Thorax

metastasus of tumor cells occurs by three mechanisms...

the _______ and ______ connect the thorax to the neck and abdomen

the costovertebral articulation is what type of joint?

what are the true ribs

what are the false ribs

what are the floating ribs

what does this show

what type of joint is the costochondral

what type of joint is the interchondral

what type of joint is the sternocostal

what type of joint is the manubriosternal?

what does this show (red line)

what does this show? (red)

what does this show (red)?

innervation intercostal muscles

fx of external intercostals

fx internal intercostals

fx innermost intercostals

O and I subcostal muscles

action subcostal muscles

what innervates the subcostal muscles

O and I transversus thoracis

action transversus thoracis

innervation of transversus thoracis

innervation diaphragm

these intercostals attach to the vertebrae but not the sternum

these intercostals attach to the sternum but not to the vertebar

these intercostals dont directly attach to the sternum or vertebrae

what two muscles are the intercostal v, a, and n between?

during inhalation, diaphragm _____ and gut pressure ______

what level is the caval hiatus, esophagea; hiatius, and aortic hiatus at

what lives in the caval hiatus (x2)

what lives in the esophageal hiatus (x3)

what lives in the aortic hiatus (x3)

diaphragm action: increases volume will ___________ pressure in the thoracic cavity and decreases volume will ______ pressure in theabdominal cavity

accessory muscles of respiration (x5)

what is at risk most in TOS

what does this show?

what provides collateral support to the thorax

where do the posterior and anterior intercostal veins drain

where would a needle be inserted for an intercostal nerve block

herniation where the gut goes through the diaphragm

collapsed lung

lung tumor that can impinge on sympathetic chain and lower trunk of brachial plexus

three spaces of the thoracic cavity

inflamed pleuea

air into pleural cavity, lung partial or complete collapse (atelectasis); pain, difficulty breathing, shortness of breath (open, tension)

diagnosis? location?

ligament continuous between the visceral and parietal pleura

thickening at the top of the ling that connects to the neck fascia

where is a thoracentesis done?
what layers does it go through?

where does the needle stop in a thoracocentesis?

which of the pleuea is pain sensitive

which of the pleura receives blood from bronchiole vessels

which of the pleura receives blood from somatics

what innervates the costal and periphera; diaphragmatic pleura

what innervates the mediastinal and central diaphragmatic pleura

these can be removed from the lungs if they become canceroys because they are so vast

where are preganglionic sympathetic neurons situated

what is the end of the sympathetic trunk called

where is the lateral horn located (sympathetic)(also white ramus only here)

red

yellow

purple

green

gray

blue

black

pathway of sympathetics to the body wall

pathway of sympathetics to viscera above diaphragm

organs from ________________ receive sympathetic axos directly from the sympathetic chain

sympathetics to viscera below diaphragm pathway

where do parasympathetics distribute

where do parasympathetic axons reside from

what does the vagus nerve provide parasympathetic innervation to

part of the heart that streamlines (directs) flow like a funnel through the pulmonaric valve

these arteries supply blood to the broncus and lungs

a condition where a blood clot travels to the lungs and blocks one or more pulmonary arteries.
-results in obstucted blood flow to lung, infarct and respiractory distress

increased pressure in pulmonary veins, congestive heart faiulure

accumulation of fluid in the pleural cavity

what does the base of the pericardiym attach to? anteriory? posteriorlu?

where does the percardium recieve its blood supply

what drains the pericrdium

what innervates the pericardium

this can be used as an area to clamp if you want to cut off blood supply to the great vessels of the heart

inflamation of the pericardium, patients present with abbrupt, pleuritic, positioned left precordial chest pain after a viran prodrome

fluid in the pericardial sac, can restrict beating of the heart
early signs are dyspnea and reduced exercise tolerance

what is the posterior right atrium (sinus venarum) derived from

what is the anterior right atrium derived from

this receives blood from the coronary veins of the heart and places it in the right atrium

this is the location of the AV node and nodal bundles in the septal wall of the right atrium

this is the obliterated (fetal reminant) of the foramen ovale in the septal wall of the right atrium

This is a defect in the atrium or septal wall that causes oxygenated blood to mix with deoxy blood of the heart

valve is between the heart's two right chambers. It has three thin flaps of tissue, called cusps or leaflets.

what is the left atrium derived from

what does the left atrium receive blood from

one of the four heart valves, located between the left atrium and left ventricle, that ensures blood flows in one direction. It has two flaps, or leaflets

what valves are open during systole?

what valves are open during diastole

pathway of cardiac conducting

functions of the cardiac skeleton (x4)

what does the right coronary a supply

branches of the right coronary a

supplies ledr atrium, centricles,, and mosr of the IV septum

what nodes drain the breasts

where does lymph from skin/fascia of the thoracic wall drain

greater splanchnic n spinal level

lesser planchnic n spinal level

least splanchnic n spinal level

what supplies the parasympathetic innervation to the heart? sympathetic?

what defines the superior mediastinum

what supplies the thymus (blood)

fx of thymus

branches of left branchiocepahallic v

branches of right brachiocephalic v

a congenital (1 in 2000),
abnormal stenosis of
aorta; typically occurs
near ligamentum
arteriosum
good collateral
circulation can develop
to deliver blood around
blockage, these
enlarged arteries will
cause notching and
erosion of bordering ribs

what acts as collateral circulation in cases of a blocked ascending aorta/stenosis/coarctation of the aorta

what are two things that are in danger od compressing the trachea

what branches off the thoracic aorta (x6)

what structures are able to compress the esophagus (x3)

venous channels of the posterior mediastinum that drain the body wall; highly variable

this can provude an alterbate venous route to the heart in cause of IVC blockage

a depression of the sternum; “funnel chest”; associated with exercise
intolerance, dyspnea, chest pain

an anterior protrusion of the sternum; “pigeon chest”; associated with
dyspnea, frequent respiratory tract infections; commonly found with scoliosis

what are some signs/ symptoms of thoracic outlet symdrome

a severe, potentially life-threatening injury caused by multiple rib fractures, where a segment of the chest wall separates and moves paradoxically during breathing, leading to difficulty breathing and impaired oxygenation

what nerves are the most at risk of injury when an intercostal nerve block is performed

60% of malignant brest tumors arise from _______ of breast

structures most at risk during masectomy or radical dissection of diseased axillary lymph nodes (x3

where should the stethescope be placed to listen to breath sounds from the superior lobes

where should the stethescope be placed if yoy want to listen to breath sounds from the middle lobe

where should the stethescope be placed if you want to listen to breath sounds from the lower lobes

where would a chest tube be inserted
purpose: drain large amount of air, fluid, etc from pleural space

common sites of metastases from the lungs (x4)

collapse of lung or lobe resulting from blockage of some part of the airway; the opening to
the right middle lobe is the smallest/most narrow, as a result the R middle lobe is the most commonly
affected; obstructive atelectasis may cause mediastinal shift towards the affected lung

spitting up blood”; bleeding from the airway from bronchial a >> pulmonary arteries;

what could be damaged in pericardocentesis

Compression of the heart from accumulated fluid in the pericardial sac; associated with beck's triad

what is beck's triad

3 most common sites of occlusion in the coronary arteries

chest pain from the heart resulting from insufficient supply of oxygen to cardiac muscle

this results in a dissociation between the atrial and ventricylar contractions

compression of the left recurrent laryngeal nerve from a cardiovascular etiology:
enlarged left atrium (from mitral valve stenosis), aneurysm of the aortic arch
a. Hoarseness > dysphagia > dyspnea

what three points is the aorta fixed at: suscepatbale to damage from MVA

creation of space within the wall of the aorta; this space can accumulate significant
amounts of blood resulting in strokes and/or infarcts
a. tearing of the tunica intima and subsequent accumulation of blood volume in the wall of the vessel
b. signs and symptoms: hypotension, exsanguination, stroke, ischemia, claudication, compression (mass effect)