6th anatomy exam: antthoracic Flashcards

Terms Definitions
thoracic wall boundaries:
Posteriorly - vertebral columnAnteriorly - sternum and costal cartilagesLaterally - ribs and intercostal spaceSuperiorly - suprapleural membrane (dense fascial layer) at the thoracic inletInferiorly - diaphragm
glandular tissue of breast is drained by ___ ___.
lactiferous ducts
nipple is surrouned by pigmented skin called ____.
- areola
breast tissue is separated by underlying muscles by the ___ ___.
retromammary space
where does breast cancer usually start?
- epithelial lining of lactiferous ducts
The endothoracic fascia is a thin layer of ___ ___ tissue separating the ___ pleura and ___ ___ from the thoracic wall.
- loose connective- parietal pleura- fibrous pericardium
endothoracic fascia:
- thin layer of loose connective tissue that separates the parietal pleura and fibrous pericardium from the thoracic wall
what separates the parietal pleura and fibrous pericardium from the thoracic wall?
- endothoracic fascia
the pleura (visceral) and pericardium are:
coverings of thoracic viscera
thoracic wall layers from external to internal:
SkinSuperficial and deep fascia, breastMuscle Sternum, costal cartilages, ribs and intercostal musclesEndothoracic fasciathin layer of loose connective tissue seperating parietal pleura and fibrous pericardium from the thoracic wallPleura (visceral) and pericardiumcoverings of thoracic viscera
The ___ ___ separating the lobes of the mammary gland extend from the skin to the ___ __ ___ as ___ ___.
- upper septum- deep pectoral fascia- suspensory ligaments
lymphatic drainage of breast: lateral region drains into the ___ (__)____ ___ ___.
pectoral (anterior) axillary lymph nodes
Lymphatic drainage of breast: medial region drains into ___ __ (___) nodes or via __ ___ to opposite breast.
- internal thoracic (parasternal) nodes- lymph vessels
what nodes of lymph drainage contain 75% of lymph?
- posterior aka subscapular nodes -lateral aka humeral nodes- central axillary
where does breast cancer metastacize to?
liver and subdiaphragmatic nodes
figure out whats important about interpectoral nodes aka Rotter's nodes
thoracic wall function:
ProtectionRespirationSite of muscle attachment for upper limbs
thoracic wall apertures:
Superior thoracic aperture/thoracic inletInferior thoracic aperture/thoracic outlet
important parts of sternum:
- manubrium- body- xiphoid process
suprasternal jugular notch:
- superior margin of manubrium- easily felt between medial ends of clavicles
manubriosternal joint:
- b/w manubrium and sterunm at the sternal angle
sternal angle is aka angle of ___, it is the angle made by the ___ and ___ of the ___. what level of spine is it at?
- Louis- manubrium and body of sternum- T4 and T5, 2nd costal cartilage
Xiphisternal joint:
- joint between xiphoid process and sternum- T8 and T9
The subcostal angle is at the __ end of the __, between the ___ ___ of the ___ ___ ___.
- inferior end of sternum- between sternal attachment of seventh costal cartilages
Costal margin is the __ border of the ___, formed by ___ (and what ribs?)
- lower border of the thorax, formed by cartilage (ribs7-10, end of 11 and 12)
The intercostal space is the space between __. There are __ of these spaces. The 5th intercostal space is between what two ribs?
- ribs- 11- 5th intercostal space is b/w 5th and 6th rib
All ribs are attached to the ___ ___.
- thoracic vertebrae
True ribs attach directly to the ___ via ___ _____, which allows for mobility of the thoarcic wall. These include ribs __ through ___.
- directly to sternum via costal cartilages- ribs 1-7, first one is hard to palpate b/c deep to clavicle
False ribs attach ___ to the ___via pieces of ___ along the ___ ___. What ribs are false ribs?
- indirectly- sternum- cartilage- costal margin. - ribs 8 through 10
___ ribs have no sternal connection. Which ribs does this group include?
- Floating ribs- ribs 11 and 12
parts of the rib:
Head (articular facets) Neck Tubercle (articular facet for transverse process of vertebrae)BodyAngle - where body turns sharply forwardCostal groove - on inferior, internal surface, VAN
The intercostal space has __ layers of ___ muscles.
3 layers respiratory
The superficial layer of muscle in the intercostal space contains the ___ ___ ___, whose fibers run __ and __. These muscles extend from the __ of ribs posteriorly to the ___ tips of the ribs. Near the costal cartilage, this muscle gets replaced by a thin
- external intercostal muscles- down and medially- tubercle- anterior- external intercostal membrane
intercostal space middle layer:
- internal intercostal muscle
the internal intercostal muscle fibers run ___ and ___ and extend ___ as far as the lateral border of the ___ and posteriorly to the angle of the ___.
- downward and out- anteriorly - sternum- ribs
The most posterior portion of the internal intecostal muscle is replaced by the ___ __ ___.
internal intercostal membrane
The deepest layer of intercostal muscles is formed by thin __ muscles with variable locations. They include?
- vestigal muscles- Innermost intercostal muscle- lateral- Transverse thoracis muscle- fan shaped muscle on anterior wall- Subcostal muscle- posterior
The intercostal space consists of ___ which stands for what?
VAN: - intercostal vein- intercostal artery- intercostal nerve
VAN lies under the cover of the costal groove of the upper rib between the __ ___ ___ __ layers and along the __ ___ of the inferior border of the rib.
- 2 deepest muscle layers- internal surface of the inferior border
The posterior intercostal arteries in the first two intercostal spaces are branches from the ___ ___ ___. The lower nine intercostal spaces (3-11) are supplied by intercostal branches from the ___ ___ ____.
- superior intercostal artery- descending (thoracic) aorta
the internal thoracic artery is also known as what?
- internal mammary artery
The anterior intercostal arteries in the first 6 intercostal spaces are branches from the ___ ___ __. The anterior intercostal arteries in the lower five intercostal spaces are branches from the ____ ___, which is one of the terminal branches of the ___
- internal thoracic artery- musculophrenic artery, one of the terminal branches from the internal thoracic artery
Each intercostal artery gives off branches to the ___, ____, and ___ ____.
- muscles- skin- parietal pleura
The anterior intercostal veins drain into the ___ ___ ___ or ___ ___.
- internal thoracic vein- musculophrenic vein
Corresponding posterior intercostal veins drain backward into the:
azygos v.hemiazygos v.accessory hemiazygos v.l. or r. superior intercostal v.
anteior and posterior intercostal arteries ___.
Branches of the internal thoracic artery:
Pericardiacophrenic a.Anterior intercostal a.Collateral branchesPerforating and sternal branches
terminal branches of internal thoracic artery:
Musculophrenic a.Superior Epigastric a.
pericardiacophrenic artery runs with what nerve?
phrenic nerve
intercostal nerves are from the ___/___ rami of the first ___ ___ spinal nerves. They run between the deepest layers of intercostal muscles, the ___ ___ and the ____ aka ___ ____.
- anterior/ventral rami- first 11 thoracic spinal nerves- internal intercostal muscle- innermost/transverse intercostal muscle
the 12th thoracic spinal nerve ventral rami is the:
subcostal nerve
is the ventral or dorsal rami bigger?
- ventral
branches of the intercostal nerves:
Please Catch Little ApplesP: Parietal pleura sensory branchesC: Collateral branchL: Lateral cutaneous branch> lateral thorax and abdomenA: Anterior cutaneous branch> anterior thorax and abdomen
Sensory innervation of the back is from ___ rami of ___ nerves ___- ___.
- dorsal- spinal- C4- S3
the phrenic nerve is ___ rami of __, __, __.
- anterior- C3, C4, C5
the phrenic nerves passes ___ to the root of the lung.
- anterior
___ fibers of the phrenic nerve supply muscles of the diaphragm.
____ fibers of the phrenic nerve carry sensory innervation to central region of the diaphragm and pleura.
- Afferent
the phrenic nerve runs with what artery and vein?
- pericardiacophrenic artery and vein in the superior and middle mediastinum
the vagus nerve passes ___ the root of the lung?
what nerve passes in front of root of lung?
- phrenic nerve
what nerve passes behind root of lung?
- vagus nerve
In the neck, the vagus nerve runs with the __ __ artery and then __ __ vein.
- common carotid artery- internal jugular vein
Vagus nerve contributes to:
- thoracic vagal cardiac nerve- cardiac plexus- pulmonary pleux- anterior and posterior esophageal plexus- trunks of vagus nerve extend into posterior mediastinum (anterior and posterior vagal trunks)
what nerve extends into the abdomen with the esophagus?
- vagus nerve
the trunks of what nerve go into the posterior mediastinum?
- anterior and posterior vagus nerve trunks
the sympathetic trunk is continuous with the __ and ___ trunks and extends throughout the ___/___ ____.
- cervical- abdominal- superior/posterior mediastinum
the sympathetic trunk is located where?
- near the heads of the ribs
Ganlia of the sympathetic trunk contain __ and __ ___ ___ which connect to the corresponding __ ___.
- white and gray communicating rami- spinal nerves
the sympathetic trunk is sometimes visible throught the ___ ___.
costal pleura
the sympathetic trunk gives rise to what 4 nerves?
- greater splanchic nerve- lesser splanchic nerve- least splanchic nerve- preganglionic fibers that supply the abdominal viscera
ganglia and nerves from the sympathetic trunk:
- Greater splanchic nerve (thoracic sympathetic ganglia 5-9)- Less splanchic nerve (thoracic sympathetic ganglia 10,11)- Least splanchic nerve (thoracic sympathetic ganglia 12)- the lower 8 (5 through 12) thoracic sympathetic ganglia mainly give preganglionic fibers which supply the abdominal viscera
trachea begins at ___ cartilage which is at the body of the ___ ___ vertebrae.
- cricoid- 6th cervical
the trachea extends to the ___ ___ which is level ___.
- sternal angle- T4
length and diameter of trachea:
length: 12-13 cm longdiameter: 2.5 cm
There are __ to ___ C shaped cartilage rings of ___ cartilage to keep the lumen patent. Trachea has tracheal muscles and smooth muscles that lay ___.
- 16-20- hyaline- posteriorly
the trachea ends at the bifurcation of the __ and __ ___ ___.
- right and left main bronchus- aka primary and principle bronchi
- ridge separating the opening of the right and left main bronchus
The right main bronchus is __, __, and __ ___ than the left main bronchus.
- wider- shorter- more vertical
how long is right main bronchus?
-2.4 cm long
At the hilum, what does the right main bronchus branch into?
- superior, middle, and inferior lobar bronchus
is the right or left main bronchus the more likely site for foreign objects?
- right main bronchus b/c more straight
The left main bronchus is ___, __, and more ___ than the right main bronchus.
- narrower, longer, more horizontal
how long is left main bronchus?
- 5 cm long
At hilum what does the left main bronchus divide into?
- superior and inferior lobar bronchus
name primary, secondary and tertiary bronchi:
- primary: left and right main bronchi- secondary: lobar bronchus branches from main bronchus- tertiary: segmental bronchus
name two parts of the pleura:
- parietal pleura- visceral pleura
what pleura lines the thoracic wall, the thoracic surface of the diaphragm, the lateral part of the mediastinum, and extends to the roof of the neck?
- parietal pleura
what pleura completely covers the surface of the lungs and extends into the depths of interlobar fissures?
- visceral pleura
parietal pleura:
- covers thoracic wall, thoracic surface of diaphragm, lateral part of mediastinum, and extends to roof of the neck
visceral pleura:
- covers entire surface of lungs and goes into interlobar fissures
The ___ ligament is formed where the ___ pleura folds on itself.
- pulmonary- visceral
the space between the two pleura is filled with fluid.
the parietal pleura is subdivided into:
- cervical pleura- costal pleura- diaphragmatic pleura- mediastinal pleura
____ _____ is the lower area of the pleural cavity, formed by the ___ __, into which the lung expands on inspiration.
- Costodiaphragmatic recess- parietal pleura
if the lung has fluid in it, where is this fluid likely located?
- costodiaphragmatic recess
the parietal pleura is sensitive to ___, ___, ___, and ___.
- pain- temperature- touch- pressure
The costal area the parietal pleura is innervated by ___ nerves.
- intercostal nerves
The mediastinal region of the parietal pleura is innervated by the ___ nerve.
- phrenic
The diaphragmatic area of the parietal pleura is innervated by the ___ nerve in the dome and the ___ ___ ___ __ in the periphery.
- phrenic- lower six intercostal nerves
The visceral pleura is innervated by the ___ nervous system. It gets motor ___ and visceral ____. Its nerve supply is the ___ plexus. It is sensitive to ___ but not to __ or ___.
- autonomic- efferents- afferents- pulmonary plexus nerve supply- stretch- not to pain or touch
The nerve supply of the lung is the ___ trunk found at each ___ __. This trunk receives branches from the __ ___ and ___ fibers from the __ nerve.
- pulmonary trunk- lung root- sympathetic trunk- parasympathetic fibers from the vagus nerve.
Blood supply to the lungs is the ___ ___ branching from the ____ aorta.
- bronchial arteries- descending aorta
Bronchial veins drain into what two veins?
- azygous vein- hemiazygous vein
The apex of the lung projects into the ___ of the ___. The roof is the lung is the ___ membrane.
- base- suprapleural
The base of the lung is the __ surface that sits on the ____.
- concave- diaphragm
surfaces of the lungs:
- mediastinal surface- diaphragmatic surface- costal surface
- in lungs, the depression at the middle of the mediastinal surface
the root of the lung is formed from the ___, ___, ___, and ___ entering and exiting the hilum.
- bronchi- vessels- nerves- lymphatics
pulmonary ligament:
loose fold of visceral pleura hanging down below the root of the lung, continues inferiorly almost to diaphragmatic surface
is the right or left lung larger?
- right lung larger
The right lung has __ lobes. name them and their fissures.
3 lobes: - superior/upper- middle- inferior/lower- oblique fissure- horizontal fissure
the right bronchus is also known as the ___ bronchus.
- eparterial bronchus
what 3 grooves are in the right lung?
- esophagus groove- superior vena cava groove- azygous vein groove
the right lung has a small ___ ___.
cardiac impression
The left lung has __ lobes. name them.
2- superior and inferior lobes divided by an oblique fissure
special features of left lung:
- deep cardiac impression- cardiac notch- groove for descending aorta- lingula
if you're looking at the inside of a lung, and the left side is smooth, then it is a ___ lung.
The ____ segments of lung are the anatomical, functional, and surgical units of the lung. There are around __ to ___ per lung. Each region is served by a single ____ (___) bronchus from a ___ (___) bronchus.
- bronchopulmonary segments- 8 to 10- segmental (tertiary)- lobar (secondary)
bronchopulmonary segments:
Subdivision of a lung lobePyramidal shape, apex toward lung rootSurrounded by connective tissueContains a segmental (tertiary) bronchus and artery, lymph vessels and autonomic nn.Segmental (small pulmonary) veins lie in the connective tissue between adjacent segments (septal margins)Segmental arteries run with the bronchusA diseased segment (structural unit) can be removed surgically
area between two bronchopulmonary segments:
septal margins
segmental veins are ___ ___ veins.
small pulmonary veins
___ veins are in the connective tissue between adjacent lobes in the ___ ___.
- segmental (small pulmonary veins)- septal margins
a pulmonary artery follows the ___ bronchus into the ____ segment and continues down the ___ tree.
- tertiary bronchus- bronchocephalic segment- bronchiole
pulmonary veins are located in the ___ tissue between ____ segments. These veins carry ___ blood from the ___ to the __ side of the heart.
- connective- bronchopulmonary - oxygenated- left
pulmonary aka segmental veins carry ___ blood from the ___ to the ___ side of the heart.
- oxygenated- alveoli- left
lymphatics of the thorax:
Parasternal nodesPosterior mediastinal nodesIntercostal nodesParatracheal nodesSuperior phrenic nodesThoracic duct
lymphatics of thorax:
Please Pretend Interest Playing Sunday's Tunes. - Parasternal nodes- Posterior mediastinal nodes- Intercostal nodes- Paratracheal nodes- Superior phrenic nodes- Thoracic duct
The ___ (___) plexus lies underneath the visceral pleura and drains lymph into the ___.
- subpleural (superficial) plexus- hilum
___ nodes drain lymph from the deepest portion of lungs.
- pulmonary
look up flow of lymph in lungs
____ nodes are on the right and left main bronchus.
The ___ nodes aka the ___ nodes are located at the tracheal bifurcation.
- tracheobronchial nodes aka carinal nodes
____ nodes are lymph nodes around the trachea.
The thoracic duct is only on the ___ side, but the ____ ___ __ is on both sides.
- thoracic duct- left side only- bronchomediastinal lymphatic duct is on both sides
the thoracic duct drains into the ___ vein.
- subclavian vein
the bronchomediastinal lymphatic duct drains into the ____ vein.
- brachiocephalic vein
the thoracic duct begins below the ___ at the __ level as a dilated sac called the ___ ___.
diaphragmL2cisterna chyli
the thoracic duct ascends through the ___ opening at the ___ level along the __ side of the ___ aorta between the ___ and ___ vein.
- aortic- T12- right- descending- aorta - azygous
the thoracic ducts crosses the ___and moves behind the ___.
- midline- esophagus
around the ___ angle, the thoracic duct has moved completely over on the ___ side of the __.
- sternal- left- esophagus
the thoracic duct drains into the venous system at the junction of what two veins located at the root of the neck?
- left subclavian vein and internal jugular vein
the thoracic duct conveys lymph to the blood from __ the ___, the ___ side of the ___, __ , and ___, and the ___ arm.
- below the diaphragm- left side of thorax, head, and neck- left arm
Pneumothorax as result of injury or disease, ___ enters the ___ ___from the lungs or through the chest wall.
- air enters the pleural cavity
spontaneous pneumothorax:
- most common type- usually results from rupture of bullae/bleb on the lung surface- most often results in a tension pneumothorax
In spontaneous pneumothorax from a ruptures bulla, what layer has been ruptured?
- visceral pleura only
tension pneumothorax is often referred to a ___ pressure pneumothorax, can be caused by puncture from a ___ ___.
- positive- fractured rib
In positive pressure/tension pneumothorax of the right side, what happens?
- right lung is collapsed- heart and left lung are shifted to left
With open pneumothorax the ___ __ is exposed to the ___ through an open wound in the chest wall into the lung. With this injury, both __ and ___ pleura are damaged, so there is no build up of pressure.
- pleural cavity- atmosphere- parietal and visceral
Other names for open pneumothorax:
- blowing wound- sucking pneumothorax
is an open pneumothorax a tension pneumothorax?
no b/c both pleura are damaged
closed pneumothorax a piece of ___ ___ surrounding an ___ ___ in the chest acts as a ___, letting air __ but not ___. This is/is not a type of tension pneumothorax.
- visceral pleura- open wound- valve- lets air in- does not let air out- closed is tension pneumothorax
- aka hydropneumothorax- fluid in pleural cavity
- aka hemopneumothorax: blood in pleural cavity
signs and symptoms of tension pneumothorax:
- dyspnea- difficulty breathing so severe anxiety- sharp pain on affected side- air in pleural space irritates parietal pleura- patient is tachypneic (increased breathing rate) and tachycardic- trachial deviation: opposite side the tens, pnue- purplish to bluish discoloration of lips and nail beds
Pleuritis aka ___ and define:
- pleurisy- inflammation of the pleura that roughens the surface of the lung- can produce friction rub or a pleural rub- can be heard with stethoscope- usually results in pain being referred to as cutaneous distribution of the intercostal nerves (thoracic and abdominal walls)
Pulmonary embolism (PE):
- obstruction of a large pulmonary artery by a thrombus- sector of lung is ventilated but not perfused with blood- caused by embolus (mobile clot) from leg or pelvic vein that travels to heart and lodged in pulmonary vein
- sources of emoblism:
- blood clot- fat globule- air bubble
deep vein thrombosis
Pulmonary embolism (PE) can result in __ ___ ___.
- acute respiratory distress - large embolus occludes pulmonary artery- major decrease in oxygenated blood- a person can die in minutes
Chronic Obstructive Pulmonary Disease (COPD):
- a progressive disease that makes it hard to breathe- often associated with coughing that produces lots of mucus- usually caused by emphysema (damaged alveolar walls) and/or chronic bronchitis (constant irritation and inflammation of bronchi)
In COPD, less air flows in and out of airways due to one or more of the following:
Bronchi and alveoli lose their elasticityWalls between alveoli are destroyedWalls of airways become thick and inflamedLarge mucus production, clogged airways
major cause of diability and 4th leading cause of death in the U.S.
Flail chest:
Caused by multiple rib fractursSizeable segment of the anterior or lateral thoracic wall moves freelyInward on inhalation, outward on exhalationVery painful injury
dislocation of ribs happens at the ___ joint.
- sternocostal joint- severe pain when laugh or cough
Chest Injury Rule:
- any injury below the nipple may also involve abdominal organs- fractured rib may puncture upper abdominal organs: liver, spleen, or stomach
intercostal neurovascular bundle:
- VAN- vulnerable to injury from fracture ribs due to location beneath inferior border of ribs
if you have to insert a needle in b/w ribs, where should you do it?
- superior to the lower rib bordering the space to avoid the intercostal neurovascular bundle aka VAN
symptoms of breast cancer in the skin:
- leathery, thickened appearance caused by the interference of lymph drainage- edema, excess fluid in subcutaneous tissue- prominent development of pores giving an orange peel appearnce of skin- dimpled or puckering skin/nipple due to cancer invasion of suspensory ligament- often extensive metastases has occured to other organs/bone-
sternal angle is at level of:
T4, T5
the sternal angle at level of T4, T5, is the inferior margin of the ___ ___ but the superior margin of the ___ of the ___ ___.
- inferior margin of aortic arch- superior margin of bifurcation of pulmonary trunk
other important features of sternal angle:
- ligamentum arteriosum- left recurrent laryngeal nerve- trachial bifurcation- carina- superior extend of pericardial sac about aorta and pulmonary trunk- highest level of oblique and horizontal fissure- superior margin of the lung root- arch of azygos vein and its entry into the superior vena cava
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