Week 2 Respiratory - Thorax, Mediastinum, Chest Wall and Breast ✅ Flashcards
What is the manubriosternal joint better known as?
Sternal angle/angle of Louis
Which level is sternal angle at?
T4
Which part of the sternum does the diaphragm attach to?
Xiphoid process
Which rib is the biggest?
Rib 8
What is the definition of a true rib?
Attaches to sternum via own costal cartilage
What is the definition of a false rib?
Attaches to sternum via costal cartilage of rib 7
What is the definition of a floating rib?
Has no costal cartilage and does not attach to sternum
Which ribs are true ribs?
1-7
Which ribs are false ribs?
8-10
Which ribs are floating ribs?
11-12
What is the function of costal cartilage?
Allow movement
Which medications can weaken the ribs?
Steroids
e.g. in COPD
What is the definition of typical ribs?
Connects to vertebrae at the same level (superior articular head) and level above (inferior articular head)
Which ribs are typical ribs?
3-9
Which vertebrae does rib 1 attach onto?
T1
Which vertebrae does rib 2 attach onto?
T1 and T4 but looks atypical
Which ribs are most commonly fractured?
4-10
Which ribs indicate high energy trauma and can cause other internal injuries?
1-3
How many vertebrae are there?
Cervical
Thoracic
Lumbar
Sacral
Coccygeal
7 cervical (C1-7 in neck)
12 thoracic (T1-12 in thoracic spinal column)
5 lumbar (L1-5 in lower back)
5 sacral (S1-5 - forms the sacrum, usually fused)
4 coccygeal (Co1-4)
Is the spinous process posterior or anterior?
Posterior
What is the function of transverse process?
Articulates with tubercle of rib
What are demifacets?
Where part of the head of the rib or part of the costal cartilage articulates
Rib tubercle always articulates with corresponding spinous process - true or false?
True
Where will a pancoast tumour press?
In the thoracic inlet
What could a pancoast tumour cause?
Horner’s syndrome
Why does pancoast tumour cause parathesia?
Presses on the nerves
What is a barrel chest?
Hyperexpansion of the chest due to hyperexpansion of the lungs
What condition is barrel chest seen in?
COPD
What is pectus excavatum?
Ribs and the breastbone (sternum) grow inward and form a dent in the chest
What is pectus carinatum?
When part of the breastbone is pushed outwards or raised
Where is the mediastinum?
Between left and right pleural cavity
What is the superior mediastinum?
Mediastinum above sternal angle
What is the middle mediastinum?
Pericardium
What is the anterior mediastinum?
Anterior to pericardium
What is the posterior mediastinum?
Posterior to pericardium
Where is the location of the aorta in the mediastinum?
Posterior mediastinumWh
What does the internal thoracic artery supply?
Anterior intercostal arteries 1-6 then bifurcates into ? and musculophrenic artery 7-9
Which vein drains into superior vena cava?
Azygos vein
What lymph structure does the abdomen drain into?
Cisterna chyli
Where does the cisterna chyli drain into?
Thoracic duct
Which parts of the body does the thoracic duct drain?
LEFT:
Head, neck, thorax, arm
+ ALL pelvis and lower limbs
What does the right lymphatic duct drain?
RIGHT:
Head, neck, thorax, arm
What side of the body is Virchow’s node on?
Left
How many intercostal spaces are there?
11
Why are the collateral branches superior of rib clinically significant?
Be careful not to hit when inserting drains etc!
What are the 3 intercostal muscles?
External
Internal
Innermost
What order are the collateral vessels in?
VAN
Lateral - medial
Is the diaphragm higher on the right or left side? Why?
Right due to liver
What does the diaphragm seal?
Inferior thoracic inlet
What does the diaphragm attach to?
Xiphoid process
Anterior lateral costal margin
Inferior lateral ribs 11+12
Abdominal wall
Lumbar region
When breathing out, how far can the diaphragm raise to?
Rib 4 right, rib 5 left
At which level does the IVC pass through the diaphragm?
T8
At which level does the oesophagus pass through the diaphragm (oesophageal hiatus)?
T10
At which level does the aorta pass through the diaphragm (aortic hiatus)?
T12
At which level does most of posterior mediastinum contents pass through the diaphragm?
T12
What does the word phrenic relate to?
Diaphragm
Which arteries supply the diaphragm?
Pericardiacophrenic, muscolophrenic and inferior phrenic
Which veins drain the diaphragm?
Azygos system
Inferior vena cava
Brachiocephalic veins
Which nerves supply the diaphragm?
C3 C4 C5
What are the muscles of the chest wall?
Pectoralis major
Pectoralis minor
Serratus anterior
Which structures are found at the sternal angle?
RATPLANT
Rib 2
Aortic arch
Tracheal bifurcation
Pulmonary trunk
Ligamentum arteriosum
Azygos vein drains into SVC
Nerves -
loop of recurrent laryngeal nerve
Thoracic duct
Where is the safe triangle located?
Anterior lateral borer of pectoralis major
Posterior lateral border of latissimus dorsi
5th intercostal space
How many lactiferous ducts are there in a breast?
~15
How do the breasts change during pregnancy? How do they compare with non-pregnancy?
Enlarged with more secretary lobules
Nonpregnant - more fat
What is the difference in breasts male vs female?
Males do not have mammary glands
How much lymph moves to the axillary glands laterally from the breasts?
~75%
Why are dimples a feature of breast cancer?
Mass compresses against the suspensory ligaments which pulls the skin down
What is peau d’orange?
Orange peel appearance - usually oedema
