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Anatomy
Thorax
149
Anatomy
Graduate
10/22/2011

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Term
What are dermatomes slanted in some areas of the body and horizontal in others?
Definition
due to embryology and development
Term
Which spinal nerves are associated with the intercostal nerves? Where are the intercostal nerves located?
Definition
-anterior rami of spinal nerves T1-T11
-they lie in the intercostal space between the ribs
Term
Is the innervation to the muscles of the thoracic wall somatic or visceral?
Definition
somatic
Term
Which spinal nerve supplies to dermatome at the level of the clavicles and immediately below?
Definition
C5
Term
Give some characteristics of shingles
Definition
-reactivation of chicken pox virus
-Follows the dermatome levels of the spinal ganglia for which it effects
-skin area involved is red and vesicular eruptions appear
-mostly sensory, but sometimes muscle weakness can occur
Term
At what spinal level is the thymus located?
Definition
T4/T5
Term
When is the thymus largest?
Definition
In childhood
Term
Which type of immune cells mature in the thymus?
Definition
T cells
Term
What is special about the tissue of the thymus?
Definition
It is hematopoietic tissue, blood can be produced there
Term
Which nerve is the esophageal plexus formed from?
Definition
The vagus nerve
Term
Esophageal varicose develop due to elevated pressure in which vein?
Definition
The portal vein
Term
How many ribs are there? Which are true? false? floating? Which ribs are the "typical" ribs?
Definition
-12
-1-7
-11-12
-3-9
Term
Each vertebrae articulates with how many ribs? How many vertebrae does each rib articulate with?
Definition
2 and 2
Term
What is unique about rib 1?
Definition
It has a single facet on its head for articulation with only T1. it also has an attachment for the scalene muscle
Term
What is unique about rib 2?
Definition
it has a tuberosity for the serratus anterior
Term
What is unique about ribs 10-12? What is even more unique about 11 and 12?
Definition
-10-12: only have one facet and articulate with a single vertebrae
-11&12: have no neck or tubercle
Term
How are the intercostal spaces named?
Definition
According to the rib forming the superior border
Term
At what vertebral level is the sternal angle?
Definition
T4/T5
Term
What is the xyphoid process a point of attachment for?
Definition
the diaphragm
Term
Rib 1 is rarely fractured, but if it is broken injury to which to structures will likely occur?
Definition
-brachial plexus
-subclavian arteries
Term
Flail chest results from what?
Definition
Multiple rib fractures
Term
What is a pneumothorax? What is the difference between an open and a tension pneumothorax?
Definition
-Air enters the pleural cavity, takes up space, and restricts lung expansion
-Tension: air enters pleural cavity through wound in inhalation, but cannot leave on exhalation
-Open: air enters pleural cavity through the wound on inhalation and exits on inhalation
Term
What is usually the cause of a spontaneous pneumothorax?
Definition
A bulla ruptures
*a bulla is when little alveoli group into larger air sacs (like in emphysema) and turn into a blister like growth on the lung
Term
What are some consequences of an extra cervical rib?
Definition
-may interfere with neurovascular structures resulting in thoracic outlet syndrome
-can put stresses on lower part of the brachial plexus
Term
Where are the three places on the vertebrae that a rib articulates?
Definition
-On the body at the superior and inferior costal facets of the superior vertebrae and the vertebrae of the same number
-transverse process of the vertebrae of same number
Term
Which rib articulates with the sternal angle?
Definition
Rib 2
Term
What significance does the T4/T5 level have with the aorta?
Definition
It is where the aorta transitions from ascending to arch then to descending
Term
About at what level of the vertebrae does the aorta pierce the diaphragm?
Definition
T12
Term
About at what level of the vertebrae does the esophagus pierce the diaphragm?
Definition
T10
Term
About at what level of the vertebrae does the vena cavae?
Definition
T8
Term
What vertebral level does the diaphragm posteriorly descend to?
Definition
L1/L2
Term
What is the action of the diaphragm when you inspire? expire?
Definition
-contracts (flattens)--> induces pressure change which results in air being drawn into the lungs
-relaxes
Term
What are three arteries that supply blood to the diaphragm?
Definition
-inferior phrenic- which branch directly from abdominal aorta
-superior phrenic- which branch from lower thoracic aorta
-branches of the internal thoracic arteries from above
Term
In terms of alveolar and atmospheric pressure, list these actions in order of greatest to least pressure: expiration, inspiration, at rest
Definition
-expiration
-at rest
-inspiration
Term
Which nerves supply the diaphragm?
Definition
C3, C4, and C5, the phrenic nerves
Term
Do the parietal and visceral pleura move together during inspiration and expiration? Describe the pleural cavity.
Definition
-yes
-it is between the visceral and parietal pleura. a potential space, never a real space unless there is some pathology (i.e. pneumothorax
Term
The two pleural cavities of the thorax are separately enclosed spaces except for at the ________ through which the airways and blood vessels enter and leave.
Definition
isthmus
Term
What is the difference between the parietal and visceral pleura?
Definition
Parietal lines the walls of the pleural cavities
visceral lines the surface of the lung
Term
Name 6 significant things about vertebral level TIV/TV
Definition
-passes through sternal angle anteriorly
-separates superior mediastinum from the inferior superior limit of the pericardium
-arch of aorta
-superior vena cava penetrates the pericardium to enter heart
-trachea bifurcates into right and left primary bronchi
-superior limit of pulmonary trunk
Term
The thoracic aorta branches into the internal thoracic arteries which then branch into what that pass laterally around the thoracic wall?
Definition
posterior and anterior intercostal vessels
Term
Intercostal nerves are from the anterior/posterior (?) rami of which spinal nerves?
Definition
anterior rami of thoracic spinal nerves
Term
Which two veins converge to form the superior vena cava?
Definition
the right and left brachicephalic veins
Term
Superiorly, what are the 4 major branches of the aorta?
Definition
Right and left common carotid artery and right and left subclavian artery
Term
Does the head of the rib articulate with the vertebrae or the sternum?
Definition
vertebrae
Term
Which ribs articulate with the sternum? What types of joints do they form?
Definition
1-7, synovial joints except for Rib 1
Term
Where do intercostal nerves and major arteries and veins lie?
Definition
in the costal groove along the inferior margin of the superior rib and pass between the inner two layers of muscle
Term
What is the order of the arteries, nerves and veins in each intercostal space?
Definition
Vein is most superior, then artery, and then nerve (VAN)
Term
Which way do the fibers of the external intercostal muscles run? what is the O and I? what do they function in?
Definition
-like hands going into pockets
-O: inferior aspect of rib above
-I; superior aspect of rib below
-function in inspiration
Term
Which way do the fibers of the internal intercostals run? What is the O and I? what do they function in?
Definition
-like hands under suspenders
-O: rib below
-I; rib above
-function in expiration
Term
The innermost intercostal muscles are the same as which other intercostal muscles?
Definition
internal and innermost
Term
Which nerve innervates the intercostal muscles?
Definition
intercostal nerve
Term
What is the O,I, and A of the diaphragm muscle?
Definition
O- typhoid process of sternum
I- costal margin of the thoracic wall, vertebrae of lumbar region
A- aids in inspiration, recoils with expiration
Term
What supplies blood to the anterior thoracic wall? Which artery do these arteries arise from? Which arteries do these arteries give rise to?
Definition
-internal thoracic arteries
-arise from the subclavian arteries
-give rise to the anterior intercostal arteries
Term
At the level of the 6th intercostal space each internal thoracic artery divides into two branches. what are these branches?
Definition
-superior epigastric which supplies the anterior abdominal wall
-musculophrenic which goes through the diaphragm
Term
What delivers the blood supply to the posterior thoracic wall?
Definition
Descending aorta which gives rise to the posterior intercostal arteries
Term
Blood is returned from the anterior thoracic wall by the anterior intercostal veins which carry blood to the internal thoracic veins which empty into what?
Definition
the right and left brachicephalic veins
Term
The posterior wall is drained by the posterior intercostal veins which empty into the bayous venous system. The ________ vein dumps into the posterior aspect of the ______/______/______
Definition
-azygous
-superior vena cava
Term
How many lobes does the left lung have? the right?
Definition
-2
-3
Term
What comprises the root of the lung?
Definition
primary bronchi, pulmonary arteries, and pulmonary veins
Term
At what vertebral level does the trachea split into the R and L bronchi? Which primary bronchi do aspirated objects end up in usually?
Definition
-4th thoracic vertebral level
-right because it continues nearly vertically while the left veers laterally
Term
What is the depression on the L lung?
Definition
the cardiac notch
Term
The tertiary (segmental) bronchi supply segments of lung tissue called what?
Definition
bronchopulmonary segments
Term
Each bronchopulmonary segment consists of many small compartments called what? What are these compartments composed of?
Definition
-Lobules
-lymphatics, arterioles, venules, terminal bronchioles, respiratory bronchioles, alveolar ducts, alveolar sacs, alveoli
Term
What do type 1 pneumocytes do?
Definition
they are macrophages in the alveoli
Term
what do type 2 pneumocytes do?
Definition
produce surfactant that reduces the surface tension in the alveoli and prevents the alveoli from collapsing at the end of expiration
Term
What are the three layers of the trachea?
Definition
mucosa, submucosa, and hyaline cartilage
Term
What is the carina?
Definition
the internal ridge on the last ring of cartilage of the trachea. it is where the bronchi bifurcate
Term
T of F: each bronchopulmonary segment is independently supplied by a tertiary branch of the pulmonary artery.
Definition
True
Term
Terminal bronchioles give rise to what?
Definition
respiratory bronchioles
Term
Respiratory bronchioles divide in to 2-11 what? which give rise to what?
Definition
-alveolar ducts
-alveolar sacs (basic unit of gas exchange)
Term
When a blood clot is stationary in that body it is called what? when it breaks free and travels it is call what?
Definition
-embolus
-thrombus
Term
What do the pulmonary arteries do? Where does bifurcation of the pulmonary trunk occur? Which one R or L is longer?
Definition
-carry deoxygenated blood to the lungs
-T4/T5
-R is longer
Term
What do pulmonary veins do?
Definition
carry oxygenated blood from the lungs back to the heart
Term
How do the bronchial veins return to the heart?
Definition
-via the azygous vein
Term
Bronchial arteries originate from what?
Definition
thoracic aorta
Term
The superficial and deep lymphatic plexuses both drain into what?
Definition
deep veins in the base of the neck or they may drain into the R lymphatic trunk or thoracic duct
Term
where is the deep lymphatic plexus located in the lung?
Definition
submucosa of the bronchi
Term
Mammary glands are modified _______ glands
Definition
sweat
Term
What is the circular pigmented area of skin surrounding the nipple called?
Definition
areola
Term
Innervation of breast is via anterior and lateral cutaneous branches of the ____-_____ intercostal nerves
Definition
2-6th
Term
75% of the lymphatic drainage from the breasts drains into which nodes?
Definition
axillary nodes
Term
What is significant about the suspensory ligaments in the breast?
Definition
if you have a lesion that causes fibrosis, it can tug on the suspensory ligaments and cause dimpling of the skin of the breast
Term
What is important about the fascia that lies beneath the breast and over the pectoral muscle?
Definition
Lesions will track along the path of least resistance and most likely follow the fascia downward following gravity
Term
Divide the breast into _______ to conduct examinations
Definition
quadrants
Term
Branching of the ________ ducts occur in breast tissues during menstrual periods and pregnancy
Definition
lactiferous
Term
What is the name of the white to yellowish pre milk fluid that secretes from the nipples during the last trimester of pregnancy? What is significant about it?
Definition
-colostrum
-it is rich in proteins, immune agents and growth factors affecting the infant's intestines
Term
Which two veins drain the posterior and lateral parts of the left thoracic wall? Which vein do they flow into?
Definition
-hemiazygos and accessory hemiazygos veins
-drain into the azygous vein
Term
Where does the remaining 25% of lymphatic drainage that does not drain via that axillary nodes go? These nodes drain into what?
Definition
-parasternal nodes
-bronchomediastinal trunk
Term
Why are the supraclavicular lymph nodes nicknamed "sister mary's lymph nodes"?
Definition
Sister mary, a nurse and nun, was the first to make the observation that many women with metastasis had hard supraclavicular lymph nodes, meaning that the cancer had metastasized to the supraclavicular lymph nodes
Term
The parasympathetic fibers from the vagus nerve innervate what three areas of the lungs?
Definition
-motor to the smooth muscle of the bronchial tree (bronchoconstrictor)
-inhibitory to the pulmonary vessels (vasodilator)
-secretory to the glands of the bronchial tree (secretomotor)
Term
The central part of the diaphragmatic pleura and mediastinal pleura are supplied by what nerves?
Definition
the phrenic nerves
Term
Horizontal plane passing through which two structures separates the mediastinum into superior and inferior parts?
Definition
-sternal angle
-intervertebral disc between T4/T5
Term
the inferior mediastinum is subdivided by the ________
Definition
pericardium
Term
The fibrous _______ is the tough CT outer layer that defines the boundaries of the middle mediastinum
Definition
pericardium
Term
The _______ pericardium is thin and has two parts. what are the two parts?
Definition
-serous
-parietal: lines inner surface of the fibrous pericardium
-visceral: adheres to the heart and forms the outer layer or epicardium
Term
Between the parietal and visceral layers of the serous pericardium is what?
Definition
A potential space filled with pericardial fluid that reduces the friction between the two membranes
Term
Bleeding into the pericardial cavity compresses the heart and is potentially lethal. What is the name for this?
Definition
cardiac tamponade
Term
Which nerves pass through the serous pericardium?
Definition
the phrenic nerves, C3-C5
Term
What are three major vessels that are included in the middle mediastinum?
Definition
-superior and inferior vena cava
-pulmonary trunk (R and L pulmonary arteries)
-ascending aorta
Term
What are the vertebral levels of the thoracic aorta?
Definition
Begins at T4 and ends at T12
Term
The heart has two surfaces and two borders, what are they?
Definition
-anterior and inferior
-right and left
Term
Where is the auscultation position for:
-the aortic valve
-the mitral valve
-the tricuspid valve
-the pulmonary valve
Definition
-right of the sternum at the 2nd intercostal space
-at the apex, usually midclavicular around the 5th intercostal space
-just left of sternum at 5th intercostal space
-just left of sternum at 2nd intercostal space
Term
What are the sulci of the heart?
Definition
grooves on the surface of the heart containing coronary blood vessels and fat
Term
Which sulcus encircles the heart and marks the boundary between the atria and the ventricles?
Definition
coronary sulcus
Term
from what three sources does the right atrium receive blood?
Definition
-superior vena cava
-inferior vena cava
-coronary sinus
Term
Where is the tricuspid valve located?
Definition
Between the right atria and the right ventricle
Term
Which part of the heart forms most of the anterior surface of the heart?
Definition
right ventricle
Term
Where is the pulmonary semilunar valve located?
Definition
in-between the right ventricle and the pulmonary trunk
Term
What are chordae tendinae?
Definition
cords between valve cusps and papillary muscles
Term
Which part of the heart forms most of the base of the heart?
Definition
left atrium
Term
Where is the bicuspid valve located? What are some other names for this valve?
Definition
-in between the left atrium and ventricle
-LAMB: left atrioventricular, mitral, bicuspid
Term
Which part of the heart receives blood from the lungs? How many pulmonary veins are there?
Definition
Left atrium
-4 veins, 2 left and 2 right
Term
Which part of the heart forms the apex?
Definition
left ventricle
Term
Where is the aortic semilunar valve located?
Definition
in-between left ventricle and ascending aorta
Term
What lie just above the aortic semilunar valve?
Definition
openings to the coronary arteries
Term
What is the moderator band?
Definition
a single specialized trabeculum that forms a bridge between the lower portion of the inter ventricular septum and the base of the anterior papillary muscle. It carries a portion of the cardiac conduction system, the right bundle of the AV bundle, to the anterior wall of the right ventricle
Term
Dense ________/________ rings surround the valves of the heart, fuse and merge with the _________/_________
Definition
-connective tissue
-interventricular septum
Term
What is a function of the fibrous skeleton of the heart regarding conduction of impulses?
Definition
it acts as an electrical insulator between the atria and ventricles, preventing direct propagation of AP's to ventricles
Term
When the atrioventricular valves are open are the chordae tendinae and papillary muscles relaxed or contracted?
Definition
relaxed
Term
What is mitral valve insufficiency aka mitral valve prolapse?
Definition
blood regurgitates into the left atrium when the left ventricle contracts
Term
What is pulmonary valve stenosis?
Definition
valve cusps are fused, restriction of right ventricular outflow, right ventricle hypertrophies
Term
What is pulmonary valve incompetence?
Definition
back rush of blood under high pressure into the R ventricle during diastole
Term
What is aortic valve stenosis commonly caused by?
Definition
rheumatic fever (left ventricle hypertrophies)
Term
What is aortic valve insufficiency?
Definition
aortic regurgitation into the L ventricle
Term
What is coarctation of the aorta?
Definition
narrow segment of the aorta. depending on where the narrowing is it can be more or less serious
Term
What is patent ductus arteriosus?
Definition
The ductus arterioles remains open
Term
What is atrial septal defect?
Definition
Foramen ovale fails to close and blood will have to shunt from L to R and puts increased load on the R side of the heart
Term
What is a ventricular septal defect?
Definition
Opening in the inter ventricular septum. blood will shunt from L to R
Term
What is teratology of Fallot?
Definition
Aorta and pulmonary trunk are emerging from the wrong places. Aorta emerges from both ventricles: enlarged right ventricle, inter ventricular septal defect, stenosed pulmonary valve
Term
What is the end diastolic volume (EDV)?
Definition
volume in the ventricle at the end of diastole
Term
What is the end systolic volume (ESV)?
Definition
volume in the ventricle at the end of systole
Term
What is the stroke volume?
Definition
the volume ejected per beat from each ventricle
Term
SV= What- What?
Definition
SV=EDV-ESV
Term
What is the coronary circulation?
Definition
blood supply to the heart muscle
Term
What specifically do the L and R coronary arteries supply?
Definition
L: both ventricles and inter ventricular septum
R: supplies the R atrium and ventricle, SA and AV nodes, the interatrial septum, part of left atrium, and part of left ventricle
Term
What is the sequence of the internal conduction system of the heart?
Definition
SA-AV-bundle of HIS-purkinje fibers
Term
What are the three most common sites of coronary artery occlusion?
Definition
-anterior LAD branch of the LCA
-RCA
-circumflex branch of the LCA
Term
Name the 4 cardiac veins
Definition
-great CV
-middle CV
-small CV
-posterior CV
Term
Where is the SA node located?
Definition
R atria
Term
Where is the AV node located?
Definition
in atrial septum, transmits to bundle of his
Term
What is the AV bundle of his?
Definition
-the connection between the atria and ventricles
-divides into bundle branches and purkinje fivers
Term
The autonomic NS is responsible for regulation of what three aspects of the heart?
Definition
-heart rate
-force of contraction
-cardiac output
Term
what is CHF?
Definition
congestive heart failure: chronic or acute state that results when the heart is not capable of supplying the oxygen demands of the body
Term
Where does blood back up in left sided heart failure?
Definition
into the lungs as pulmonary edema
Term
where does blood back up in right side heart failure?
Definition
the tissues as peripheral edema
Term
Contrast the effects of unilateral and bilateral damage to the recurrent laryngeal nerves?
Definition
-unilateral= voice changes (hoarseness)
-bilateral= breathing difficulties and aphonia (inability to speak)
Term
Which veins drain blood from the body wall and move it to empty into the superior vena cava?
Definition
Azygos veins (azygos, hemiazygos, and accessory hemiazygos)
Term
Where does the greater splanchnic nerve, the lesser splanchnic nerve, and the least splanchnic nerve arise from?
Definition
-greater= 5-10th thoracic ganglia
-less=10-11 thoracic ganglia
-least= 12 thoracic ganglion
Term
What are the sounds heard for air filled, fluid filled, and solid tissue upon auscultation?
Definition
-air filled= resonant sound
-fluid filled= dull sound
-solid= flat sound
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