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MGA > Thorax Wall > Flashcards

Thorax Wall Flashcards

1
Q

true ribs

A

1-7, attached to sternum

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2
Q

false ribs

A

8-12, costal cartilages of 8-10 articulate with the superior cartilage

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3
Q

what does the sternal edge of the 10th rib attach to?

A

costal cartilage of 9th rib

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4
Q

floating ribs

A

11-12, no anterior connections to other ribs or sternum

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5
Q

label rib

A
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6
Q

sternum

A
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7
Q

where does the head of the rib articulate?

A

demifacets of the superior costal facet and inferior costal facet of 2 adjacent vertebrae

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8
Q

where does the tubercle of the rib articulate

A

transverse process of the corresponding vertebra

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9
Q

what type of joint is formed at the head of rib and vertebra?

A

synovial joint

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10
Q

what is unique about the jointof the head of rib and superior and inferior costal facet

A

it is a synovial joint divided into 2 compartments by intrarticular ligament

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11
Q

ligament between the neck of rib and transverse process?

A

costotransverse ligament

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12
Q

ligament lateral to the joint and runs between the transverse process and tubercle of rib

A

lateral costotransverse ligament

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13
Q

external intercostal muscle location

A

between ribs, extends from tubercles of rib to the costal cartilages

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14
Q

function of external intercostal muscles

A

elevate ribs, most active in inspiration

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15
Q

internal intercostal location

A

deep to external intercostals, muscle fibers extend from sternum to the angle of the ribs

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16
Q

where is the internal intercostal membrane?

A

extends posteriorly toward vertebral column

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17
Q

external intercostal membrane location

A

extending from costal cartilage to the sternum

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18
Q

internal intercostal function

A

depress ribs, most active in expiration

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19
Q

innermost intercostal muscle function and location

A
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20
Q

depress ribs, most evident in lateral throracic wall, fibers running in dame direction of internal intercostals

A
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21
Q

transverse thoracic muscle location

A

originate from posterior part of xiphoid process, inferior aspect of body of sternum and adjacent costal cartilages; fibers run superolaterally to insert onto the lower borders of ribs 2-6

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22
Q

function of transverse thoracic muscle

A

depress ribs

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23
Q

where are vessels and nerves that supply intercostals?

A

just inferior to the inferior border of the rib, between internal intercostal and innermost intercostals; VAN - intercostal vein, intercostal artery, intercostal nerve

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24
Q

significance of location of the intercostal nerves, arteries and veins

A

when giving a nerve block, needle to be inserted just inferior to the inferior rib border to find the nerve

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25
Q

function of the internal intercostal interchondral part

A

elevation of the ribs at the chostrochondral joint, increases anteroposterior dimension

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26
Q

meaning of “pump handle” movement of ribs

A

in the upper/anteiror ribs, ribs are elevated, and sternum moves upward and forward, increasing anteroposterior dimension of the thorax

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27
Q

meaning of “bucket handle movement” of ribs

A

in lateral and lower ribs, ribs are elevated and the shafts of the ribs move laterally, increasing the transverse dimension of the thorax

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28
Q

what occurs during passive expiration

A

diaphragm, intercostals relax, decreases intrathoracic volume and increases intrathoracic pressure, intra-abdominal pressure decreases, and abdominal viscera are decompressed, allowing stretched elastic tissue of lungs to recoil and expel air

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29
Q

what gives rise to the anterior intercostal arteries of the upper 6 intercostals?

A

the subclavian arteries give off the internal thoracic arteries, which give rise to the anterior intercostal arteries of the upper 6 intercostals

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30
Q

what occurs at the 6th intercostal space?

A

the internal thoracic arteries terminate by dividing into the superior epigastric and musculophrenic arteries

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31
Q

where do the lower 6 anterior intercostal arteries arise from?

A

the musculophrenic arteries (that split from the internal thoracic)

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32
Q

where do the posterior intercostal arteries originate from?

A

the thoracic aorta - except the first 2 posterior intercostal arteries taht arise from the supreme intercostal artery (branch of the costocervical trunk)

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33
Q

where do the 1st 2 posterior intercostal arteries arise from?

A

supreme intercostal artery that is a branch from the costocervical trunk

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34
Q

significance of the sternal angle?

A
  1. the 2nd rib attaches there
  2. the division of the superior and inferior mediastinum
  3. the trachea bifurcates
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35
Q

where do posterior intercostal veins drain?

A

into the azygos vein, which drains into the superior vena cava

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36
Q

where do the anterior intercostal veins drain

A

into the musculophrenic or internal thoracic veins

37
Q

where do the intercostal nerves branch off?

A

ventral rami of T1-T11 spinal nerves

38
Q

what is the subcostal nerve?

A

ventral ramus of the T12 spinal nerve, lies inferior to 12th rub

39
Q

what branches off the intercostal nerves?

A

the lateral cutaneous branch, and the anterior cutaneous branch

40
Q

what is significant about the lateral cutaneous branch of T2?

A

the lateral cutaneous branch of T2 joints the medial brachial cutaneous nerve to supply the medial side of the arm, this is why cardiac pain is referred to the medial side of the left arm

41
Q

what makes up the superior thoracic aperture and what does it contain?(thoracic inlet)

A

T1 vertebra, rib 1 and manubrium of sternum; contains superior aspects of the pleural cavities and mediastinum

42
Q

what makes up the inferior thoracic aperture?

A

T12 vertebra, rib 12, distal “ends” of lower ribs, xiphoid process, closed by diaphragm

43
Q

what goes into the superior thoracic aperture?

A

trachea, esophagus, brachiocephalic vein, phrenic nerve and vagus nerve

44
Q

what comes out of the superior thoracic aperture

A

brachiocephalic artery, left common carotid artery, left subclavian artery, thoracic duct, sympathetic trunks

45
Q

what comes into the inferior thoracic aperture?

A

inferior vena cava

46
Q

what comes out of the inferior thoracic aperture?

A

descending aorta, esophagus

47
Q

what is the primary muscle of inspiration

A

diaphragm

48
Q

what does the diaphragm attach to

A

xiphoid process, ribs, lumbar vertebrae

49
Q

innervation diaphragm (C3,C4,C5)

A

phrenic nerve

50
Q

blood supply diaphragm

A

superior and inferior phrenic arteries just off the aorta

51
Q

what structures travel between the thorax and abdomen that pass through the diaphragm?

A

aorta, inferior vena cava, esophagus, vagus nerve, thoracic duct, azygos/hemiazygos vein

52
Q

what surrounds the lungs?

A

parietal pleura lining the thoracic cavity, visceral pleura in direct contact with lung

53
Q

divisions of the parietal pleura

A

cervical pleura, costal pleura, diaphragmatic pleura, mediastinal pleura

54
Q

what surrounds the parietal pleura?

A

endothoracic pleura - holds parietal pleura to thorax wall

55
Q

where is the cervical pleura?

A

covers the apex of the lung, extends into the thoracic inlet, superior to 1st rib, cupola (dome over apex)

56
Q

what innervates the parietal pleura?

A

somatic afferent fibers

57
Q

what specifically innervates the costal pleura

A

intercostal nerves - can pinpoint specific, localized pain (pleurisy)

58
Q

what innervates diaphragmatic and mediastinal pleura?

A

phrenic nerves, causes referred, dull, not well localized pain in the C3-C5 dermatomes (lateral neck and supraclavicular regions)

59
Q

what is the costodiaphragmatic and costomediastinal recesses?

A

extensions of pleural cavities that are devoid of lung tissue, and are potential spaces where fluid can collect

60
Q

how far does the pleura extend?

A

at midclavicular line: rib 8

at midaxillary line: rib 10

posteriorly: T12

61
Q

inferior margin of the lung (quiet respiration)?

A

midclavicular line: rib 6

midaxillary line: rib 8

posteriorly: T10

62
Q

where to insert needle for thoracentesis?

A

inferior to rib 8 in the 9th intercostal space, so the lung is not punctured. insert the needle tip superiorly to reduce the risk of puncturing the liver

63
Q

what is the root of the lung?

A

“forearm of the fist that is the lung”

structures that attach the lung to structures in the mediastinum like pulmonary artery, veins, bronchus

64
Q

what is the hilum of lung

A

entry and exit point of the root structures

65
Q

what structures are in the root/hilum of the lung?

A

pulmonary artery (superior), pulmonary veins (inferior), primary bronchus

66
Q

what is the pulmonary ligament

A

transition of parietal to visceral pleura, extends inferiorly from lung root

67
Q

lobes and fissures of the right lung

A

3 lobes, superior, inferior, middle; 2 fissures, horizontal and oblique

68
Q

lobes and fissures of left lung

A

2 lobes, superior and inferior, 1 oblique fissure

69
Q

what is an azygos lobe

A

a laterally displaced azygos vein makes a deep fissure into the apical segment of the right upper lobe during embryological development

70
Q

what is a pancoast tumor?

A

tumor involving apex of lung, may involve recurrent laryngeal nerve, inferior portion of brachial plexus (C8, T1), sympathetic trunks, subclavian blood vessels

71
Q

impressions on medial surface of right lung

A

heart, superior and inferior vena cava, azygos vein, esophagus

72
Q

impressions on medial surface of left lung

A

heart, aortic arch, descending aorta, esophagus

73
Q

where does the trachea divide into primary bronchi?

A

sternal angle

74
Q

explain the divisions of the trachea

A

trachea divides into the primary bronchi at the sternal angle, primary bronchi enter the hilum and divide into secondary/lobar bronchi (3 right lung, 2 left lung), lobar bronchi divide into tertiary (segmental), then alevoli

75
Q

clinical significance of the right primary bronchus

A

right primary bronchus is shorter, wider, more vertically oriented than left, so foreign objects more likely to enter this side

76
Q

where does the larynx transition to the trachea?

A

at C6

77
Q

what is the carina?

A

the last cartilaginous ring of the trachea that makes a “keel” cartilage at the tracheal bifurcation

78
Q

what do the pulmonary arteries carry?

A

deoxygenated blood from the right ventricle to the lungs

79
Q

what do the pulmonary veins carry?

A

oxygenated blood from the lungs to the left atrium

80
Q

what is a bronchopulmonary segment

A

area of lung supplied by a tertiary bronchus and its accompanying pulmonary artery branch (8-10 of these in each lung)

81
Q

flow of lymph in the lungs?

A

lymphatic vessels initially drain into pulmonary lymph nodes around the lobar bronchi, then drain into the bronchopulmonary lymph nodes in the hilum, then drain into the superior and inferior tracheobronchial lymph nodes that are superior and inferior to the bifurcation of the trachea and primary bronchi, then flows to the right and left bronchomediastinal lymph trunks

82
Q

what is asthma

A

variable obstruction of the airway caused by spasmodic contraction of the smooth muscle in the bronchial tree

83
Q

what is bronchitis

A

inflammation of mucous membranes of the bronchial tree

84
Q

what is emphysema

A

destruction of the walls of the airspaces distal to the terminal bronchioles, reducing surface are for gas exhange

85
Q

what is COPD

A

includes chronic bronchitis and emphysema

86
Q

what is pleurisy

A

inflammation of the pleura, pain sensed by intercostal nerves

87
Q

what is pneumothorax

A

air in the pleural cavity that results in partial or total collapse of the lung

88
Q

causes of pneumothorax

A

parietal pleura penetrated by external trauma or visceral pleura interrupted by ruptured pulmonary cysts

89
Q

mechanism of pneumothorax

A

pleura punctured, air enters pleural cavity and lung on same side as injury collapses due to its own surface tension and recoil of elastic fibers

MGA (27 decks)

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