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MD3001 Cardiology > Thoracic Wall > Flashcards

Thoracic Wall Flashcards

1
Q

What are the 3 main functions of the thorax?

A
  • protection: heart and vessels, lungs, major airways, stomach, spleen and kidneys
  • respiration: resists negative intra-thoracic pressure, works with abdominal muscles when breathing
  • movement: provides attachment for muscles
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2
Q

What are the properties of the thorax?

A
  • connects upper limb, abdomen and neck
  • haematopoiesis
  • transverse diameter greater than sagittal diameter
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3
Q

What is an important feature of thoracic vertebrae for its movement

A

its articular surfaces are set on the arc of a circle which allows for rotation rather than flexion and extension

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4
Q

Function of costal cartilage?

A

elasticity and mobility

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5
Q

Different types of ribs

A
  • true ribs (1-7): attach to sternum directly by CC
  • false ribs (8-10): attach to sternum indirectly through CC of 7th rib
  • floating ribs (11-12): no attachment to sternum
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6
Q

What is the purpose of the costal groove?

A

for nerves and vessels to run through and acts as protection

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7
Q

What are the different parts of the sternum?

A
  • manubrium
  • body
  • xiphoid process
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8
Q

Describe the relations of the sternal angle

A
  • 2nd CC
  • T4-5 intervertebral discs
  • proximal and distal boundaries of aortic arch
  • bifurcation of trachea
  • superior limit of pulmonary trunk
  • azygos vein opening to SVC
  • ligamentum arteriosum
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9
Q

Describe the costovertebral joint

A
  • joint between a rib and superior costal facet of corresponding vertebra and inferior costal facet of vertebra above
  • synovial
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10
Q

Describe the costotransverse joint

A
  • joint between tubercle of rib and transverse process of corresponding vertebrae
  • joints 1-7: curved for rotary movement
  • joints 8-10: flat facets for gliding movement
  • movement significant in respiration
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11
Q

What are the boundaries of the thoracic inlet?

A
  • T1
  • 1 CC
  • manubrium
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12
Q

What is contained in the thoracic inlet?

A

structures from the thorax to neck:

  • vessels that supply and drain the head and neck
  • trachea
  • oesophagus
  • vagus and recurrent laryngeal nerves
  • phrenic nerves

structures from the thorax to the upper limb:

  • subclavian vein and artery
  • inferior trunk of BP
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13
Q

What are the boundaries of the thoracic outlet?

A
  • T 10-12 ribs

- CC 7-10

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14
Q

Describe Thoracic Outlet Syndrome

A
  • related to thoracic inlet

- compression of the nerves or blood vessels in the thoracic inlet

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15
Q

What are the 3 common areas of compression in Thoracic Outlet Syndrome?

A
  • scalene triangle
  • costoclavicular space between first rib and clavicle
  • sub-pectoral space
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16
Q

What are Montgomery glands?

A
  • visible portions on skin surface within areola of the breast
  • sebaceous gland
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17
Q

Describe what is contained in the breast

A
  • 15-25 lobes of lobules and ducts surrounded by fat and connective tissue stroma
  • suspensory ligaments (Cooper’s ligaments): condensation of connective tissue
  • connects deep fascia to dermis of skin
  • supports the breast
  • retromammary space: loose connective tissue layer between deep superficial fascia and deep fascia to allow movement over underlying structures
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18
Q

Describe breast tissue

A
  • between superficial and deep layers of superficial fascia

- on pec major, serratus anterior and external oblique muscles

19
Q

Where is deep pectoralis fascia found?

A
  • between superifical and deep fascia
20
Q

Describe vascular supply of the breast

A
  • internal thoracic artery: mammary branches and anterior intercostal arteries
  • axillary artery: lateral thoracic artery and thoraco-acromial artery
21
Q

Describe vascular drainage of the breast

A

veins follow the arteries and drain to mainly axillary and internal thoracic veins

22
Q

Describe lymph drainage of the breast

A
  • areola and lateral quadrants: axillary lymph nodes
  • medial quadrants: parasternal lymph nodes to opposite breast
  • inferior quadrants: inferior phrenic lymph nodes
23
Q

What can excessive development of pec minor result in?

A

compression of the subclavian artery and vein which can result in thoracic outlet syndrome

24
Q

What muscles assist with inspiration and expiration?

A
  • serratus anterior

- serratus posterior superior and inferior

25
Q

External intercostal muscles

A
  • anteriorly muscle fibres replaced by external intercostal membrane
  • contract to elevate ribs during inspiration
  • origin is superior end closer to vertebral column
26
Q

Internal intercostal muscles

A
  • posteriorly muscle fibres replaced with internal intercostal membrane
  • contract to pull ribs downwards during expiration
  • origin is inferior end closer to vertebral column
27
Q

Other thorax muscles

A
  • innermost intercostal: deep surface covered with endothoracic fascia
  • transversus thoracis: posterior to sternum, internal aspect of ribs and CC 3-6 to sternum and costal margin
  • subcostalis: on posterior wall
28
Q

What can cause damage to the spinal nerve?

A
  • arthritis
  • fracture
  • disc prolapse (hernia)
29
Q

Where do intercostal nerves lie and in what order?

A

in the costal groove VAN, nerves become superficial parasternally to form anterior cutaneous branch

30
Q

What does the suprascapular nerve originate and supply?

A
  • C3-4

- supplies skin down to 2 CC

31
Q

What does T1 supply?

A
  • none anteriorly

- joins BP to supply medial arm, forearm, small muscles of the hand and muscles of the 1st intercostal space

32
Q

What does T2 supply?

A
  • gives off large lateral cutaneous branch to supply thorax wall in axilla and upper medial part of upper limb
33
Q

What does T7-12 supply?

A

skin and muscles of the abdominal wall

34
Q

Posterior arterial supply of the thoracic wall

A
  • originates at subclavian artery
  • goes to costocervical trunk
  • to supreme intercostal artery to branch to 1st and 2nd posterior intercostal arteries
  • 3-11 posterior intercostal arteries branch from the thoracic aorta
35
Q

Anterior arterial supply of thoracic wall

A
  • 1-6 anterior intercostal arteries branch off of internal thoracic artery
  • terminates as superior epigastric and musculophrenic arteries
  • 7-10 anterior intercostal arteries branch off musculophrenic arteries
36
Q

Anterior venous drainage of thoracic wall

A

anterior intercostal veins drain to internal thoracic veins to brachioceohalic vein

37
Q

Posterior venous drainage of thoracic wall

A

RIGHT:

  • 1: right brachiocephalic vein
  • 2-4: right superior intercostal vein to azygos
  • 5-11: azygos

LEFT:

  • 1: left brachiocephalic vein
  • 2-4: left superior intercostal vein to left brachiocephalic vein
  • 5-8: accessory hemiazygos to azygos
  • 9-11: hemiazygos to azygos
38
Q

Azygos system

A
  • drains posterior thorax and part of posterior abdominal wall
  • connects superior and inferior vena cava
39
Q

Hemiazygos

A
  • inferior hemiazygos vein
  • has connections with left renal vein
  • passes through or behind left crus of diaphragm
  • crosses to the right at T9 to join azygos
40
Q

Accessory hemiazygos

A
  • superior hemiazygos
  • descends from 4th intercostal space and crosses to right at T8
  • can open into azygos/hemiazygos/both
41
Q

Lymphatic drainage of thoracic wall

A

anteriorly:
- parasternal nodes and bronchomediastinal trunk

posteriorly:
- intercostal nodes and thoracic duct inferiorly or bronchomediastinal trunks superiorly

42
Q

Rib fractures

A
  • most common between ribs 3-10
  • uncommon in ribs 1-2 due to proctection from the clavicle
  • little can be done for fractures other than binding to limit movement
  • fractures can cause haemothorax, pneumothorax or splenic injury
43
Q

Costochondral joint

A
  • between rib and CC

- primary cartilaginous joint

44
Q

Costosternal joint

A
  • between CC and sternum

- synovial

MD3001 Cardiology (56 decks)

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