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thorax
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09/23/2010

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Term
true ribs
Definition
1-7 attach sternum
Term
total ribs
Definition
12
Term
false ribs
Definition
8-10 attach at 7th cost cart
Term
floating ribs
Definition
11,12
Term
typical ribs
what
how typical

aypical means what
Definition
3-9 or 2-10 - may vary
two costal attachments at vertebra
1 at transverse process

attach at 1 vertebral costal facet
Term
5th rib attaches to which verts superior costal articulating facet?
Definition
5th
Term
pect major has two innervations

pect minor one
Definition
lateral/medial pectoral

medial pectoral
Term
between pect major/minor
Definition
clavipectoral fascia

medial/sup to CP fascia neurovas bundle of thoracoacromial a/v and lateral pectoral pierce
Term
breast located in what fascia
Definition
superficial
Term
mammallary crease. where

nipple, males ?
Definition
around 6th rib

4th space
Term
suspense ligs of cooper attach to what, but not what
Definition
dermis, not deep fascia
Term
retromam space, bet what?
Definition
deep fascia of pect major and breast
Term
cause of dimples vs retraction

small dimples?
Definition
dimples: invasion of suspens ligs

nipple retraction: of lact ducts

lymphedema
Term
how breast ca spread to brain/verts?
Definition
ax nodes - posterior intercostal veins - azygos/hemi
or
- vert. venous plexuses surrounding spinal cord system to verts or brain

azy runs along spine
Term
how know if cancer in pect major fram breast?
Definition
when pect contracts, boob elevates
Term
ax and parasternal nodes drain to what nodes
Definition
clavicular
Term
what intercostal muscle can you see from costal cart to sternum?
Definition
inner intercostal.

external laterally to costal cart then stop
Term
external intecost, direction
Definition
towards middle
Term
which in from axillar v/a?
Definition
VEIN
Term
transverus thoracis
given rise by what muscle
do what
Definition
innermost intercost
hold down internal thoracic
Term
intercostal n between which intercost muscles?
Definition
innermost and inner
Term
limits of
thoracic cavity
mediastinum
Definition
diaphragm to ribs

lungs/diaphram
Term
referred pain
how
Definition
afferent visceral, afferent motor converge at same levels of spinal cord
Term
problems with mediastinum, or any pushing on diaphram results in pain where?

ex. pain in mediastinum/diaphragm
ex. pain in stomach/pancreas/spleen/liver/Q
Definition
shoulder, neck (PHRENIC)

between shoulder blades (SPLANCHNIC, T5,6)

phrenic nerve motor/sensory to diaphragm but also SENSORY TO MEDIASTINAL PLEURA

if blow up cavity with air for study, shoulders will hurt after
Term
parietal pleuras
pain, nerve

visceral pleura
pain nerves
Definition
localized, sensitive (can be referred) somatic

poorly localized, insensitive autonomic

disease wont really hurt until invades parietal layer
Term
pleural cavity
bt what
Definition
parietal/visceral pleura
Term
cardiac notch at what rib space
Definition
4th
Term
if at 1st rib what is the space below called?
Definition
1st space!

spaces take name of rib ABOVE
Term
mid clavicular
lungs
pleura
Definition
6
8
Term
mid axillary
lung
pleura
Definition
8
10
Term
scapular (inf angle(
lung
pleura
Definition
10
12
Term
why only one fissure on left
Definition
no room for 3 lobes, heart there
Term
pulmonary ligament
function
what is it
Definition
connection between visceral/parietal pleura

at hilum, visceral pleura of lung becomes parietal (think of fist in baloon... has to become parietal at some point
Term
pneumo
Definition
air/gas
Term
leading cause of maternal death
Definition
pul embolism (from DVT)
Term
bronchus branches a what topographical struct
Definition
sternal angle
Term
bronchus intermedius what side where how diff from left main bronchus
Definition

right side. right below right upper lobe bronchus wider and more vertical then left main bronch

 

[image]

Term
if something aspirated, where likely to get stuck
Definition
right main bronchus.
wider and more vertically in line with trachea
Term
bronchial arteries/veins
function
Definition
feed, drain visceral pleura/tissue of lungs.
do not function in gas exchange
Term
bronchial branching

right side has how many lobes?
left?

about how many segments on each side?
Definition
main (prim) -> lobes (secondary) -> segments (tertiary)

Right: 3
Left: 2 (not enough room for 3!)

about 10 on each side
Term
bronchus
bronchiole
avioli

compostion?
when does cartilage stop?
Definition
bronchus - cart
bronchiole - smooth m, elastic fiber
avioli - elastic fiber

cart stops at about 1mm diameter
Term
parasymph effects
Definition
vasodilates systemic vessles
(decrease heart rate, BP, stroke v)
increase mucous, less exchange
constricts bronchiole lumen, slower oxygenation
constricts coronoary arts
Term
symph effects
Definition
constrict systemic vessels
decrease mucous
dilate bronchioles
dilate cornary art (increase BF to <3)
Term
diaphragm flattens upon inspiration why?
Definition
increase thoracic volume
Term
inspiration: what intercostal muscle contracts
why
Definition
external

raise ribcage
Term
expiration
what m contracts?
why?
Definition
inner intercostal

bring ribcage down
Term
pneumothorax (open)
what?
Definition
air getting into pleural cavity, pressure rises and lung collapses
Term
pneumothorax (closed)
what happens

affect on venous return?
Definition
inspiration
air into pleural cavity (puncture) causing ipsilateral lung to collapse.
mediastinum shifts to opposite side

expiration
open wound closes from pressure inside, air cannot get out, mediastinum pushes to other side

increased pressure impairs venous return
Term
hemithorax
Definition
one side of chest
Term
hemothorax
hydrothorax
pyothorax
chylothorax
Definition
blood (usual injury to intercostal vess)
watery stuff (maybe from effusion into pcavity)
pus
lymph
Term
2 ways stuff could get into pleural space?
Definition
opening in parietal pleural

leakage through visceral pleura
Term
thoracentisis
where?
where in this place?
Definition
2nd/3rd intercost space

above upper boarder of ribso dont hit intercostal vessels/nerves
Term
why does lung collapse when air in PC
Definition
surface tension between pleura broken.
collapses due to inherent elasticity (recoil)
Term
percussion sounds
dull
resonant
flat
Definition
dull: fluid
resonant: air
flat: solid
Term
symptoms of pul embolism
Definition
tachycardia, dyspnea
Term
heart, how many beats/min

average age
Definition
70

75
Term
pericardium
layers, layers

outer layer continuous with?
Definition
fibrous & serous

serous: parietal and visceral

fibrous layer continuous with central tendon of diaphrahm
Term
cardiac tamponade
what
result - which causes
end result
how treat?
Definition
compression of heart

due to fluid accumulation in pericardium, increased pericard pressure on heart. cant fill up!!

decreased vent filling/StrokeV
vents get bigger to compensate (cardiomeglay)

usually shock or death

pericardiocentesis (remove liquid from pericard sac)
Term
pericardiocenteisis
where put needle in? space?
drain?
Definition
xiphoid/costal margin, 5th space

cardiac notch allows easy drainage that doesnt affect L lung
Term
what could cause heart compression
Definition
liquid in peri sac but stab wound (blood), perforated heart wall after Hattack)
Term
mediastinum structs anatomically lower when lying or standing
Definition
standing. gravity pulls down
Term
what sulcus separates A/V
Definition
coronary
Term
percussion of heart
sounds normally dull where?
Definition
4th, 5th, 6th intercost spaces 6 cm to left
Term
conus arteriosis
where
Definition
only right ventricle
where pul art starts
Term
tricuspid valve
how many papillary m, where
Definition
3 papillary muscles attached to cordae tendinae

ant/post/septal
Term
ductus arteriosis
function
becomes what
where
Definition
bt aorta to pul trunk/artery

shunts blood from pul artery to aorta
LIGAMENTUM ARTERIOUS
Term
pap muscles contract/relax during systole
Definition
contract, close valve so no backflow, respond to pressure
Term
interventricular septum
what is made of?
Definition
muscle!
will bulge
Term
thrombi
why form?
Definition
due to certain types of heart disease, detach and occlude stff
Term
septomarginal trabecular
also called
funtion
Definition
moderator band (R vent)
part of electrical conduction system
Term
pectinate muscle
Definition
R has more, L has only in auricle.
from embryonic atrium
Term
what of L atrium is anterior
Definition
aurcile
Term
sinus of Valsalva
Definition
aortic sinuses
Term
RCA
branches
prx - distal

LCA
Definition
AV branch
marginal (supplies r boarder)
Post IV (right post descending)

ant IV (LAntDescending)
circumflex
Term
Dominance
% R, % left

what means


why is having left dominant dangerous
Definition
R, 70
L, 10

SOURCE of posterior descending artery

LCA easily occulded
Term
CABG

use what?
Definition
corn art bypass graft

internal thoracic artery (divert)
or
great saphenous vein
or radial artery
Term
most common sites of embolism resulting in infarct
Definition
LAD, RCA, circumflex
Term
ischemic heart diease
cause
Definition
athlerosclerosis
Term
typical place of myocardio referred pain
Definition
medial aspect of left upper arm
Term
CAD / electric system
SA/AV nodes supplied by?
AV bundle supplied by?
Definition
SA/AV -RCA
AV bundle -LCA

NOTE: av bundle runs down AV septum
Term
heart block
damage to what?

bundle block
damage to what
Definition
damage to AV node
vents contract but much slower

AV bundle
normal systole in one branch only (asnychronus contraction)
Term
Cardiac veins
drain where
branches?
Definition
drain to Csinus

great vein follows LAD
middle follows post IV
small follows marginal
Term
listening to valves:
aortic
pulmonic
tricuspid
mitrial
Definition
2nd space/sternum right
2nd space/sternum left
5th space/sternum left
5th space/mid-clavicular (apex of heart), where costal cart ends
Term
only cxn bt atria/vent
Definition
av bundle
Term
apex contracts? (direction)

atria contracts?
Definition
down up

up down
Term
topographic borders of mediastinum
ant
post

sup mediastinum

inferior mediastinum
Definition
sternal angle to xiph-sternal joint

T5-T9

sternal angle to sup thoracic aperature

sternal angle to diaphragm
Term
orientation of vessels in mediastinum
Definition
Veins - ant
arteries - poster
nerves - most post
Term
embryonic origin of thymus
Definition
endoderm
3rd laryngeal pouch
Term
blood path when IVC/SVC obstructed?
Definition
IVC: through azygos to SVC
SVC: drain into abdominal walls then up azygos
Term
AAA
pain manifests where?
other sympts
Definition
back
dyspnea, AAA may compress trachea/esophagus/Recurrent laryngeal n (difficulty breath/swallow)
Term
branches of brachiocephalic vein (L/R)

BCv dumps into
Definition
internal jugular v. + subclavian

SVC
Term
branches of aortic arch

med to lateral
Definition
brachiocephalic trunk
(r. common carotid, r sub)

L common carotid
L subclavian
Term
Bovine Arch
% people
what
Definition
L common carotid comes off brachiocephalic artery
L carrot can come off at prox/distal trunk

12%

so now BC artery would have 3 branches, r sub, r carrot, l carrot
Term
Bowline Arch
what?
% people
Definition
two brachiocephalic trunks
1.2%
Term
L vertebral artery comes off aorta (instead of L subclavian)

%?
Definition
2.5
Term
collateral blood with aortic coarctation
Definition
less blood to inferior body. due to narrowing of lumen of aorta. prox/dis to ligamentum arteriosis

so blood goes from posterior intercostals moves anterior and inferior.
Term
landmark for left recurrent laryngeal nerve?
Definition
ligamentum arteriosum
Term
Patent Ductus Arteriosis
problem after birth?
common in?
#/1000?
female or male?
how treat non invasively?
Definition
pressure drives blood from aorta through DA to pulmonary trunk/arteries.

more blood to lungs increases pul pressure (-> pul edema)

decreased systemic flow,
LV compensates and pumps more (hypertrophy)

more in females,
8/1000
give anti-inflammatorys.
Term
Wwhat keeps ductus arterious open?
Definition
prostangladins AKA INFLAMMATION
Term
inflamm of bronchi or aorta will cause what nerve to get compressed
Definition
left recurrent laryngeal
Term
left recurr laryngeal n. under what?

right RLn. under what?
Definition
aorta/ligamentum arteriosis

R subclavian
Term
cardiac plexus
originiates from what?
supplies what?
controls what?
where sits?
Definition
vagus nerves/sympathetic trunk
heart
constriction of coronary a, heart rate
aortic arch
Term
pulmonary plexus
originates from?
controls
sits?
Definition
vagus nerves/sympathetic trunk
bronchiole constriction
pul trunk
Term
bifurcation of trachea at vert lvl? (carina)
Definition
T4, sternal angle (2nd rib)
Term
anterior mediastinum
Definition
thymus, lymph nodes, fat, connective tissue
Term
middle mediastinum
Definition
pericardium, heart, root of great vessels, arch of azygos, main bronchi
Term
posterior mediastinum
Definition
largest region, T5-T12, esophagus, aorta, azygos & hemizygos, thoracic duct, vagus nerves, sympathetic trunks, splanchnic nerves
Term
esophagus deviates to become anterior to aorta at what vert lvl
Definition
T8/9
Term
azygos, thoracic duct, aorta
right to left
Definition
azygos, TD, aorta
Term
laceration fo Thoracic duct
result
Definition
chylothorax - accumulation of chyle in pleura
Term
azygos joins SVC at what vert lvl

drains blood from where?
Definition
T4 (sternal angle)

post walls of abdomen and thorax
Term
hemiazygos
arises from where?
crosses verts to join azygos where?
Definition
post renal vein

T6/7 (post to Tduct/aorta)
Term
accessory hemiazygos
where crosses over?
drains blood from where?
Definition
T8

intercostal veins 4-8
Term
Splanchnic Nerves
innervate what?
Definition
supply viscera inferior to diaphragm

Greater, lesser, least (T5-12)
medial to sympathetic trunk
Term
what vert level, aortic arch
Definition
T3
Term
anterior cardiac vein drains where?
Definition
coronary sinus
Term
normal, quiet expiration lying down is acheived by contraction of what?
Definition
elastic tissue of lungs/thoracic wall. EXPIRATION IS PASSIVE
Term
CIRCUMFLEX BRANCh supplies what?
Definition
left atrium, left ventricle
Term
posterior intercostal arteries 3-12 supplied by?

what supplies upper 6 intercost arteries?
Definition
aorta

internal thoracic
Term
thorocentesis
where preformed preferrably?
Definition
1-2 spaces below the fluid, not below the 9th. mix axillary line
Term
apex of heart receives blood form what coronary artery generally?
Definition
LAD (goes all the way down)
Term
major muscles upon active expiration?
Definition
abdominal (not diaphragm)
Term
muscles of inspiration
Definition
diaphragm, external intercostal, levator,
Term
what vein passes over root of r lung?
Definition
azygos arch
Term
venous drainage - intercostals
Definition
2-4 intercost veins form SUPERIOR IC vein wich drains into (L) brachiocephalic, R (azygos)
Term
internal thoracic vein drains into what?
Definition
brachiocephalic vein
Term
coronary arteries at max blood flow at?
systole/diastole
Definition
diastole
Term
LUB DUB
what closes during lub?
dub?
Definition
tricuspid/mitrial

aortic/pulmonary
Term
septum primum = character?
septum secondum =
Definition
SP = thin, membranous
SS = musccular thick
Term
ventricle formation
Definition
atrium in back, ventricle in front
endocardial cushions begin to grow into ridges of tissue on opposite sides (crossing each other) of trucus arteriorsis (superior to vent) making a spiral. forming AORTICOPILMONARY SEPTUM

muscular vent septum grows from floor, partially dividing ventricles. when aorticopulmonary septum and intervent septum meet, aorta and pul trunk are formed.
Term
VSD
main development cause?

blood goes where?
Definition
often associated with irregular partitioning of conotruncal region - failure of ridges to fuse and descend.

blood from left V to right vent and to pulmonary trunk (higher P to lower P) - leading to pul edema
Term
how treat VSD?
Definition
Dacron patch or reduce flow to pulmonary trunk.
Term
tetrology of Fallot
most frequent abnormality of conotruncal region
what?

4 things associated

presents as?
Definition
unequal division of conus, produces 4 alterations:

Intervent septal defect
Hypertrophy of Right V
Overriding aorta
Pulmonary stenosis (small pul trunk)

body cyanosis
Term
persistant truncus arteriosis
Definition
contruncal ridges fail to fuse, blood from R/L vents move into aorta/pul trunk fused and mix
Term
4th pharangeal arch
6th
3rd
all become what
Definition
4th subbclavian/aorta
6th pulmonary artery (6P)
3rd thymus
Term
fetal circulation
Definition
oxy blood (placenta) - umbilical vein - ductus venosus (bypass liver) - IFC - RA - foramen ovale - LA - LV - aorta - body - umbilical artery - placenta

or

RA - RV - PT - DArteriosis - Aorta - body - umbilical artery - placenta
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