Term
| Divisions of Mediastinum? |
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Definition
***SUPERIOR - Superior thoracic aperature to a plane transversing sternal angle and T4/T5.Contents=Great vessels, trachea, espophagus
***INFERIOR - Sternal angle at T4/T5 to xiphosternal junction at T9/T10(diaphragm). Contains Thymus, Heart, Thoracic Aorta, Azygos V's
Remember - positions described as patient in supine position. As pt. stands, levels drop 1-2 vertebra! |
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Term
| Autonomics to Lungs / Mediastinum |
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Definition
Sympathetic from ganglion
Parasympathetics from Vagus N |
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Term
| Pattern of Lymphatic drainage lungs? |
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Definition
***Right and inferior aspect of the left lower lung fieds drain to the right lymphatic duct.
***ONLY right upper lung fields drain to the Thoracic Duct (primary drainage for most of body) |
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Term
| How does cadiac tamponade occur? |
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Definition
| Excess exudate during pericarditis, (infection / blood / fluid) fills the pericardial cavity. Fibrous pericardium doesn't stretch well and collection compresses on heart preventing filling & contraction, |
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Term
Heart blood flow - Valve Sequence?
Which side are Mitral and Tricuspid Valves on? |
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Definition
Try Pulling My Aorta= Tricuspid, Pulmonary, Mitral, Aortic
***LAB RAT = Left Atrium Bicuspid (Mitral), Right Atrium Tricuspid! |
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Term
| Significance of the Omental Foramen? |
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Definition
| Allows admission into the omental bursa. Superior omental bursa recess runs posterior to liver and the inverior omental bursa runs down into greater omentum. A potential space for fluid, infection.... |
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Term
| Portal Triad of the Hepatoduodenal Ligament? |
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Definition
| Contains the Hepatic Artery, Common Bile Duct and the Portal Vein |
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Term
| Stenosis VS Insufficiency? |
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Definition
| Stenosis the valve fails to open fully and slows blood movement. *** Insufficiency - Valve fails to close properly and backflow, murmers and thrills occur. |
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Term
| Dermatomes for heart pain correspond with what N.? |
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Definition
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Term
| First heart sound caused by?****Second heart sound is caused by??? |
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Definition
| 1st = Lub - AV valves (Tricuspid / Bicuspid (Mitral) valves closing.**** 2nd heart sound = Dub - Semilunar valves (Pulmonary & Aortic) closing. |
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Term
| Significance of the Transverse Pericardial Sinus? |
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Definition
| Forms a space under the aortic Arch, behind the pulmonary trunk where a surgeon can ligate the great vessels and place pt on heart-lung bypass during heart surgery. |
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Term
Where is heart located?
Pericardial Layers? |
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Definition
In the SUPINE position Transverse plane from Sternal Angle -> T4/5 level passes through ascending aorta and plane Xiphosternal joint - T9 passes just below base / inferior heart. When standing, everything drops approx 1 vertebral level**** 2/3 of heart lies left of midline (sternum) with apex on Left.
***Fibrous pericardium (outer layer) anchors heart to diaphragm and sternum.
***Serous inner bilayer consists of parietal and visceral layers. Fluid lubricates and reduces friction. |
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Term
| Most common heart valve problems? |
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Definition
| Aortic V. Stenosis due to degenerative calcification (6th decade) and formerly often due to rheumatic fever. **** Mitral Valve Prolapse, is common and found in 1/20, often young females and often a incidental finding. |
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Term
| Purpose of the Heart's Fibrous Skeleton? |
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Definition
| It insulates and forms an electrical barrier between the Atria and Ventricles. It gives ride to attachments and prevents excess valve dilation. |
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Term
| Heart Surface Anatomy... What lies Where? |
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Definition
| Anterior (sternocostal) mostly right Ventricle. Inferior (diaphragm) mainly left ventricle. Left (pulmonic) side is primarily left ventricle and right (pulmonic) side right atrium. Apex - (left side) is left ventricle. |
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Term
| Contents of Mediastinum Anterior to Posterior? |
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Definition
| Thymus, Heart, Esophagus, Thoracic Aorta, Azygos V. |
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Term
| Division of Mediastinum Superior and Inferior? |
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Definition
| Superior mediastinum is from thoracic aperature to transverse plane crossing at the sternal angle and cutting through the T4/5 region. **** Inferior mediastinum runs from plane defining lower border of superior mediastinum to the T9/10 level and plane transversing through the xiphisternal angle. |
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Term
Pattern of lymphatic drainage of lungs?
Important in Lung Ca. ... |
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Definition
| Right and inferior aspect of Left lung fields drain towards and into the RIGHT lymphatic duct. ONLY the left upper lung drains to the Thoracic Duct! |
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Term
| Autonomics to the lungs and mediastinum are from a plexus which combines fibers from what nerves? |
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Definition
| Sympathetic Ganglion and the Parasympathetic's from the Vagus N. CN X |
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Term
| What's the schema of arteries, veins and bronchus at the Hilum / Root of the Lung? |
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Definition
| Bronchus are found posterior and superior. Veins are found lower and anterior. Arteries are found higher in the root. |
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Term
| # of Lobar Bronchi in each Lung? **** # of segments? *** What area of lung is prone to pneumonia in the bedridden patient? |
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Definition
| RIGHT LUNG has 3 Bronchi, 10 segments.**** LEFT LUNG has 2 Bronchi, 8-10 segments**** Segments will branch another 20-25 times till becoming functional.****Superior Segments of the inferior lobes are prone to pneumonia in the bedridden. |
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Term
| Where, at what level does the trachea bifurcate?*** What's found looking inside the trachea as it bifurcates and what can it mean?**** Which way will f/b's fall? |
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Definition
| Sternal Angle - T4-5. Carina is located there and if deformed can be an indicator of cancer or disease. Right bronchus is more vertical and larger, F/B's often enter R. Bronchus. |
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Term
| Landmarks for lungs and pleural reflections (pleural spaces)? |
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Definition
Lung @ MCL=6th ICS*** Pleura = 8th ICS.
Lung @ Midaxillary L.=8th ICS, Pleura = 10th.*** Lung at Mid scapular L. = 10th ICS and pleura at 12th.*** Or, just remember 6,8,10 (front to back) and add 2 for pleura... |
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Term
| What Arteries and Veins are found inside the chest plate and anastomoses with the anterior intercostal arteries, veins and nerves? |
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Definition
| Internal Thoracic Arteries and Veins. Found each side inside the sternum and runs under the transversus thoracis muscles. |
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Term
| Number of lobes and fissures of each lung. Where are they? |
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Definition
| LEFT Lung has 2 lobes - Superior and inferior. Has an oblique fissure, a cardiac notch and lingula located on the superior lobe, anterior-inferior aspects.**** RIGHT Lung has 3 lobes (Superior, Middle and Inferior) and has a horizontal and oblique fissure. |
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Term
| Location of costodiaphragmatic recesses? |
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Definition
| Posterior T10-12. Lateral is 8th to 10th space, anterior follows along the costal cartilage. |
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Term
| Location of Phrenic and Vagus nerves in relation to the lung? |
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Definition
| Phrenic is anterior to the root / hilum. Vagus is posterior |
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Term
| Chest pain can be caused by? |
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Definition
| Pulmonary and cardiac ds., intestinal and gallbladder disorders, Musculoskeletal disorders. |
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Term
| Typical thoracic ribs: Where are costal facets? The rib head articulates with? Where is the weakest point. The rib tubercle articulates with ? |
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Definition
| The head of the rib articulates with the facet of the thoracic vertebra it's rib number corresponds with and the facet on the vertebra above.**** The transverse costal facets on the thoracic vertebra are on the transverse processes and the tubercle of the rib articulates with teh corresponding numbered vertebra.****The weakest point of the rib is just anterior to it's angle. |
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Term
| How high does the diaphragm rise in the ribcage? |
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Definition
| To just below the 7th-8th ribs. |
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Term
| True, False and Floating Ribs? # of intercostal spaces? # system? |
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Definition
| True = Ribs 1-7, Cartilages attach to sternum.*** False Ribs 8-10, cartilages attach to cartilages above.***Floating Ribs 11-12**** Upper and lower 2-3 ribs atypical - top 2 ribs have muscle attachments and notches for great vessels.**** 11 intercostal spaces named for the ribs ABOVE the intercostal space. |
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Term
| Chest landmarks / levels: Sternal angle? Body of Sternum? Xiphisternal Joint? Xiphoid? Diaphragm? |
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Definition
| Sternal Angle = Rib 2 **** Sternum Body T5-9 *** Xiphisternal Joint T9-10 *** Xiphoid T10 *** Diaphragm T7-8 |
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Term
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Definition
| Ribs 1 & 2 - Broad and short, sharply curved. Rib 1 has groove for subclavians and scalene tubercle. Lower 2-3 ribs atypical and have no neck or tubercle that articulates with a vertebral transverse process. |
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Term
| Thoracic Cage Movements and how do they change? |
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Definition
| Vertical diameter changes by diaphragm flattening upon exhalation. Transverse diameter increases like a bucket handle - as if lifting a rib from the lateral aspect. Anteroposterior diameter changes and rises like grabbing the sternum like a pump handle. |
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Term
| Thoracic aperatures and what passes through them? |
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Definition
| Superior inlet - approx size of a 2x4, entering is the trachea, esophagus, nerves and vessels.*** Inferior outlet closed by the diaphragm with openings and the IVC, Esophagus and descending aorta pass through at T8, T10, T12 levels. |
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Term
| How are the thoracic wall muscles arranged? Layers? |
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Definition
| External intercostals run inferomedially from rib above to rib below.***Internal Intercostals run deep to externals and run at right angles to them, running inferolaterally from rib above to below. Innermost intercosals are similar to internal, seperated by nerves and vessels.*** All innervated by intercostal nerves. |
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Term
| Where do vessels and nerves run that supply the chest wall and ribs? What nerves and in what order are the structures arranged? |
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Definition
| Notch under rib is protectived and these structures run between the internal and innermost muscles.*** Order is Vein, Artery, Nerve with the vein lying closest to the rib. The ventral rami T1-11 serves intercostals and T12 is the subcostal serves these areas. |
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Term
| Lung pain sensory is from? |
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Definition
| Parietal Pleura, branches of the intercostal and phrenic nerves. There are no pain receptors in visceral lung pleura! |
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Term
| Layers into teh lung from outside in? Imagine a knife wound? |
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Definition
| Skin, Adipose & fascia, external intercostal muscle, internal intercostal muscle, innermost intercostal muscle, costal parietal pleura, bisceral pleura of lung, lung tissue alveoli... |
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Term
| Where would thoracentesis be performed? |
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Definition
| 9th intercostal space at mid axillary line. Insert the needle high enough to avoid damage to collateral vessels and nerves during expiration. |
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Term
| Inner chest wall muscles & functions? |
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Definition
| Subcostal muscles, transverse thoracic muscle. The transverse thoracic muscles run over the internal thoracic arteries and veins on the inner, anterior chest wall. **** Functions: Expansion of ribs, thorax and maintain a rigid chest wall. |
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Term
| Landmark levels: Nipple (on those with little breast tissue)? Aortic arch, Apex of lung? Dermatomes T4 / T10? |
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Definition
| Nipple is 4th ICS, and T4 dermatome. T10 dermatome = Umbillicus and superior illiac spine. Lung apex rises above 1st rib, (particularly in infants & children). |
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