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2015-06-29 11:20:14
clinical anatomy
Clinical Anatomy
Lecture no 2: the Thorax
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  1. the region of the body between theneck and the abdomen
  2. framework of the walls of the thorax which is formed by the vertebral column behind, the ribs and intercostalspaces on either side, and the sternum and costal cartilagesin front
    thoracic cage
  3. The cavity of the thorax can be divided into a median partition called _______
  4. The lungs are covered by a thin membrane called
    visceral pleura
  5. inner surface of the chest wall
    parietal pleura
  6. two membranous sacs formed, one on each side of the thorax, between the lungs and the thoracic walls.
    pleural cavities
  7. thoracic wall is formed by
    • posteriorly by the thoracic part of the vertebral column
    • anteriorly by the sternum and costal cartilages
    • laterally by the ribs and intercostal spaces
    • superiorly by the suprapleural membrane
    • inferiorly by the diaphragm
  8. separates the thoracic cavity from the abdominal cavity
  9. lies in the midline of the anterior chest wall
  10. the upper part of the sternum
  11. articulates above with themanubrium at the manubriosternal joint and below withthe xiphoid process at the xiphisternal joint
    body of the sternum
  12. a thin plate of cartilage that becomes ossified at its proximal end during adult life. No ribs or costal cartilages are attached to it
    xiphoid process
  13. formed by the articulationof the manubrium with the body of the sternum
    sternal angle
  14. another term for sternal angle
    angle of Louis/ manubriosternal joint
  15. lies opposite to sternal angle
    the intervertebral disc between the 4th and 5th thoracic vertebrae
  16. lies opposite to xiphisternal joint
    the body of the ninth thoracic vertebra
  17. attached anteriorly to the sternum by their costal cartilages
    True ribs
  18. what are the True ribs
    1st - 7th ribs
  19. attached anteriorly to each other and to the 7th rib by means of their costal cartilages and small synovial joints
    False ribs
  20. what are the false ribs
    8th - 12th ribs
  21. have no anterior attachment
    Floating ribs
  22. what are the Floating ribs
    11th and 12th rib
  23. a long, twisted, flat bone having a rounded,smooth superior border and a sharp, thin inferior border
    typical rib
  24. accommodates the intercostal vessels and nerve located at the inferior border of the rib
    costal groove
  25. has two facets for articulation with the numerically corresponding vertebral body and that of the vertebra immediately above
  26. constricted portion situated between thehead and the tubercle
  27. a prominence onthe outer surface of the rib at the junction of the neckwith the shaft
  28. thin and flattened andtwisted on its long axis
  29. where the shaft of the rib bends sharply forward
  30. bars of cartilage connecting the upper seven ribs to the lateral edge of the sternum and the 8th,9th, and 10th ribs to the cartilage immediately above
    Costal cartilages
  31. the cartilages of the 11th and 12th ribs end in
    abdominal musculature
  32. a cartilaginous joint between the manubrium and the body of the sternum
    manubriosternal joint
  33. a cartilaginous jointbetween the xiphoid process (cartilage) and the body of thesternum
    xiphisternal joint
  34. 1st rib and the three lowest ribs have a ________ joint with their corresponding vertebral body
    single synovial
  35. connects the head to the intervertebral disc
    intraarticular ligament
  36. Joints of the Heads of the Ribs
    Synovial joint
  37. Joints of the tubercle of the Ribs (This joint is absent on the 11th and 12th ribs.)
    synovial joint
  38. Joints of the Ribs and Costal Cartilages
    cartilaginous joints
  39. Joints of the Costal Cartilages with the Sternum
    • 1st costal cartilages articulate with manubrium, by cartilaginous joints
    • 2nd to 7th costal cartilages articulate with the lateralborder of the sternum by synovial joints
    • 6th - 10th costal cartilages articulate withone another along their borders by small synovial joints
    • 11th and 12th ribs are embedded inthe abdominal musculature
  40. The chest cavity communicates with the root of the neckthrough an opening called
    thoracic outlet
  41. The spaces between the ribs contain three muscles of respiration
    • external intercostal
    • internal intercostal
    • innermost intercostal muscle
  42. innermost intercostalmuscle is lined internally by
    endothoracic fascia
  43. forms the most superficial layer. Its fibers are directed downward and forward from the inferior border of the rib above to the superior border of the rib below
    external intercostal muscle
  44. forms the intermediate layer. Its fibers are directed downward and backward from the subcostal groove of the rib above to the upper border of the rib below
    internal intercostal muscle
  45. forms the deepest layer and corresponds to the transversus abdominis muscle in the anterior abdominal wall
    innermost intercostal muscle
  46. The posterior intercostal arteries of the first two spaces are branches from the ________
    superior intercostal artery
  47. of the costocervical trunk of the subclavian artery. The posterior intercostal arteries of the lower nine spaces are branches of the ________
    descending thoracic aorta
  48. The anterior intercostal arteries of the first six spaces are branches of the ________
    internal thoracic artery
  49. The anterior intercostal arteries of the lower spaces are branches of the ________, one of the terminal branches of the internal thoracic artery
    musculophrenic artery
  50. The corresponding posterior intercostal veins drain backward into the ________
    azygos or hemiazygos veins
  51. the anterior intercostal veins drain forward into the ________
    internal thoracic and the musculophrenic veins.
  52. the thorax opens into the root of the neck bya narrow aperture
    thoracic outlet
  53. either side of thoracic outlet is closed by a dense fascial layer called
    suprapleural membrane
  54. thin muscular and tendinous septum that separates the chest cavity above from the abdominal cavity below
  55. arising from the posterior surface of the xiphoid process
    sternal part
  56. arising from the deep surfaces of the lower six ribs and their costal cartilages
    costal part
  57. arising by vertical columns or crura and from the arcuate ligaments
    vertebral part
  58. arises from the sides of the bodies of the first three lumbar vertebrae and the intervertebral discs
    right crus
  59. arises from the sides of the bodies of the first two lumbarvertebrae and the intervertebral disc
    left crus
  60. Lateral to the crura the diaphragm arises from the ________
    medial and lateral arcuate ligaments
  61. The diaphragm is inserted into a ________, which is shaped like three leaves
    central tendon
  62. reaches as high as the upper border of the 5th rib
    right dome
  63. left dome mayreach the lower border of the 5th rib
    left dome
  64. support the right and left lungs
  65. supports the heart
    central tendon
  66. Motor Nerve Supply of the Diaphragm
    The right and left phrenic nerves(C3, 4, 5)
  67. sensory nerve Supply of the Diaphragm
    parietal pleura and peritoneum covering the central surfaces of the diaphragm
  68. function of the diaphragm
    • Muscle of inspiration
    • Muscle of abdominal straining
    • Weight-lifting muscle
    • Thoracoabdominal pump
  69. On contraction, the diaphragm pulls its central tendon down and increases the vertical diameter of the thorax
    Muscle of inspiration
  70. the most important muscle used in inspiration
  71. The descent of the diaphragm decreases the intrathoracic pressure and at the same time increases the intra-abdominal pressure
    Thoracoabdominal pump
  72. The contraction of the diaphragm assists the contraction of the muscles of the anterior abdominal wall in raising the intra-abdominal pressure for micturition, defecation, and parturition.
    Muscle of abdominal straining
  73. the diaphragm assists the muscles of the anterior abdominal wall in raising the intra-abdominal pressure to such an extent that it helps support the vertebral column and prevent flexion
    Weight-lifting muscle
  74. Openings in the Diaphragm
    • aortic opening
    • esophageal opening
    • caval opening
  75. anterior to the body of the 12th thoracic vertebra between the crura . It transmits the aorta, the thoracic duct, and the azygos vein
    aortic opening
  76. lies at the level of the 10th thoracic vertebra in a sling of muscle fibers derived from the right crus. It transmits the esophagus, theright and left vagus nerves, the esophageal branches of the left gastric vessels, and the lymphatics from the lower third of the esophagus
    esophageal opening
  77. lies at the level of the 8th thoracic vertebra in the central tendon . It transmits the inferior vena cava and terminal branches of the right phrenic nerve.
    caval opening
  78. triangular in shape and arises by its apex from the tip of the transverse process and is inserted into the rib below
    Levatores Costarum
  79. its action raises the rib below and is therefore an inspiratory muscle
    Levatores Costarum
  80. a thin, flat muscle that arises from the lower cervical and upper thoracic spines.Its fibers pass downward and laterally and are inserted into the upper ribs
    Serratus Posterior Superior Muscle
  81. Its action is to elevate the ribs and is therefore an inspiratory muscle
    Serratus Posterior Superior Muscle
  82. a thin, flat muscle that arises from the upper lumbar and lower thoracic spines. Its fibers pass upward and laterally and are inserted into the lower rib
    Serratus Posterior Inferior Muscle
  83. It depresses the ribs and is therefore an expiratory muscle
    Serratus Posterior Inferior Muscle
  84. the angle made between the manubrium and the body of the sternum
    sternal angle (angle of Louis)
  85. the superior margin of the manubrium sterni and is easily felt between the prominent medial ends of the clavicles in the midline
    suprasternal notch
  86. the joint between the xiphoid process of the sternum and the body of the sternum
    It lies opposite the body of the ninth thoracic vertebra
  87. situated at the inferior end of the sternum, between the sternal attachments of the 7th costal cartilages
    subcostal angle
  88. the lower boundary of the thorax and is formed by the cartilages of the 7th, 8th, 9th, and 10th ribs and the ends of the 11th and 12th cartilages
    costal margin
  89. subcutaneous throughout its entire length and can be easily palpated .It articulates at its lateral extremity with the acromion proces sof the scapula
  90. lies deep to the clavicle and cannot be palpated
    1st rib
  91. The apex of the heart is formed by the lower portion of the
    left ventricle
  92. formed by the lower border of the pectoralis major muscle
    anterior fold
  93. formed by the tendon of the latissimus dorsi muscle as it passes around the lower border of the teres major muscle
    posterior fold
  94. begins behind the sternoclavicular joint and runs downward, almost reaching the midline behind the sternal angle. It then continues downward until it reaches the xiphisternal joint
    anterior border of the right lung
  95. has a similar course, but at the level of the fourth costal cartilage it deviates laterally and extends for a variable distance beyond the lateral margin of the sternum to form the cardiac notch
    anterior border of the left lung
  96. midinspiration follows a curving line, which crosses the 6th rib in the midclavicular line and the 8th rib in the midaxillary line, and reaches the 10th rib adjacent to the vertebral column posteriorly
    lower border of the lung
  97. extends downward from the spinous process of the 7th cervical vertebra to the level of the 10th thoracic vertebra and lies about 1.5 in.(4 cm) from the midline
    posterior border of the lung
  98. indicated on the surface by a line drawn from the root of the spine of the scapula obliquely downward, laterally and anteriorly, following the course of the 6th rib to the sixth costochondral junction
    oblique fissure
  99. represented by a line drawn horizontally along the fourth costal cartilage to meet the oblique fissure in the midaxillary line
    horizontal fissure
  100. The lines, which indicate the limits of the parietal pleura where it lies close to the body surface, are referred to as the ________
    lines of pleural reflection
  101. bulges upward into the neck and has a surface marking identical to that of the apex of the lung
    cervical pleura
  102. The distance between the two borders corresponds to the ________
    costodiaphragmatic recess
  103. The arch of the aorta and the roots of the brachiocephalic and left common carotid arteries lie behind the ________
    manubrium sterni
  104. it also lie behind the manubrium sterni
    superior vena cava and the terminal parts of th eright and left brachiocephalic veins