Cadaver anatomy Thorax
Which nerve provides parasympathetic innervation to the heart?
Vagus CN X
What is valvular stenosis?
Valve doesn't open fully
Know where the posterior intercostal veins drain to return to the superior vena cava.
azygous/hemizaygous veins
What lymph nodes receive superficial drainage of the lungs?
bronchopulmonary lymph nodes of the hilum tracheobronchial nodes
between which two parts of the pleura would you find the costal line of pleural reflection?
cartilages
Which 3 coronary arteries are most commonly occluded in coronary artery disease?
circumflex branch right coronary artery left coronary artery
What are the effects of sympathetic innervation to the lungs?
inhibit bronchial muscles (bronchodilation) motor to pulmonary vessels (vasoconstriction) inhibit gland secretion
Know where the anterior intercostal veins drain to return to the superior vena cava
internal thoracic vein
Which chambers of the heart are found on the right pulmonary surface?
right atrium
What are the main muscles of the thoracic wall?
External, internal, innermost intercostals Transversus thoracis subcostal levatores costar
Joints of thoracic wall and bone/cartilages that articulate in each type of joint
Intervertebral Bones/cartilage Joints 1) costovertebral Synovial plane joint (besides rib 1) 2) costotransverse Synovial plane joint (besides rib 1) 3) & 4) sternocostal Synovial plane joint (besides rib 1) 5) sternoclavicular Synovial saddle joint 6) costochondral Cartilaginous joint Interchondral (synovial plane joint) 7) Manubriosternal Synovial plane joint 8) Xiphisternal Cartilaginous joint
What complications can arise from having supernumerary C7 associated rib?
It can impinge in brachial plexus and compress subclavian artery (ischemia to upper limb) or compress spinal nerve (arm tingling)
What does the root of the lungs connect?
Lungs to heart and trachea
what are 3 functions of the dense collagen cardiac skeleton?
-anchor to fibrous skeleton -supports AV canals and semilunar valves -insulates the atrial conduction from the ventricular conduction
What are the four parts to the parietal pleura?
-costal part -mediastinal part -diaphragmatic part -cervical part
which rib indicates the inferior limit of the pleura on the anterior side of the thorax?
10th rib/costal cartilage
what would help locate the horizontal fissure?
4th rib/costal cartilage
on the anterior side of the thorax, which rib indicates the inferior limit of the lung?
8th and costal cartilage of 6th rib
What is the surgical importance of the transverse pericardial sinus?
Allows coronary bypass machine attachment, clamping of aorta and pulmonary trunk
What is the clinical significance of the bronchopulmonary segmentation of the lung?
Allows resection of the lung to treat damage or disease, multiple segments, lobes, or the entire lobe to be removed.
The sternal angle is a surface landmark for what deeper structures?
Aortic arch, trachea, at 2nd pair of costal cartilages
where do the left and right coronary arteries arise?
Aortic semilunar valve
What is flail chest and how does it affect the directions ribs move during inspiration and expiration?
More than 1 break in the ribs Inspiration: moves inward Expiration: moves outwards
What are the effects of parasympathetic innervation to the lungs?
Motor to smooth muscle of bronchial tree (bronchoconstriction) Inhibit constriction of pulmonary vessels (vasodilation) secretory to glands
know the location of the AV node
Near intertribal septum, near coronary sinus
What structures make up the root of the lung?
Opening for root= hilum (hole) Contents: - pulmonary veins - pulmonary arteries - bronchi - bronchial vessels
What are the 3 layers of the pericardial sac?
Outer layer: fibrous pericardium Serous layer:Parietal pericardium Inner layer = Visceral pericardium (epicardium)
Which nerve is injured when the diaphragm is paralyzed?
Phrenic nerve
what do the pulmonary and aortic semilunar vales do?
Prevents back flow of blood to right ventricle
What are the arteries that supply the lungs
Pulmonary arteries
Which lymph nodes receive deep lymphatic drainage of the lungs?
Pulmonary lymph nodes tracheobronchial nodes
Why would a thoracentesis be performed?
Remove blood, fluid, pus
What deeper structure lies just to the right of the manubrium?
Superior vena cava
what deeper structures lies just right of the manubrium?
Superior vena cava
What structures attach the breast to the deep pectoral fascia?
Suspensory ligament
What is rib 1?
Atypical
Which nodes receive most the lymphatic drainage from the breast?
Axillary nodes
How many/what type of arteries supply each intercostal space?
Each intercostal space (1-11) is served by 1 posterior intercostal artery and 2 anterior intercostal arteries
What is the action of external intercostals?
Elevate ribs during quiet and forced inspiration
What are the 3 layers of the heart?
Epicardium (visceral pericardium) Myocardium Endocardium
Know the location of the SA node
(pacemaker) at auction of SVC and right atrium
How does the close association of axillary nodes with the breast relate to breast cancer?
Extension of mammary tissue into the axillary process of breast where ~75% of lymph drains into axillary nodes
How many/what type of veins drain each intercostal space?
1 posterior intercostal vein & 1 subcostal vein
What are the 4 roles of the thoracic wall?
1) protect thoracic organs (some abdominal) 2) resist negative pressure from recoil of lungs 3) attachment/support of upper limb 4) attachment of muscles of upper limbs, neck, abdomen, back, & respiration
Be able to explain why an opening in the pleural cavity leads to collapse of the lung.
Because the change in pressure
What is the cardiac cycle?
Beginning of one heart beat to beginning of next. Ventricle filling Ventricle emptying
What are the veins that drain the lungs?
Bronchial veins and pulmonary veins
Know which cranial nerve provides innervation to the lungs.
CNX
What effect does sympathetic innervation have on the heart?
Can increase heart rate and force contraction, dilate coronary arteries
Where is the tendon of the diaphragm muscle?
Common central tendon
What connections are disrupted in a rib separation?
Costochondral junction displacement (rib & costal cartilage)
What is the action of internal intercostals?
Depresses ribs during forced expiration
How is movement of the diaphragm affected, and what happens to abdominal organs if one half of the diaphragm is paralyzed?
Diaphragm doesn't lower
What connections are disrupted in a rib dislocation?
Displacement at sternocostal joint
Know that actions of: external intercostals, internal intercostals
External intercostals: Action: elevate ribs during quiet & forced inspiration Internal intercostals: Action: depress rib during forced expiration
Know the main branches of the right and left coronary arteries. Know which coronary veins drain the left side of the heart and which drain the right.
Great cardiac (left), left posterior ventricular and left marginal Small and middle cardiac vein (right) Empty into coronary sinus (posterior side of heart)
What joints articulate with costotransverse and costovertebral joints?
Head, neck, and tubercle of the rib and the synovial plane joint
What changes occur in intrathoracic volume and diameter of thorax during inspiration?
Increase in volume and diameter
Where does sympathetic innervation of heart arise?
Lateral horns of spinal cord (T1-T6) Postsynaptic fibers end in SA and AV nodes
What are the main veins draining the breast?
Lateral thoracic vein internal thoracic vein axillary vein
Which chambers of the heart are found on the diaphragmatic surface?
Left & some right ventricle near diaphragm tendon
Which atrium has thicker walls?
Left atrium
know the anatomical features of right and left lung, including bronchopulmonary segments.
Left lung: 2 lobes & 1 fissure -superior lobe - oblique fissure - inferior lobe Right lung: 3 lobes & 2 fissures -superior lobe - horizontal fissure - middle lobe- oblique fissure - inferior lobe 10 bronchopulmonary segments per lung
Which chambers of the heart are found on the left pulmonary surface?
Left ventricle, forms cardiac impression on left lung
which chamber of the heart has the thicket myocardium and why?
Left ventricle- arterial pressure higher, harder working
Where would you find the fossa ovalis?
Right atrium
Which bronchus is an inhaled object more likely to enter? Why?
Right bronchus, because it is wide, short, and straight
Which chambers of the heart are found on the sternocostal surface?
Right ventricle
Know how the conduction system relays the cues to the muscle fibers
SA nodes transmits to AV node by myogenic conduction AV node > ventricles via AV bundle - through fibrous skeleton of heart membranous part of IVS
What 3 structures return low-oxygen blood to the right atrium of the heart?
SVC IVC coronary sinus
how are papillary muscles contracted before their associated ventricles contract accomplished by the cardiac conduction system.
Septomarginal trabecular (moderator band) carries portion of bundle branches of conduction system over to the papillary muscle to help coordinate papillary muscle contraction
Which layer secretes fluid into the pericardial cavity?
Serous layer: Parietal pericardium
What effect does parasympathetic innervation have on the heart
Slows heart rate, reduce force contraction, constrict coronary arteries
What is the effect on the associated ventricle of stenosis of the aortic valve? why?
The left ventricle hypertrophy
3 larger arteries send branches to the thoracic wall. know the main arteries and the names of the branches they send to the thoracic wall
Thoracic aorta --> posterior intercostal arteries Subclavian artery --> internal thoracic artery & supreme intercostal artery Axillary artery--> superior & lateral thoracic arteries
Know the order of branching bronchi/bronchioles/aveoli from the main bronchi to the alveoli of the alveolar sacs
Trachea Right main bronchus Right superior lobar bronchus Right middle lobar bronchus Segmental bronchus Right lower lobar bronchus Trachea Left main bronchus Left superior lobar bronchus Left inferior lobar bronchus
Know the location of the tricuspid and bicuspid/mitral valves and the structures that help open/close them.
Tricuspid -right ventricle Mitral (bicuspid) -left ventricle -loudest closer (apex beat)
Main muscle of respiration
diaphragm
During inspiration, how does the shape of the diaphragm change and which direction is the tendon pulled?
diaphragm contracts pulls tendon inferiorly
what property to the costal carriages add to the thoracic wall? and limit?
elasticity and limits its anterior expansion
What is supernumerary rib?
extra ribs, usually in cervical region
What portion of the breast is susceptible to formation of adenocarcinoma?
from epithelial cells of the lactiferous ducts
Which vessels are commonly used to create coronary bypass
great saphenous and radial artery
What are the main arteries supplying the breast
lateral thoracic artery thoracoacromial artery branches of internal thoracic artery
What happens if the mitral valve is prolapsed?
leaflets are enlarged and floppy extends into atrium during systole
know the 3 main cavities of the thoracic cavity.
left & right pulmonary cavities mediastinum visceral & parietal pleura
What are 2 functions of serous fluid in the pleural cavities?
lubricates surface tension keeps lungs in contact with thoracic wall
Where are ribs likely to break
middle ribs, away from attachment point
what is the main function of the lungs?
oxygenated blood by bringing inspired air close to venous blood in pulmonary capillaries
What is the function of the auricles found on both the right and left atria?
pectinate muscles
What is valvular insufficiency?
regurgitation when valve doesn't fully close
Which layer(s) of the heart receive oxygen/nutrient/waste exchange from coronary circulation?
right atrium most of the right ventricle part of the left ventricle (diaphragmatic surface) Part of the IV septum (usually posterior third) SA node (~60%) AV node (~80%)
from the surface of the thorax, what landmark would help locate the oblique fissure of the lung?
spinous process of T2, 6th costal carriage, medial border of the scapula
between which two parts would you find the sternal line of pleural reflection?
sternum
What makes rib 1 atypical?
superior thoracic aperture shortest, broadest most sharply curved 1 facet head
Where would a needle be inserted to perform a thoracentesis? & why should individual expire all air?
superior to rib through muscles into pleural cavity expiration, upright, 9th intercostal space To decrease changes of puncturing the diaphragm
Which valve commonly has stenosis?
the aortic valve
Know the features of a typical rib
tubercles, neck, angle, body, costal cartilage
How is the pericardial sac held in place within the mediastinum?
tunica adventitia of great vessels posterior surface of sternum (sternopericardial ligaments) central tendon of diaphragm (pericardiacophrenic ligaments)
