi (R&L main) to secondary (lobar) to tertiary (segmetal 10)
Describe the pleurae of the lungs
Parietal: outer layer that attaches to chest wall
Visceral: cannot detach from lung
Pleural cavity between P & V w/ serous fluid for lubrication during respiration
Describe the pleural recesses
Costomediastinal recess: between costal and mediastinal pleura
Costodiaphragmatic recess: between diaphragmatic and costal pleura
List the layers of the pericardium from superficial to deep
Fibrous paricardium
Parietal paricardium
Visceral
paricardium
What are the remaining structures of fetal circulation?
Fossa ovalis
Ligamentum arteriosum
Describe fossa ovalis
Fossa ovalis is located in the interatrial septum
It shunted blood from the R to L atrium to avoid the lungs during fetal development
Describe ligamentum arteriosum
Attaches/Located between aorta and pulmonary artery
Shunted blood away from the lungs during fetal development
What does RA LS stand for/ mean?
RA LS relates to the location of the Pulmonary Artery at the roots of the right and left lungs.
On the Right lung, the Pulmonary artery can be found on the more Anterior aspect of the root.
On the Left lung, the Pulmonary Artery can be found on the Superior aspect of the root.
The root of the lung also includes the Pulmonary veins and the primary bronchi (depending on cut).
Identify what lung this is based off of the structures displayed on the medial aspect. Name the structures.
Left Lung : LS
Purple is pulmonary a.
White is primary bronchus
Pink is pulmonary vv.
Identify what lung this is based off of the structures on its medial aspect. Name the structures.
Right Lung: RA
Purple is pulmonary a.
Pink is pulmonary vv.
White is primary bronchus
Identify the view of the heart and name the missing structures.
Anterior view
1: Right auricle
2: Right ventricle
3: Cardiac apex
4: Anterior interventricular sulcus
5: Left auricle
Identify what view of the heart and name the missing surface features.
Anterior view
1: Right Atrium
2: Coronary Sulcus
3: Left ventricle
4: Reflected pericardium
5: Ligamentum arteriosum
Identify the view of the heart and name the missing surface features.
Posterior view
1: Left auricle
2: Left ventricle
3: Right atrium
Identify the view of the heart and name the missing surface features.
Posterior view
1: Left atrium
2: Coronary sulcus
3: reflected Pericardium
Explain cardiac referred pain and the anatomy behind it.
Cardiac referred pain is when the pain felt is not localized to the area of injury at the heart and instead felt in the skin of the L pectoral, shoulder, and medial UE, through connections through the somatic nervous system and visceral nervous system.
Pain receptors in myocardium detect stimulus and relays through visceral afferent axons in sympathetic pathways —> cell bodies in dorsal root ganglions that are shared with general somatic axons in skin —> brain interpreting the stimulus from the skin rather than the visceral.
Explain the conduction system of the heart.
SA node in atrium
AV node near R atrioventricular valve —> atrioventricular bundle which splits in Interventricular septum into L & R bundle branches that excite the L & R ventricles respectively
The moderator band/ septomarginal trabeculae provide R bundle branch with rapid access to lateral wall of R. Ventricle for proper contraction timing
Identify the chamber of the heart shown and name the internal features missing.
Right Atrium
1: Superior vena cava
2: Fossa ovalis
3: Valved orfice of coronary sulcus
4: Pectinate muscles
5: Right auricle
identify the chamber of the heart and name the missing internal features.
Right Atrium
1: Interatrial septum
2: Valved orifice of inferior vena cava
3: R. Atrioventricular orifice w/ atrioventricular valve
4: Crista terminalis
Identify the chamber of the heart shown and name the missing internal features.
Right Ventricle
1: Pulmonary trunk
2: Interventricular septum
3: Posterior papillary muscle
4: R. Atrioventricular valve (ant. Cusp)
Identify the chamber of the heat and name the missing internal features.
Right Ventricle
1: Supraventricular crest
2: Anterior papillary muscle
3: trabeculae carneae
4: Valve of pulmonary trunk
Identify the chamber of the heart and name the missing internal features.
Right Ventricle
1: Septal papillary muscle
2: Septomarginal trabecula
3: Chordae tendineae
4: Conus arteriosus
Identify the chambers and name the missing internal features.
Left Atrium & Ventricle
1: Pectinate muscles
2: Trabeculae carneae of interventricular septum
3: Posterior papillary muscle
4: Interatrial septum
5: Valve of foramen ovale
6: Left auricle
Identify the chambers of the heart and name the missing internal features.
Left Atrium & Ventricle
1: Left superior pulmonary v.
2: Left atrium
3: Left atrioventricular valve
4: Chordae tendineae
5: Anterior Papillary muscles
What are the sympathetic chain ganglia?
Series of interconnected ganglia located on either side of the vertebral column extending from the base of the skull to the coccyx
Describe the function of the sympathetic chain ganglia
responsible for the fight or flight response, including increased heart rate, dilating bronchi, and inhibiting digestive functions
Describe the two types of rami communicantes and their origins
White (lateral horns of T1-L2)
Grey (C1-S5)
Describe the function of white rami communicantes
Function: carry preganglionic sympathetic axons to the sympathetic chain (ganglia), and abdominal ganglia, and sensory axons from the viscera to the spinal cord
Describe the function of gray rami communicantes
Function: carry postgang. symp. axons from the symp. chain to the spinal nerves for distribution through the dorsal and ventral rami, and sensory axons from the viscera to the spinal cord. These fibers then continue to innervate target organs, such as blood vessels, sweat glands, and piloerector muscles
Describe the relation of intercostal nerves to the rami communicantes?
White rami communicantes:
intercostal nerves receive preganglionic symp. fibers from white rami comm. that then enter the sympathetic chain ganglia
Grey rami communicantes:
after synapsing in the sympathetic chain ganclia, postganglionic symp. fiers exit through gray rami comm. and join the intercostal nn. to reach their target tissues
