Exam Block 2

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Boundaries of the superior thoracic aperture

• manubrium

• 1st rib

• 1st thoracic vertebrae

Boundaries of inferior thoracic aperture

• costal arch and xiphoid process anteriorly

• 12th rib and 12th thoracic vertebrae posteriorly

Boundaries of the mediastinum

• lateral- both lungs

• anterior- superior thoracic aperture

• posterior - inferior thoracic aperture

What are true ribs 1-7?

ribs that articulate directly to the sternum via costal cartilage.

What are false ribs 8-12?

not connected to the sternum

What are the properties of typical ribs 3-9?

• head with 2 facets for articulation

• neck

• thin body with a costal groove

• articulates with costal arch or cartilage.

What makes the first rib an atypical rib?

• scalene tubercle

• separates groove for subclavian vein and artery

• flattened shape like a boomerang

What makes the 10th rib atypical?

it only has one articular facet for the vertebral body. All other features are the same.

What makes the 11th and 12th ribs atypical?

they are floating and do not articulate with cartilages.

What is the sternal articulation with the second rib?

Sternal angle

Where is the sternal articulation for the 7th rib?

Xiphosternal junction

What type of joint is the Manubriosternal

cartilaginous but it may ossify. Between manubrium and sternal angle

What type of joint is xiphisternal joint?

cartilaginous between the body and xiphoid process.

What type of joint is the sternocostal joint?

synovial. Between costal cartilages and costal notches in sternum

What type of joint is the Costochondral joint?

cartilaginous - between costal cartilage and ribs.

What type of joins are Interchondral Joints

synovial - between costal cartilages of 6th - 8th and sometimes 9th and 10th.

What does the inferior costal facet articulate with?

superior articular facet on the head of the rib one number higher.

What does the superior costal facet articulate with?

inferior articular facet n the head of the rib of the same number.

What reinforces the costovertebral joint?

Radiate ligament of head of rib

Pump Handle movement

• Superior and anterior movement if the sternum

• Expand and contract anteroposterior aspects of the thoracic cavity

Bucket handle movement

• Elevation of lateral shaft of the ribs anteriorly and posteriorly

• expand and contract the mediolateral aspect of the thoracic cavity.

Between what layers of intercostal muscles do the intercostal vessels and nerve course?

between the internal and innermost layers.

The external intercostal muscles are discontinuous in what direction?

Anteriorly- they are articulated with the sternum via the external intercostal membrane.

What is the function of the external intercostals?

• elevate the ribs during forced inspiration.

The internal intercostals are discontinuous in what direction?

posteriorly- joins the vertebral bodies via the internal intercostal membrane

What is the function of the internal intercostals?

depress ribs during forced expiration

The innermost intercostals are discontinuous in what direction?

anteriorly, posteriorly, and lateral halves of the rib cage on the innermost layer

What is the function of the innermost intercostals?

depress ribs during forces expiration

What are the muscles of the innermost layer of intercostals?

• transversus thoracis

• innermost intercostal

• subcostal muscles

Transversus thoracis

• anterior muscle of the innermost layer

• from sternum to anterior part of first 6-7 ribs

Subcostal muscles

• posterior muscles of the innermost layer in the lower 4 intercostal spaces

• pull the ribs closer together

What is the order of the intercostal vessels from anterior to posterior between the internal and innermost layers?

• vein, artery, nerve.

• VAN

What is the blood supply to the upper half of the ribs (2-6)?

internal thoracic artery

What is the blood supply to the lower half of the ribs (7+)?

musculophrenic artery

Where do the dorsal intercostal arteries come from?

aorta

What is the name of the dome shape in the cervical pleura formed by the apex of the lung?

cupula

what is the name of the area where fluid can be removed from the pleural cavity?

costodiaphragmatic recess

What is the dividing line between the superior and inferior mediastinum?

• transverse thoracic plane at the level of the sternal angle

• T4/5 disc

What are the boundaries of the anterior mediastinum?

between the sternal body and the pericardium

houses the thymus and fat

What are the boundaries for the middle mediastinum?

• heart and pericardium

• basically just the heart

What are the boundaries for the posterior mediastinum?

• posterior to the heart and anterior to vertebral bodies.

How far down does the inferior mediastinum go?

xiphisternal junction

T9/10

Spheres of the heart pressed together to form a wall between between 2 chambers is a what?

• septum

• interatrial and interventricular

Coronary sulcus

• groove between the atria and ventricle

• like a crown around the heart

interventricular sulcus

• groove between two ventricles

• There is no sulcus between atria

Another name for the right atrioventricular valve

• tricuspid

another name for the left atrioventricular valve

• mitral

• bicuspid

What is the blood supply and drainage for the heart itself?

• coronary artery and vein found within the coronary and interventricular sulci

what are the three layers of pericardium?

• visceral - (epicardium) closely adhered to the heart.

• Parietal - between visceral and outermost layer

• fibrous - outermost layer

Diaphragmatic surface

• left ventricle

Sternocostal surface

• right ventricle

Left surface

• left ventricle

Right surface

right atrium

Apex

pointy end of left ventricle

Base

mostly left atrium

The name of the smooth area in the right atrium that blood comes into?

sinus venerum

What is the musclular wall inside the auricles made of?

pectinate muscles

What divides the pectinate muscles from the sinus venerum?

Crista terminalis

Depression of fetal circulation in the interatrial septum

Fossa ovalis. Formerly know as foramen ovalis.

What is the ridge called on the superior part of fossa ovalis

limbus of fossa ovalis

Blood that made it to the pulmonary trunk in fetal circulation was redirected to the aorta via what structure?

ductus arterious

Ridges on the muscle of the right ventricle

trabeculae carnae

What is the specialization of muscle called between the septal wall that carries purkinje fibers?

septomarginal trabeculae (moderator band)

Funnel-shaped part of the wall leading to the pulmonary trunk?

Conus arteriosus

Muscle that separates trabeculae carnae from the conus arteriosus

supraventricular crest

Blood flows through what valve from the left ventricle to get to the aorta?

aortic semilunar valve

What is the difference between the aortic and pulmonary semilunar valves?

• aortic has a posterior cusp

• pulmonary has an anterior cusp

What are the first two branches off of the aorta after the aortic semilunar valve?

right and left coronary arteries

What is the third cusp of the tricuspid valve besides ant. and post.?

septal cusp (parallel to interventricular septum

What is the sulcus between the atria and ventricles that houses the coronary ateries and veins?

coronary sulcus

The left coronary artery splits into…

-circumflex branch (coronary sulcus)

-anterior interventricular artery (ant. interventricular sulcus

Branch of right coronary artery that supplies the blood to the SA node.

Sinoatrial artery

What do the small, middle, and great cardiac veins drain into?

coronary sinus before going to right atrium

How do purkinje fibers get to the right ventricle?

septomarginal trabeculum

Where do the primary Bronchi go?

to the lungs

What is another name for secondary Bronchi and where do they go?

• lobar bronchi

• to the lobes

What is the comparison of lung volume between the right and left lungs?

Right lung has an average of 17% larger volume

What is the Hilus of the lung?

The point where various structures like vessels reach the lung.

What is the function of the Azygos vein

• drains the posterior mediastinum

• unpaired vein

• right side

Where do the intercostal arteries 3 to 12 branch off of?

• directly from the descending aorta

where do the intercostal arteries 1 and 2 come from?

deep cervical branch of costocervical trunk.

Where does the costo-cervical trunk come from?

Subclavian artery

What are the branches of the Aorta in the Posterior Mediastinum?

• posterior intercostal arteries

• bronchial arteries

• esophageal arteries

What is the anterior vagal trunk

combination of vagus nerve from left vagus and esophageal plexus

What is the posterior vagal trunk?

Combination of the right vagus nerve and the esophageal plexus.

What drains the left side of the posterior mediastinum?

• hemiazygos and accessory hemiazygos veins

• these are covered by the descending aorta

Platysma

• origin- skin of the neck and upper shoulder

• insertion- mandible

• action - pulls down the side of the mouth

• innervation - facial nerve

What is the investing layer of deep cervical fascia?

• encloses the entire neck

• has splits to cover the SCM and Trap

What is the pretracheal layer of deep cervical fascia?

• Covers infrahyoid muscles

• covers thyroid gland, larynx, pharynx, trachea and esophagus

What is the prevertebral layer of deep cervical fascia?

• surrounds vertebral column and the surrounding muscles.

What is the carotid sheath?

• covers the carotid artery, internal jugular vein, and vagus nerve.

Sternocleidomastoid

• origin- manubrium and medial aspect of clavicle

• insertion- mastoid process

• action- contralateral neck rotation, lateral neck flexion, neck flexion (bilateral contraction)

• innervation - CN XI

Anterior belly of digastric

• origin- digastric fossa of mandible

• insertion - digastric tendon of hyoid bone

• action- lowers mandible and raises hyoid bone

• innervation- mylohyoid nerve

Posterior belly of the digastric

• origin- mastoid process

• insertion- digastric tendon of hyoid bone

• action- elevates and retracts hyoid bone

• innervation- facial nerve

Stylohyoid

• origin- styloid process of temporal bone

• insertion- hyoid bone

• action - elevates and retracts hyoid bone

• innervation- facial nerve

Wraps around the tendon of the posterior digastric muscle

Borders of the anterior triangle

• median vertical line of the neck

• inferior mandible

• anterior border of SCM

Borders of the posterior triangle

• middle third of clavicle

• posterior border of SCM

• anterior border of trapezius

What are the divisions of the anterior triangle?

• macular triangle

• carotid triangle

• submandibular triangle

• submental triangle

Boundaries of the Muscular triangle

• midline of neck

• superior omohyoid

• SCM

boundaries of the carotid triangle

• superior omohyoid

• posterior digastric

• SCM