Anatomy Mod 3

What is located at the sternal angle?

1)bifurcation of trachea(carina)
2)beginning and end of aortic arch
3) 2nd Rib
How many thoracic vertebrae are there?
12
What are the borders of the costovertebral angle? What is located in it?
last rib(12) and spine

Kidneys
What is the vertical line through sternum in mid-saggital plane?
Anterior median (midsternal) line
What is the vertical through midpoints of the clavicles, parallel to median line?
Midclavicular lines (MCL)
vertical line along anterior axillary fold (formed by pec major)?
Anterior Axillary
vertical line though apex of axilla (armpit)?
Mid axillary line
vertical line through posterior axillary fold (formed by latissimus dorsi and teres
major)?
Posterior axillary line
vertical line through spinous processes of vertebrae in mid-saggital plane?
Posterior median (midspinal or midvertebral) line
vertical lines that pass
through inferior
angles of the scapula,
line is parallel to
posterior median line?
Scapular lines
Auscultation Ally location?
between midvertebral and scapular line
Where is Erb's point?
Left 3rd ICS
Where is the aortic area?
R 2nd ICS
Where is the Pulmonic area?
L 2nd ICS
Where is the tricuspid(area) auscultated?
L 4th or 5th ICS
Where is the Mitral/Apex?
L 5th ICS/midcalvicular line
Bones of the thoracic wall?
ribs, vertebrae T1-T12, sternum(manubrium/xyphoid included)
True Ribs & attachment
1-7 - attach directly to sternum
False Ribs & attachment
8-10 - attach "indirectly" to sternum via 7th Rib
Floating Ribs
11 & 12
Typical & Atypical Ribs (#'s)?
Typical: 3-9
Atypical: 1,2,10-12
Typical Rib Landmarks?
Head, Neck, Tubercle, Shaft, Costal Angle
What is the most common site of Rib Fracture?
Costal Angle
What side of the rib articulates with the vertebrae?
head - via facets
Common landmarks of thoracic vertebrae?
spinous process, transverse process, costal facets, transverse costal facets
Which thoracic vertebrae do not have transverse facets?
11 & 12
Which vertebrae only have 1 costal facet?
9-12
What does the superior aperture contain?
esophagus, trachea, nerves and blood vessels to head/neck/UE
What does the inferior aperture contain?
allows esophagus, IVC, aorta to pass to abdominal cavity
Costovertebral joint connect?
rib with vertebral body
costotransverse joints connect?
rib with transverse process
costochondral joints connect?
ribs articulate with cartilage
sternocostal joints connect?
costal cartilage and sternum
SC joint connection?
sternum and clavicle
Where is the sternal angle located?
munbriosternal joint
What happens to thoracic wall during inspiration?
increase in AP & lateral diameter(bucket handle) and superior to inferior length
What is active during inspiration at rest?
diaphragm
What is active during inspiration in exercise(not extreme)?
diaphragm & external intercostals
What is active during inspiration in extreme exercsie?
diaphragm, external intercostals, SCM, scalenes, maybe PECS
What is active during expiration in exercise?
internal intercostals & abdominals(rectus & obliques)
What is an accessory pattern?
abnormal pattern - "shrug" found in patients with COPD and other pulmonary diseases
Layers of thoracic wall musculature superficial to deep?
external intercostals --> internal intercostals --> innermost intercostals
Transversus thoracis function?
expiration - depress ribs)
subcostal muscles function?
inspiration - elevate ribs
levator costarum function?
inspiration - elevate ribs
Phrenic Nerve Action/innervation
motor/sensory to diaphragm (C3-5)
Regions of the diaphragm?
sternal/costal/lumbar
Intercostal nerve pathway?
Exit spinal IVF--branches into anterior/posterior rami
What does the anterior rami of intercostal nerves supply?
intercostal spaces
Herpes Zoster (Shingles)
dormant virus in single segmental nerve
What are the branches of the thoracic aorta?
posterior intercostal & subcostal
Posterior intercostal arteries supply?
3rd-11th intercostal spaces (COMPLETE 10th&11th coverage)
subcostal artery supplies?
inferior to 12th rib
What are the thoracic branches of the subclavian artery?
costocervical trunk & internal thoracic artery
What does the costocervical trunk supply?
1st, 2nd ICS
What does the internal thoracic artery supply
anterior 1-9th ICS
What veins drain the intercostal spaces?
intercostal veins
Intercostal veins drain to?
-posterior to azygos system (azygos/hemi/accessory hemi)
-anteriorly into internal thoracic veins
Hemizygos and accessory hemizygos receive blood from where?
left 5th-12th ICS
Azygos vein receives blood from where?
Right intercostals & hemi/accessory hemi veins
Azygos vein drains to?
SVC
Which intercostal veins drain directly to brachiocephalic trunk?
Left 1-4th intercsotals
what is the Thoracentesis? and our concern?
-Travel in ICS just inferior to rib (VAN)
-avoiding damage to IC structures
Where is the nipple located? relation to apex of heart?
4th ICS
-apex of heart just inferior medial to L nipple
Landmarks of the female breast?
-circular base(ribs 2-6)
-axillary tail(inferior border of pec to axilla)
lymphatic drainage of breast?
-75% to axillary lymph
-medially via parasternal lymph nodes
Where do most breast cancers occur?
Upper outer (superior-lateral) quadrant
where does the trachea begin?
inferior to larynx(cricoid cartilage)
What is the ridge of the bifurcation of trachea called?
carina (@ sternal angle)
Primary bronchi
Lobar bronchi
segmental bronchi
2
2 left, 3 right
10 each side
Where does the cartilage begin to dissappear in tracheobronchial tree?
bronchioles
Where does gas exchange start in tracheobronchial tree?
Acinus/respiratory bronchioles
Which layer or pulmonary pleura is deep?
visceral pleura
Which pulmonary pleura lines the diaphragm?
parietal pleura
2 pleural recesses?
-costodiaphragmatic (larger)
-costomediastinal (antero-lateral)
What is the hilum/root?
site where hte lung becomes covered by visceral pleura
What is contained in the hilum?
- primary bronchus
• pulmonary veins
• pulmonary artery
• bronchial vessels
• pulmonary nerves
• lymph vessels
R lung anatomy?
3 lobes - superior/middle/inferior
2 fissures - horizontal/oblique
R lung: How many bronchopulmonary segments/lobe?
3-superior
2-middle
5-inferior
L lung anatomy?
2 lobes
oblique fissure
lingula & cardiac notch
Layers of the heart wall?
-myocaridum-cardiac muscle
-endocardium-lining layer of heart chambers
-epicardium-blends into visceral layer of serous pericardium
Pericardium layers?
-Parietal pericardium
-Parietal
-Fibrouspericaridum (superficial)
Fibrous pericardium attachments?
-diaphragm
-sternum via sternopericardial ligagment
What is the pericardial cavity in between?
Visceral and Parietal pericardium (serous pericardium)
R atrium landmarks?
SVC/IVC
coronary sinus opening
fossa ovalis
tricuspid valve
R ventricle landmarks?
-tricuspid valve
-papillary muscle/chordae tendinae
-pulmonary valve
L atrium landmarks?
-foramen ovale
-pulmonary vein openings
-bicuspid valve
L ventricle landmarks?
-bicuspid valve
-aortic valve
-chordae tendinae
What is the most anterior valve?
Pulmonary semilunar valve
SVC/IVC blood returns
SVC-from areas superior to diaphragm
IVC-from areas inferior to diaphragm
Pulmonary trunk function?
Sends unoxygenated blood to the lungs
Aorta pathway/branches?
-brachiocephalic trunk-->RCC & R subclavian
-LCC
-L subclavian
Coronary arteries originate where?
base of the aorta
When does the aortic pressure create backflow? causing what?
early diastole

filling of the coronary arteries to supply myocardium

R coronary artery branches
A-nodal branches (supply SA/VA nodes)
B-marginal(supplies R vntricle)
C-posterior interventricular/descending(supplies R ventricle
L Coronary artery branches
A-anterior interventricular/descending(supplies septum & left ventricle)
B-Circumflex(supples L atrium/ventricle)
C-Marginal(supplies L ventricle)
Coronary sinus receives blood FROM where?
great/middle/small cardiac veins and oblique vein of left atrium
Coronary Sinus drains INTO where?
R atrium
Conducting pathway of heart?
SA node >> AV node >> AV bundle(of his) >> bundle branches >> purkinje fibers
Anterior surface of the heart - also called what?
sternocostal surface
Diaphragmatic surface of heart - also called what?
inferior
Left surface of heart also called?
Pulmonary surface
Base of the heart formed by?
R atrium(posterior aspect)
Mediastinum sections?
Superior/Inferior
Superior mediastinum contains?
aorta/great vessels
trachea
esophagus
Inferior mediastinum sections and contains what?
Anterior - internal thoracic vessesl, fat, lymph

Middle - heart, pericardium, roots of great vessels

Posterior - esophagus,descending aorta,thoracic duct,lymph nodes

The heart shadow will be widened in what chest x-ray view?
AP
R ventricle landmarks
...
What is the ridge of the bifurcation of trachea called?
carina