Term
| sternum (via costal cartilage) |
|
Definition
| where do ribs 1-7 attach? |
|
|
Term
|
Definition
| which ribs are TRUE ribs? |
|
|
Term
| cartilage that attaches to cartilages of ribs superior |
|
Definition
| where do ribs 8-10 attach? |
|
|
Term
|
Definition
| which ribs are FALSE ribs? |
|
|
Term
| have cartilages ending in posterior abdominal wall |
|
Definition
| where do ribs 11-12 attach? |
|
|
Term
|
Definition
| which ribs are FLOATIONG ribs? |
|
|
Term
|
Definition
| what forms the infrasternal angle? |
|
|
Term
|
Definition
| area that separates ribs and costal cartilages |
|
|
Term
| bounded by 1st thoracic vertebrae, 1st pair of ribs, and superior border of the manubrium |
|
Definition
| what are the borders of the superior thoracic aperture? |
|
|
Term
| (inferior most ribs?) closed by the diaphragm |
|
Definition
| what are the borders of the inferior thoracic aperture? |
|
|
Term
| through the diaphragm or behind it |
|
Definition
| where must structures pass that travel between the thoracic and abdominal cavities? |
|
|
Term
| inferior and superior costal facets of adjacent thoracic vertebrae |
|
Definition
| what do the articular facets of the head of a rib articulate with? |
|
|
Term
| costal facet of transverse process of vertebrae of the same number (ex: rib 6 with vertebrae 6) |
|
Definition
| what does the tubercle of a rib articulate with? |
|
|
Term
|
Definition
| the costal groove is in the (inferior/superior) side of the rib |
|
|
Term
synovial, arthroidal(plane/gliding) joint
except in the first rib = synchondrosis |
|
Definition
| part of the rib that forms a joint with the sternum, what kind of joint is this |
|
|
Term
| superior is on the superior border of the vertebra, inferior is on the inferior edge of the vertebrae (so it is reversed in its relationship to the rib with the top of the joint surface being the inferior costal facet) |
|
Definition
| describe the location of the superior costal facet, inferior? |
|
|
Term
1)head
2)neck
3)tubercle
4)angle
5)costal groove
6)shaft
7)sternal end |
|
Definition
| what are the 7 parts of the rib? |
|
|
Term
|
Definition
| what side of the rib is the angle on? |
|
|
Term
|
Definition
| most superior part of the sternum |
|
|
Term
|
Definition
| important in trachiotomy, on the central superior border of the manubrium |
|
|
Term
|
Definition
| part of the manubrium that forms a joint with the clavicle |
|
|
Term
|
Definition
| where is the sternal angle? |
|
|
Term
| you want to prevent jamming the xyphoid process into the liver |
|
Definition
| why do you need to position your hands carefully when doing CPR? |
|
|
Term
| bifurcation of the trachea |
|
Definition
| what is deep to the anterior projection of the sternum? |
|
|
Term
| manubrium, body, xyphoid process |
|
Definition
| list the 3 parts of the sternum |
|
|
Term
|
Definition
| manubriosternal and _________ joints fuse and become synostosis in older persons |
|
|
Term
| failure of fusion between halves of sternal bars during development |
|
Definition
| what causes sternal cleft/foramen? |
|
|
Term
|
Definition
| what should you not confuse the sternal foramen for? |
|
|
Term
|
Definition
| most common congenital deformity of the anterior wall of the chest , in which several ribs and the sternum grow abnormally. This produces a caved-in or sunken appearance of the chest. It can either be present at birth or not develop until puberty. |
|
|
Term
|
Definition
| disorder sometimes considered to be cosmetic; however, depending on the severity, it can impair cardiac and respiratory function and cause pain in the chest and back, caused by overgrowth of bone |
|
|
Term
1) costotransverse joints
2)costochondral joints
3)interchondral joints
4)sternocostal joints |
|
Definition
| name all of the joints that exist with ribs (4) |
|
|
Term
|
Definition
| which ribs do rotation at the costotransverse joints? |
|
|
Term
|
Definition
| which ribs do gliding at the costotransverse joints? |
|
|
Term
| ribs 11-12 do not articulate with transverse processes |
|
Definition
| which ribs do not have costotransverse joints? |
|
|
Term
| primary cartilaginous joints, usually do not experience movement |
|
Definition
| what type of joint is a costochondral joint? is it a very mobile joint? |
|
|
Term
| plane synovial joints between costal cartilages 6-9, fibrous articulation between cartilages 9&10. |
|
Definition
| what type of joints are interchondral joints? and where are they located? |
|
|
Term
joints between costal cartilage and sternum
1st = cartillaginous
joints 2-7 are synovial plane joint |
|
Definition
| what kind of joints are sternocostal joints? which ribs are involved? |
|
|
Term
| anteriorly, posteriorly(sagitally), and transversely |
|
Definition
| what directions does the lung expand in inspiration? |
|
|
Term
| surface tension with the other layer of pleura (parietal pleura) |
|
Definition
| what holds the pleural layer of the lungs (visceral pleura) out? |
|
|
Term
| pressure decreases, air flows in |
|
Definition
| as the volume of the lungs increases, what happens to the pressure, and how does this drive the direction of air flow? |
|
|
Term
elastic recoil and relaxation of the diaphragm
also abdominal muscles (can't cough up mucous if there is a spinal cord injury affecting them) |
|
Definition
| what is the main cause of expiration for the lungs? |
|
|
Term
|
Definition
| when the lateral most part of the ribs are elevated and the transverese diameter of the thorax increases this is called a _____ _____ ________ |
|
|
Term
|
Definition
| when the ribs are elevated at the neck (esp ribs 2-6) resulting in an increase in the anterior-posterior diameter of the thorax it's called a _____ ______ ______ |
|
|
Term
|
Definition
| what raises the ribs during inspiration |
|
|
Term
|
Definition
| which ribs are shorter and more curved? |
|
|
Term
sagittal-upper ribs
transverse-lower ribs |
|
Definition
| which ribs increase in sagittal diameter? in transverse? |
|
|
Term
1)external intercostal
2)internal intercostal
3)innermost intercostal
4)transversus thoracis |
|
Definition
| list the intercostal muscles |
|
|
Term
origin: lower border of ribs
insertion: superior border of rib below |
|
Definition
| attachments of the external intercostal muscles: |
|
|
Term
elevate ribs
stiffen thoracic wall |
|
Definition
| action of the external intercostal muscles |
|
|
Term
anterior-inferior (hands in pockets)
fill in posterior part of intercostal space and ends at the intercostal margin |
|
Definition
| which direction do the fibers of the external intercostal muscles run? what part of the intercostal space do they fill? |
|
|
Term
| external intercostal membrane |
|
Definition
| non-muscular membrane on the anterior(Sternal) end of the external intercostal muscles made up of a continuation of the EI muscle's epimyseum. |
|
|
Term
origin: inferior border of 1 rib
insertion: superior border of rib below
(Same as innermost intercostals) |
|
Definition
| attachement site of the internal intercostal muscles: |
|
|
Term
posterior inferior(90 degrees to external intercostals)
go from sternum to the posterior angle of the rib (don't meet the vertebral border)
-same as innermost intercostals |
|
Definition
| how are the fibers of the internal intercostal muscles oriented? how much of the intercostal space do they span? |
|
|
Term
|
Definition
| what is the action of the internal intercostals? |
|
|
Term
origin: inferior border of 1 rib
insertion: superior border of rib below
(same as inner intercostals) |
|
Definition
| attachment site of the innermost intercostal muscles |
|
|
Term
posterior inferior(90 degrees to external intercostals)
go from sternum to the posterior angle of the rib (don't meet the vertebral border)
-same as internal intercostals |
|
Definition
| how are the fibers of the internal innermost muscles oriented? how much of the intercostal space do they span? |
|
|
Term
|
Definition
| action of innermost intercostal muscles |
|
|
Term
| the intercostal Nerve, Artery, and Vein |
|
Definition
| what runs between the internal and innermost intercostal muscles? |
|
|
Term
| same layer as the internal intecostal, spanning more than 1 level of ribs |
|
Definition
| where are the subcostal muscles found? |
|
|
Term
| costal cartilage of ribs 2-6, and internal surface of sternum and xiphoid process |
|
Definition
| transversus thoracic muscles attachements: |
|
|
Term
|
Definition
| transversus thoracic muscles action |
|
|
Term
|
Definition
| what layer of muscles are the transversus thoracic muscles in? |
|
|
Term
| internal thoracic artery and vein aka internal mammary |
|
Definition
| neurovascular bundle between internal and innermost layer of intercostal muscles that runs parallel(and parasagittal) to the sternum |
|
|
Term
| the internal thoracic artery because there are plenty of anastamoses with blood vessels and collateral circulation to the thorax |
|
Definition
| what blood vessel in the thorax is often used as a graft for a coronary blockage? |
|
|
Term
|
Definition
| where does the internal thoracic artery originate? and vein drain? |
|
|
Term
| anteriorly: internal intercostal artery posteriorly: posterior intercostal arteries these vessels anastamose on the anterior lateral body wall |
|
Definition
| what vessels form the collateral blood supply to the intercostal muscles? |
|
|
Term
1)levator costae
2)serratus posterior superior
3)serratus posterior inferior
4)scalene muscle |
|
Definition
| what are the posterior muscles of the thoracic wall (accessory respiratory muscles)? |
|
|
Term
| transvers processes of C7 to T12 vertebrae |
|
Definition
|
|
Term
| Superior surfaces of the ribs immediately inferior to the preceding vertebrae |
|
Definition
|
|
Term
|
Definition
| levator costae innervation |
|
|
Term
|
Definition
|
|
Term
| spinous processes of thoracic vertebrae |
|
Definition
| serratus posterior superior origin |
|
|
Term
|
Definition
| serratus posterior superior insertion |
|
|
Term
|
Definition
| serratus posterior superior innervation |
|
|
Term
| elevate the ribs which aids in inspiration |
|
Definition
| serratus posterior superior action |
|
|
Term
| spinous process of lumbar vertebrae |
|
Definition
| serratus posterior inferior origin |
|
|
Term
|
Definition
| serratus posterior inferior insertion |
|
|
Term
|
Definition
| serratus posterior inferior innervation |
|
|
Term
| primarily proprioceptive, but also depress the lower ribs, aiding in expiration |
|
Definition
| serratus posterior inferior action |
|
|
Term
| transverse process of cervical vertebrae |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| primarily neck flexion, but help hold neck steady to elevate ribs when you need to take a deep breath |
|
Definition
|
|
Term
| just below the costal groove on the inferior border of the ribs |
|
Definition
| where are the intercosta nerve/artery/vein found in relation to the ribs? |
|
|
Term
(most superior)
Vein
artery
nerve
(most inferior)
(VAN) |
|
Definition
| what is the order of structures in the subcostal neurovascular bundles? |
|
|
Term
| posterior branch of posterior intercostal arteries |
|
Definition
| what blood vessel runs next to the dorsal rami? |
|
|
Term
| posterior intercostal artery |
|
Definition
| what blood vessel comes off the aorta and runs between the internal and innermost intercostal muscle layers? |
|
|
Term
comes off in lateral body wall and runs superficial to external layer of intercostal muscles.
does not anastamose, just overlaps the posterior branch |
|
Definition
| where does the lateral branch of the posterior intercostal artery come off? does it anastomose with the posterior branch? |
|
|
Term
| the lateral cutaneous nerve |
|
Definition
| what structure follows the lateral branch of the posterior intercostal artery |
|
|
Term
| sensory and sympathetics to the corresponding dermatome |
|
Definition
| what info is carried in the lateral cutaneous branch of the intercostal nerve? |
|
|
Term
somatic motor neurons to intercostal muscles, + sensory & sympathetics to the body wall dermatome
NOTE: the ANS does control breathing, BUT, the nerves to the intercostal muscles are somatic motor neurons, not sympathetic neurons!!!!! |
|
Definition
| what info is carried by the intercostal nerves? |
|
|
Term
| parietal pleura, so there is sharp localized pain with pleurisy |
|
Definition
| which layer of pleura receives somatic sensory innervation? |
|
|
Term
| sweat glands, arrector pili muscles, and smooth muscles of the vessels of the body wall. NOT breathing muscles |
|
Definition
| What do the sympathetics in intercostal nerves go to? |
|
|
Term
ventral rami
(but not all ventral rami are intercostal n., ex: t1 branches to the brachial plexus) |
|
Definition
| Intercostal nerves are ______ ____ |
|
|
Term
|
Definition
| what side of the body is the azygous system located on? |
|
|
Term
| superior vena cava above, inferior vena cava below the diaphragm |
|
Definition
| where does the azygous system drain above the diaphragm? below? |
|
|
Term
| no, so it's alright if it gets blocked, as there are alternate routes of blood flow |
|
Definition
| does the azygous system have valves? |
|
|
Term
| ascending lumbar vein - There are 2 ascending lumbar veins, the left one is continuous with the hemizygous vein, the right continuous with the azygous vein |
|
Definition
| what is the azygous vein called below the diaphragm? |
|
|
Term
superior: accessory hemizygous to superior intercostal vein
inferior: hemiazygous vein |
|
Definition
| what are the branches off the azygous system on the left side? |
|
|
Term
|
Definition
| how many vessels normally cross from the azygous to the hemiazygous system? |
|
|
Term
nipple:T4
umbillicus: T10
inguinal ligament: T12 |
|
Definition
| what markers are used to identify dermatomes, and what are they? |
|
|
Term
|
Definition
| what dermatome does appendicitis pain go to? |
|
|
Term
|
Definition
| what dermatome does Myocardial infarction pain go to? |
|
|
Term
| superior border of the ribs because the neurovascular bundle lies just below the inferior border of each rib |
|
Definition
| where would you put the needle when you perform a thoracocentesis? |
|
|
Term
|
Definition
| chief muscle of inspiration |
|
|
Term
relaxed: dome
contracted: flat |
|
Definition
| shape of the relaxed diaphragm, contracted? |
|
|
Term
|
Definition
| what forms the floor of the thoracic cavity and the roof of the abdominal cavity? |
|
|
Term
| ventral rami(on each side) of C3, 4 and 5 keep the diaphragm alive |
|
Definition
| what nerves innervate the diaphragm? |
|
|
Term
| there is paradoxical movement, one side pushes on the abdomen, which pushes the other side up so it does the opposite of what it should |
|
Definition
| what happens when there is paralysis of 1/2 of the diaphragm(hemidiaphragm)? |
|
|
Term
| the right side, because of the presence of the heart on the left side |
|
Definition
| what side of the diaphragm is always higher? why? |
|
|
Term
|
Definition
| contraction of the diaphragm affects volume/presure in the thorax and ____ |
|
|
Term
1) peripheral muscular layer with fibers converging on the tendon
2) aponeurotic central tendon fused with the inferior surface of the pericardium |
|
Definition
| what are the 2 parts of the diaphragm, where are they located? |
|
|
Term
|
Definition
| what are the 3 parts of the muscular part of the diaphragm? |
|
|
Term
right: 1st 3 lumbar vertebrae
left: first 2 lumbar vertebrae |
|
Definition
| where does the right crus originate? the left crus? |
|
|
Term
| yes! the esophagus passes through the right crus at T10 |
|
Definition
| are the crus contractile? what structure do they wrap around? |
|
|
Term
| median arcuate ligament, it is non-contractile and anterior to the aorta, so the aorta is not affected by diaphragm movements |
|
Definition
| what ligament passes over the aorta between the two crura? why is this significant? |
|
|
Term
| psoas and quadratus laborum |
|
Definition
| meDIAL and lateral arcuate ligaments pass over what muscles? |
|
|
Term
in the central tendon at T8-T9 disc
yes, contraction of the diaphragm WIDENS this lumen |
|
Definition
| where is the vena caval foramen for the inferior vena cava? is this area contractile? |
|
|
Term
| inferior vena cava, RIGHT phrenic nerve, lymphatic vessels |
|
Definition
| what structures run through the vena caval foramen? |
|
|
Term
through the right crus at T9-T10
yes, contraction of the diaphragm CONSTRICTS this lumen (put pressure on abdominal cavity with inspiration, want the esophagus to be constricted so that it is not pushed up through the diaphragm) |
|
Definition
| where is the esophageal hiatus? is this area contractile? |
|
|
Term
| esophagus, vagal trunks, esophageal branches of the LEFT gastric vessels (something about portal hypertension with cirrhosis of the liver) |
|
Definition
| what structures go through the esophageal hiatus? |
|
|
Term
|
Definition
| what happens when the muscles around the esophageal hiatus are weakened? |
|
|
Term
poeterior to the diaphragm between crura at T12
doesn't pierce the diaphragm, so contraction has no affect on blood flow |
|
Definition
| where is the aortic hiatus? is this contractile? |
|
|
Term
aorta
thoracic duct (lymph)
azygous vein |
|
Definition
| what is located in the aortic hiatus? |
|
|
Term
1) pericardiophrenic arteries - runs with phrenic nerve
2) musculophrenic arteries - anterior margins of diaphragm
3) superior phrenic arteries - posterior part of diaphragm
4) inferior phrenic arteries - inferior surface of diaphragm |
|
Definition
| what vessels supply blood to the diaphragm? list each vessel and what part of the diaphragm they supply |
|
|
Term
| the internal thoracic artery |
|
Definition
| what artery do the pericardiacophrenic and musculophrenic arteries come off? |
|
|
Term
| in lymphatic vessels through the venacaval foramen (why we see liver cancer and right side lung cancer together) |
|
Definition
| where do cancers spread from abdominal to thoracic cavities? |
|
|
Term
| musculophrenic (the other branch is the superior epigastric) this branching happens around the 6th intercostal space |
|
Definition
| when the internal thoracic artery branches, it becomes the _____ which supplies the remaining anterior costal arteries |
|
|
Term
| the AORTA above the diaphragm, before the hiatus, (inferior is the same below the hiatus) |
|
Definition
| what artery do the superior phrenic arteries come off of? |
|
|
Term
|
Definition
| what is the motor innervation of the diaphragm? |
|
|
Term
| phrenic nerve to the central portion and intercostal nerves T7-T12 to the peripheral parts |
|
Definition
| what is the sensory innervation of the diaphragm? |
|
|
Term
septum transversum->central tendon
dorsal esophageal mesentery
peripheral rim of body wall
pleuroperitoneal membranes |
|
Definition
| the diaphragm is formed from the fusion of which 4 embryonic structures? |
|
|
Term
| the septum transversum develops from cervical myotomes then migrates caudally to form the anterior part of the diaphragm |
|
Definition
| why is the diaphragm innervated by cervical spinal cord segments? |
|
|
Term
-foramen Morgagni
-foramen Bochdalek
-Deficiency of the whole central tendon
-Congenitally large esophageal hiatus |
|
Definition
| what 4 congenital defects can lead to hernia? |
|
|
Term
|
Definition
| which are more common, acquired or congenital hernia? |
|
|
Term
| middle age when the esophageal hiatus has weakened and widened |
|
Definition
| when do acquired hernia's usually occur in patients? |
|
|
Term
|
Definition
| what are the two types of hiatus hernia? |
|
|
Term
|
Definition
| upper stomach and lower esophagus slide up when the patient bends over or lies down, causing REGURGITATION |
|
|
Term
|
Definition
| cardia remains in normal position and fundus rolls upward (no regurgitation) |
|
|
Term
|
Definition
| the breast contains ____ lobules of glandular tissue lying within fatty tissue |
|
|
Term
| the nipple, via lactiforous ducts |
|
Definition
| where do mammary glands drain |
|
|
Term
|
Definition
| pigmented area around the nipple |
|
|
Term
|
Definition
| connective tissue strips that attach to the dermis and support the lobules of the breast |
|
|
Term
|
Definition
| a potential space exists between breast tissue and the pectoral fascia called the ____ |
|
|
Term
| normally there is no connection between the breast and pectoral fascia, but if there is a tumor, the breast can become anchored to the pectoral fascia inhibiting this motion |
|
Definition
| sometimes there is an assymmetry between breasts as one does not glide up and down the thoracic wall like it should, what might cause this? |
|
|
Term
| the lymph nodes have cancerous emboli in the channels and lymph builds up and swells around the hair follicles which are anchored to the dermis. |
|
Definition
| what causes the orange peel appearance in some types of breast cancer? |
|
|
Term
| the lactiferous ducts can become retracted (due to cancer) pulling in on the nipple |
|
Definition
| what can cause the nipple to become inverted? |
|
|
Term
| no, they go to the surface independently |
|
Definition
| do lactiferous ducts join together before draining out the nipple? |
|
|
Term
upper inner
upper outer
lower inner
lower outer
axillary tail
you can also use a clock face to describe the breast |
|
Definition
| what are the regions of the breast? |
|
|
Term
| there are lots of lymph nodes that travel through the axilla, and it is a common sight of cancer |
|
Definition
| why is the axillary tail of the breast important? |
|
|
Term
internal thoracic-medial breast
lateral thoracic artery-lateral breast
thoracoacromial artery-superficial shoulder and upper breast
posterior intercostal arteries (branches from thoracic aorta) |
|
Definition
| arterial blood supply to the breast comes from the mammary branches of what vessels? (what part of the breast does each vessel supply?) |
|
|
Term
axillary vein
internal thoracic vein |
|
Definition
| what are the venous vessels of the breast? |
|
|
Term
|
Definition
| what percent of lymphatic drainage is to the axillary lymph nodes |
|
|
Term
|
Definition
| which axillary lymph nodes do not normally carry lymph? |
|
|
Term
| subscapular->drains down posterior thoracic wall, not the breast usually |
|
Definition
| which axillary lymph node can be palpated on the axillary fold if it is enlarged (where does it drain?) |
|
|
Term
| lateral, subscapular, pectoral, central, & apical |
|
Definition
| list the lymph nodes of the axilla |
|
|
Term
|
Definition
| what percentage of lymphatic drainage is to infraclavicular, supraclavicular, and parasternal nodes |
|
|
Term
|
Definition
| if there is cancer in this lymph node, it means that cancer has likely spread to the venous system |
|
|
Term
|
Definition
| which lymph node goes to the supraclavicular without going to the axillary node? |
|
|
Term
|
Definition
| if breast cancer moves from one breast to the other, what lymph vessel does it travel through? |
|
|
Term
|
Definition
| which breast lymph node receives drainage from the upper limb? |
|
|
Term
| pectoral->central->apical |
|
Definition
| where does the pectoral lymph node drain? from there? |
|
|
