Thorax Anatomy 1St Year

Front 1

What level is the jugular notch at?

Back 1

T2

Front 2

What level is the sternal angle at?

Back 2

T4/T5 (2 below T2 sternal junction)

Front 3

What is the subcostal angle?

Back 3

the angle between the midline and the costal margin. (different on the left and right)

Front 4

What is Larrey's point?

Back 4

the point between the costal margin and the xiphoid process?

Front 5

Why is larrey's point important?

Back 5

it's the landmark you would use to withdraw pericardial fluid.

Front 6

Where is traube's semilunar space?

Back 6

on the left and sitting right above rib 6.

Front 7

Draw the anterior view of the ribs. get the angles and the attachments right and include the scapula for reference.

Back 7

Front 8

Back 8

1. jugular notch at rib 1/T3
2. spine of the scapula at Rib 1/T3
3. Sternal angle at rib 2/T4
4. Rib 6 which is parallel with the oblique fissure
5. Inferior angle of the scapula which is at rib 5/T7
6. Rib 8, which is the widest rib
7. Rib 9, which is the most oblique rib
8. rib 10, which is the most inferior at the midaxial line
9. Larrey's point between rib 7 and the xiphoid process
10. the costal margin made up of the costal cartilage of ribs 7-10

Front 9

what borders the interscalene traingle? What is in the triangle?

Back 9

Borders: The anterior and middle scalene and the 1st rib
In it: the subclavian artery and the brachial plexua

Front 10

What is in front of the trangle? How do you rmember this?

Back 10

The subclavian vein because veins are always more superficial to arteries.

Front 11

What would happen if you had compression of the triangle? What is this called?

Back 11

This is thoracic outlet syndrome and involves paleness of the arm and tingling from the artery and plexus being affected.

Front 12

What nerve is affected by horner's syndrome?

Back 12

T1, the last nerve of the brachial plexus

Front 13

What happens in a pancoast tumor?

Back 13

all the structures in the triangle are compressed and you have thoracic outlet syndrome.

Front 14

Is horners syndrome a part of thoracic outlet syndrome?

Back 14

yes! T1 is part of the plexus.

Front 15

What is the movement of the upper ribs and what is it caused by?

Back 15

pump handle going anterior caused by the anterior scalenes

Front 16

What is the movement of the lower ribs and what is it caused by?

Back 16

bucket handle going lateral caused by the diaphragm pushing abdominal contents out.

Front 17

What happens if you have paralysis of the intercostal muscles during inspiration?

Back 17

the thoracic cage will depress because they are passively dragged down by the diaphragm

Front 18

When is this normal? Why?

Back 18

In babies because they have undeveloped intercostal muscles (no shell notching on radiograph)

Front 19

WHat rib is lowest on the axillary line?

Back 19

rib 10

Front 20

Which rib is directly over the posterior oblique fissure?

Back 20

rib 6

Front 21

Describe the collateral vasculature in the intercostal regions.

Back 21

each of the vessels/nerves for one rib makes a collateral going in the opposite direction for the superior margin of the rib below. (VAN NAV)

Front 22

What nerves would you anesthetize to operate on rib 7?

Back 22

collateral of rub 6 and nerve of rib 7.

Front 23

How are the anterior intercistal arteries compared to the veins?

Back 23

they run the same routes

Front 24

what does the interna thoracic artery branch into and where?

Back 24

It braches at rub 7 into the musculophrenic and the epigastric artery.

Front 25

Where do the anterior inteercostal arteries for ribs 7-9 come from?

Back 25

the musculophrenic artery

Front 26

Where do the anterior inteercostal arteries for ribs 10-11 come from?

Back 26

from the posterior intercistals

Front 27

Where do the posterior intercostal arteries come from?

Back 27

1-2 from the costocervial trunk off the subclavian
3-12 off the aorta

Front 28

Where do the 1st ribs veins drain into?

Back 28

the bracheocephalic vein?

Front 29

Where do the intercostal veins of ribs 2-4 drain into? Where does that vein drain into?

Back 29

the superior intercostal vein which drains into
R- bracheocephlic vein
L- azygous vein

Front 30

which rib levels are drained into the accessory hemiazygous and the hemiazygous?

Back 30

5-8- accessory
9-12- hemiazygous

Front 31

Where do the intercostal nerves come from?

Back 31

the ventral rami from the thoracic vertebrae

Front 32

which are the exceptions?

Back 32

intercostal nerves 1-2 which can cause referred pain

Front 33

Which intercostal arteries are longer?

Back 33

The right because the aorta is slightly on the left

Front 34

Where does the lymph of the breast drain into?

Back 34

your axillary lymph nodes

Front 35

What is the watershed line and why is it significant?

Back 35

Everything above it drains predictably into the anterior vs posterior axillary nodes depedning on which side they are on

Front 36

What drains below the watershed line?

Back 36

superficial inguinal nodes

Front 37

What drains the anterior chest not including breasts?

Back 37

the centrally located interal mammary nodes

Front 38

Where is the pulmonary vein always located on the hilum, both left and right?

Back 38

most inferior and anterior

Front 39

Does the pleural cavity and the lungs line up?

Back 39

No, the pleural cavity is 2 ribs below the lung?

Front 40

What level is the pleural line from front midclavicular to back scapular line?

Back 40

12-10-8

Front 41

why does lung cancer grow for so long without pain?

Back 41

there is no painreceptors on the visceral pleura so you won't feel it until it gets to the parietal.

Front 42

What is the normal total angle of the carina?

Back 42

65 degrees

Front 43

What is the left and right angles respectively?

Back 43

left- 40 degrees
right- 25 degrees

Front 44

What could cause the angle to widen?

Back 44

cardiac atrial hypertrophy
upper lobe atelectasis
carinal lymphadenopathy

Front 45

which bronchi is larger?

Back 45

thje right bronchi is larger, making it doubly as likely to get foreign bodies stuck into it.

Front 46

What is the hyparterial bronchus? Why is it named this?

Back 46

the left main bronchus because it sits right behind the aorta

Front 47

What is the eparterial bronchus? Why is it named this?

Back 47

the superior branch of the right bronchus. It is the only bronchus that is above a pulmonary artery.

Front 48

The following questions are about pneumonia of the different lobes. What structure will RUL PNA opbscure?

Back 48

superior right heart border

Front 49

What structure will RML PNA opbscure?

Back 49

right atrial border

Front 50

What structure will any LL PNA opbscure?

Back 50

the hemidiaphragm

Front 51

What compartment of the heart is most affected by a crushed sternum?

Back 51

the right ventricle because it sits right below it.

Front 52

What happens when you damage the right ventricle?

Back 52

bleeding into the pericardial sac and cardiac tamponade

Front 53

what sx come about from cardiac tamponade?

Back 53

Beck's triad

Front 54

What is beck's triad?

Back 54

1. hypotension from not being able to fill up the heart
2. distant heart sounds from the heart being submerged in blood
3. JVD from blood backing from the right side

Front 55

Where are the aortic and pulmonary valves heard?

Back 55

2nd right and 2nd left intercostal space respectively

Front 56

Where is the tricuspid valve sound heart?

Back 56

the right 5th intercostal space by the sternum

Front 57

Where is the bicuspid valve sound heart?

Back 57

the left midclavicular line right below the nipple

Front 58

Where are the pectinate muscles?

Back 58

on the anterior wall of the atria only

Front 59

What is the sinus venarum?

Back 59

the smooth posterior wall of the atria

Front 60

What is the thesbian and eustachian valve respectively?

Back 60

The thin menbrane bump on the coronary sinus (thesbian) and the inferior vena cava (eustachian) respectively.

Front 61

Where is the SA node?

Back 61

in the crista terminalis

Front 62

Where is the sulcus terminaline?

Back 62

running inferiorly from the crista terminalis in the atria.

Front 63

What are the superficial atrial fibers?

Back 63

neural fibers that wrap like an infinity sign threough both atria so that the SA node signal can be spread quickly

Front 64

How must you cut the heart so you can see both the ventricles?

Back 64

You cut it obliquely to the left.

Front 65

What is the moderator band?

Back 65

the muscular band in the right ventricle that anchors the right papillary muscles to the septum.

Front 66

Describe why pruning and plumping happens in the pulmonary arteries?

Back 66

There is constriction from some cause of pulmonary HTN causing the vessels to taper off (pruning) build up of pressure before this causes proximal dilation (plumping) of central branches

Front 67

what is ischemia compared to infarction?

Back 67

infarction is complete blokage and ischemia can just be partial.

Front 68

occlusion of LAD leads to dying of which parts of the hear?

Back 68

anterior part of the left ventricle and the interventricular septum

Front 69

occlusion of Left circumflex leads to dying of which parts of the hear?

Back 69

lateral part of the left ventricle

Front 70

occlusion of right coronary artery leads to dying of which parts of the hear?

Back 70

posterior part of the left ventricle and the interventricular septum (and also the right ventricle)

Front 71

What is the most common site of heart attacks?

Back 71

the left ventricle.

Front 72

What are the fibers of the ventricular myocardium for?

Back 72

they twist around to facilitate a wringing motion for ventricular contraction.

Front 73

What determines if you are right or left heart dominant?

Back 73

which coronary artery your posterior descending artery (PDA) comes off of.

Front 74

What is the only innervation in the pacemaker cells?

Back 74

the vagus nerve in the SA node

Front 75

What is the blood supply to all the pacemaker cells?

Back 75

the right coronary artery supplying the SA, AV, and bundle of His

Front 76

Why does the septum close up after birth?

Back 76

blood flow starts to go from left to right and snaps the septum primum shut against the septum secondum.

Front 77

Describe the setup of the breast in terms of lobes.

Back 77

it is kind of like the kidney where you have 15-20 lobes with lobule segments all going towards the nipple like the pyrimids

Front 78

Describe the structures along the drainage of exogenous secretions of the breast?

Back 78

you have individual acini glands that drain into lactiferous ducts which go to the nipple, but balloon into a sinus right before reaching it.

Front 79

what is the axillary tail of the breast?

Back 79

the fibrous portion of the left outer quadrant that extends into the armpit.

Front 80

What quadrant of the breast is cancer most likelt to arise in and why?

Back 80

the left outer quadrant (near the armpit) because it has the most amount of fibroglandular tissue that is always remodeling itself and is prone to cancer for this reason.

Front 81

When will you have maximal fibroglandular tissue growth? WhY?

Back 81

right before ovulation because that is when nourishing estrogen and progesterone spike

Front 82

What is the difference in breat tissue between people who have been pregnant vs have been pregnant?

Back 82

the breast of a never pregnant woman (nulleparis) has more glandular tissue because after pregnancy, glandular tissue regresses to a point that is far less than before pregnancy

Front 83

Which vertebral bodies don't have transverse costal facets?

Back 83

T11 and 12

Front 84

What other articulations do ribs 11 and 12 not have?

Back 84

and articulation with the vertebral body in the level above. they are only ataches to the vertebral body of their own level by one attachment point.

Front 85

Where does rib 1 articulate in the spine?

Back 85

inferior costal facet of C7
superior costal facet of T1
Transverse facet of T1

Front 86

Draw this pattern.

Back 86

Front 87

Where does the axillary nodes drain on the left vs right?

Back 87

left- thoracic duct
right - lymphatic duct

Front 88

Where is the level 1 mammary nodes located and called?

Back 88

these are the pectoral nodes which are lateral to the coracoid insertion of pec minor.

Front 89

Where is the level 2 mammary nodes located and called?

Back 89

central nodes- right behind pec minor
rotter's nodes- between pec minor and pec majoe
both at the coracoid insertion

Front 90

Where is the level 3 mammary nodes located and called?

Back 90

The apical nodes which are medial to pec minor

Front 91

How can I use omm to remember that rib 9 is the most oblique/slanted rib?

Back 91

The rule of 3's. From 10-12, they start decreasing in angle severity.

Front 92

Back 92

Front 93

Draw where the groups of major lymph nodes are on the anterior body.

Back 93

Front 94

Draw the hilum of the left lung

Back 94

Front 95

Draw the hilum of the right lung

Back 95

Front 96

Will the bronchi run posterior or anterior to the vessels? How do you know this?

Back 96

posterior because the heart sits anteriorly.

Front 97

Where do the pulmonary arteries run in relation to the bronchi in the right vs left?

Back 97

Right - in front
Left- above

Front 98

How do you remember this?

Back 98

2 ways:
1. Right in front
2. Remember LAB V and know that the artery is above for the left.

Front 99

How do you remember how the lobes of the lungs sit on the back?

Back 99

Imagine two sets of angel wings on top of each other.

Front 100

Draw the anterior and posterior views of the left and right lung lobes

Back 100

Front 101

Draw the main structures of the heart that are seen in a cxr (include the arteries).

Back 101