Thoracic Wall & Lungs

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Author:
mnm2186
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31858
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Thoracic Wall & Lungs
Updated:
2010-09-14 01:18:43
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Anatomy
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Exam 3
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  1. Thoracic Cavity Organization
    • 3 major spaces
    • mediastinum
    • right / left pulmonary cavities
    • 2 apertures
    • superior / inferior
  2. True Ribs
    • Vertebrocostal
    • (Ribs 1 - 7)
    • Attach directly to the sternum via costal cartilages
  3. False Ribs
    • Vertebrochondral
    • (Ribs 8 - 10)
    • Attach to the costal margin
  4. Floating Ribs
    • (Ribs 11 & 12)
    • Do not attach to the sternum
  5. Typical Ribs
    • (Ribs 3 - 9)
    • - Head (2 facets)
    • - Neck
    • - Tubercle
    • - Body / Angle
    • - Costal groove
    • - Costal cartilage
  6. Superior Atypical Ribs
    (Ribs 1-2, 10-12)

    • 1st Rib:
    • - grooves for subclavian BVs
    • - 1 articular facet on head
    • - tubercles for ant. / mid. scalene

    • 2nd Rib:
    • - 1 articular facet
    • - tubercle for posterior scalene
  7. Inferior Atypical Ribs
    (Ribs 1-2, 10-12)

    • Rib 10:
    • - 1 articular facet

    • Ribs 11 & 12:
    • - 1 articular facet
    • - floaters
    • - no necks / tubercles
  8. Which is the only atypical rib to have similar structure at the head as the typical ribs?
    • Rib 2
    • (2 articular facets)
  9. Anatomical appearance of the breast
    • - mainly subcutaneous fat
    • - modified apocrine sweat gland
    • - lobules drains into lactiferous ducts
    • - supported by suspensory ligaments
    • - 2/3 pec. major & 1/3 serratus ant.
    • - retromam. space = movement
    • - lateral region = axillary tail
  10. Anatomical levels of breast / nipples
    Breast: ribs 2-6

    Nipple: 4th intercostal space (males!)
  11. Arterial supply to the breast
    • 1. Lateral thoracic a. (lateral mammary branches)
    • 2. Internal thoracic a. (medail mammary branches)
    • 3. Post. intercostals (2-4 intercostal spaces)
  12. Venous drainage to the breast
    • 1. Axillary v. (via lat. mammary vv.)
    • 2. Internal thoracic v. (via medial mammary vv.)

    Venous drainage can reach the azygous system via intercostal veins
  13. Innervation of the breast
    Ant. / Lat. cutaneous branches of 2nd - 6th intercostal nn.

    (sensory / smooth muscle signals)
  14. Innervation of the nipple
    4th intercostal n.
  15. Lymphatic drainage of the breast
    • Subareolar lymphatic plexus
    • 75% -> axillary nodes -> r. lymphatic / thoracic ducts
    • (some in parasternal nodes)

    Lat. branches of post. intercostals -> azygous system -> thoracic duct

    some drainage into subdiaphragmatic nodes / liver
  16. Anterior muscles of forceful respiration
    • Pec. major
    • clavipectoral fascia
    • Pec. minor
  17. Major contributors of respiration
    • External intercostals
    • - membranous anteriorly
    • Internal intercostals
    • - membranous posteriorly
    • Innermost intercostals
    • - membranous anteriorly & posteriorly
  18. Which intercostal muscles are continuous w/ abdominal muscles?
    External intercostals (external oblique)

    Internal intercostals (internal oblique)
  19. Arterial supply to thorax
    2 main sources:

    • posterior intercostal aa.
    • - most arises from thoracic a.
    • - upper 2 arise from superior thoracic a. (branch of costocervical trunk)

    • anterior intercostal aa. (usually paired)
    • - arises form internal thoracic aa. (subclavian aa.)
  20. What are the terminal branches of the internal thoracic aa. in the thorax?
    1) superior epigastric aa.

    • 2) musculophrenic aa.
    • - supplies the lower spaces
    • - anastamoses w/ post. intercostals)
  21. Venous drainage of thorax
    • Parallels arterial supply except for azygos system
    • Ultimately drains via 2 routes:

    • 1) Internal thoracic vv.
    • - drains into brachiocephalic vv.

    • 2) Azygos system
    • - drains into superior vena cava
  22. Innervation of thorax
    • - intercostal n. (ant. rami T1-11)
    • - subcostal n. (ant. rami T12)

    • - intercostal branches carry sympathetic motor to smooth muscle
    • (i.e. vasculature / erector pili / hair follicles)
  23. Intercostal Spaces: Boundaries & Contents
    • lateral border = internal intercostal m.
    • medial border = innermost intercostal m.

    • Contents (superior to inferior)
    • VAN + collateral branches
  24. Structures that pass thru diaphragm @ T8
    • Caval hiatus passes through central tendon:
    • - IVC
    • - R. Phrenic n.
    • - Pericardiacophrenic a.
  25. Structures that pass thru diaphragm @ T10
    • Esophageal hiatus passes through muscular diaphragm:
    • - Esophagus
    • - Vagus n.
  26. Structures that pass thru diaphragm @ T12
    • Aortic hiatus passes posterior to diaphragm:
    • - Thoracic aorta
    • - Thoracic duct
  27. Innervation / Blood Supply to Diaphragm
    • Blood supply
    • - branches of abdominal aorta (major)
    • - thoracic aorta / intercostals / pericardiacophrenic / musculophrenic (minor)

    • Innervation
    • - Phrenic n. (C3-C5) penetrate diaphragm and innervate it from underneath
  28. At what point do the parietal and visceral pleura become continuous?
    • Hilum of the lung
    • (T5-T7) pleura reflects back on itself
    • extends inferiorly as pulmonary ligament
  29. Endothoracic fascia
    • - loose CT layer
    • - separates the parietal pleura from internal surface of thoracic wall
  30. Costodiaphragmatic Recess
    • Below 6th rib (MCL)
    • Below 8th rib (MAL)
  31. Lobes of the lungs
    • Each lung has 10 bronchopulmonary segments
    • Right Lung (3 lobes)
    • - separated by horizontal / oblique fissures

    • Left Lung (2 lobes)
    • - separated by oblique fissure
  32. Right Lung - Mediastinal surface
    • Anteriorly:
    • - groove for SVC
    • - cardiac impression
    • - pulmonary a.
    • - pulmonary v.

    • Posteriorly:
    • - groove for azygos arch
    • - groove for esophagus
    • - Bronchus
  33. Left Lung - Mediastinal surface
    • Anteriorly:
    • - large cardiac impression
    • - groove for subclavian a.
    • - pulmonary v.
    • - lingula

    • Posteriorly:
    • - groove for aortic arch / descending aorta
    • - pulmonary a.
    • - bronchus
    • - pulmonary v.
  34. Right bronchial tree
    • Trachea -> R. main bronchus
    • -> R. superior (eparterial) bronchus
    • -> R. middle / inferior bronchi
  35. Arterial supply to lung
    • Bronchial arteries
    • (branches of descending aorta)
  36. Venous drainage of lung
    • Bronchial veins
    • (right into azygos v. / left into hemiazygos system)
  37. Why can't blood oxygenation reach 100%?
    • Inside lungs, bronchial veins unite w/ pulmonary v.
    • Delivers low oxygenated blood to right atrium
  38. Thoracic autonomics
    • Parasympathetics
    • - Vagus n. (constrict)

    • Sympathetics
    • - sympathetic trunks (dialate)

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