1. Superior thoracic aperture borders
    • Posterior border: T1
    • Anterior border: costal cartilage of 1st rib and superior surface of manubrium
    • Lateral borders: 1st pair of ribs
  2. Structures that pass through superior thoracic aperture
    • Trachea
    • Esophagus
    • Thoracic duct
    • Apexes of lungs
    • Nerves: phrenic, vagus, recurrent laryngeal, and sympathetic trunks
    • Arteries: L and R common carotid arteries and L and R subclavian
    • Veins: Internal jugular veins, brachiocephalic veins, and subclavian veins
    • Lymph nodes and lymphatic vessels
  3. Inferior thoracic aperture borders
    • Much larger than superior
    • Posterior border: 12th thoracic vertebra
    • Lateral border: 11th and 12th pairs of ribs
    • Anteriorly: Costal cartilages of ribs 7-10 and xiphisternal joint
  4. Structures that pass through inferior thoracic aperture
    • Through diaphragm: inferior vena cava and esophagus
    • Posterior to diaphragm through aortic hiatus: abdominal aorta and thoracic duct
  5. 12 thoracic vertebrae and 12 ribs that articulate with each other
    • 7 true ribs (1-7): costal cartilages articulate with sternum
    • 5 false ribs (8-12): common costal cartilages with sternum
    • 11 and 12 are floating ribs: no articulation with sternum
  6. Parts of Sternum
    • Manubrium
    • Body
    • Xiphoid process
  7. Pleural cavities and mediastinum
    • 2 pleural cavities that contain lungs
    • Mediastinum: Between pleural cavities
  8. Where is the sternoclavicular joint?
    Proximal end of clavicles and manubrium of sternum also 1st costal cartilage
  9. What type of joint is the sternoclavicular joint? How many articulating ends are there?
    • Synovial saddle joint
    • 3 articulating ends
    • Proximal end of clavicle
    • Clavicular notch of manubrium
    • 1st costal cartilage
  10. What surrounds the sternoclavicular joint?
    • Joint capsule that surrounds it because it is a synovial joint
    • Lined with synovial membranes
    • Strengthened by ligaments
  11. What separates the sternoclavicular joint into different compartments?
    • Articular disc separates it into 2 compartments
    • Disc in between clavicular notch of manubrium and proximal end of clavicle
  12. What are the 4 ligaments that strengthen the sternoclavicular joint?
    • Interclavicular ligament
    • Anterior Sternoclavicular ligaments
    • Posterior sternoclavicular ligaments
    • Costoclavicular ligament
  13. Movements of the sternoclavicular joint
    • Anterior/posterior
    • Superior/inferior
    • Very small rotational movement
  14. Manubrium
    • 2 articulations: clavicle, 1st costal cartilage, and half of 2nd costal cartilage
    • Suprasternal notch (jugular notch) superiorly
    • Facets for articulating with clavicle and 1st costal cartilage
    • Demifacets for articulating with half of 2nd costal cartilage
  15. Sternal angle (Angle of Louis)
    • Angle between manubrium and body of sternum
    • Level of disc between T4-T5
  16. What is the mnemonic for structures at the level of the sternal angle?
    • Mnemonic: RATPLANT
    • Rib number 2
    • Aortic arch
    • Trachea (bifurcation into 2 bronchi)
    • Pulmonary trunk (bifurcation into R and L branches)
    • Left recurrent laryngeal under arch of aorta
    • Ligamentum arteriosum (connects aortic arch and pulmonary trunk)
    • Azygos system drains into superior vena cava
    • Nerves: cardiac plexus
    • Thoracic Duct (entering into L subclavian vein)
  17. What are the 3 muscles that are outside of the thoracic cage?
    • Serratus anterior
    • Serratus posterior superior
    • Serratus anterior inferior
  18. Serratus anterior
    • O: ribs 1-8
    • I: Medial border of scapula (costal surface)
    • N: long thoracic nerve
    • A: Protract (pulls scapula forward around thorax and against thorax) and stabilizes scapula
  19. Serratus posterior superior
    • O: Spinous process of C7-T3
    • I: Upper borders of ribs 2-5
    • N: 2-5 Intercostal nerves
    • A: Elevates ribs; assists with inspiration
  20. Serratus posterior inferior
    • O: Spinous processes of T11-L2
    • I: Ribs 9-12
    • N: 9-12 intercostal nerves
    • A: Depresses lower ribs; assists with expiration
  21. Intercostal spaces
    • 3 layers, innervated by intercostal nerves T1-T11
    • External intercostal
    • Internal intercostal
    • Innermost intercostal
  22. External intercostal muscles
    • Fibers oriented inferiorly and medially
    • Forms aponeurosis called external intercostal membrane medially
    • Inspiration
  23. Internal intercostal muscles
    • Fibers oriented superiorly and medially (opposite to external)
    • Connect directly to sternum
    • Assist in expiration
  24. Innermost intercostal
    • Fibers oriented superiorly and medially (opposite to external)
    • Expiration
  25. Mnemonic for intercostal muscle fiber directions
    • hands in pockEts (direction of external intercostal muscles)
    • hands on tIts (direction of internal and innermost intercostal muscles)
  26. Endothoracic fascia
    • Deep to inner most intercostal muscles
    • Separates intercostal muscles from pleural cavities
  27. Where is the Neurovascular bundle in the intercostal spaces?
    • between internal intercostals and innermost intercostals in subcostal groove underneath ribs
    • Mnemonic: VAN (superior to inferior)
    • Intercostal vein
    • Intercostal artery
    • Intercostal nerves
  28. What are the layers of the intercostal spaces Superficial to Deep?
    • External intercostal
    • Internal intercostal
    • Intercostal vein, artery, and nerve
    • Innermost intercostal
    • Endothoracic fascia
    • Parietal pleura
    • Visceral pleura
    • Lung
  29. Minor muscles of thoracic cage
    • Levatores costarum muscles
    • Subcostales muscles
    • Transversus thoracis muscles
  30. Levatores costarum muscles
    • 12 pairs of muscles from transverse processes of vertebrae to rib below it
    • Elevation of ribcage
  31. Subcostales muscles
    • Rib to 2 ribs below it
    • Internal surface of ribs
  32. Transversus thoracis muscles
    • O: Inferiorly on body of sternum and xiphoid process
    • I: Internally on costal cartilages 2-6
    • A: Pull ribs down
  33. 4 chambers of the heart
    • 2 atria
    • 2 ventricles
    • Right atrium and ventricle pump to pulmonary circulation
    • Left side pumps oxygenated blood to systemic circulation (more muscular because it needs to travel farther)
  34. Blood flow in heart
    • Receives deoxygenated blood from systemic circulation via superior and inferior vena cava
    • Enters Right Atrium
    • Right Atrium Contracts and blood is pushed through Tricuspid Valve
    • Enters Right Ventricle
    • Right Ventricle contracts and blood is pushed through Pulmonary Valve
    • Enters pulmonary circulation and oxygen diffuses into blood through alveoli in lungs
    • Blood pumped to Left Atrium via pulmonary artery
    • Left Atrium Contracts and blood is pushed through Bicuspid Valve (Mitral valve)
    • Enters Left Ventricle
    • Left Ventricle contracts and blood is pushed through Aortic Valve to systemic circulation
    • Blood enters arteries around body and go into capillary beds where gases, nutrients, and other things are exchanged
    • Enters venules
    • Enters veins and returns to heart via vena cava
  35. Great vessels
    • immediately lead to/from heart
    • Superior vena cava
    • Inferior vena cava
    • Pulmonary artery (Pulmonary trunk)
    • Pulmonary Vein
    • Aorta
  36. Boundaries of mediastinum
    • Central compartment in thorax that separates the 2 pleural cavities
    • Lateral border: medial aspects of pleural cavities
    • Inferior border: Diaphragm
    • Superior border: superior thoracic aperture (thoracic inlet)
    • Posterior border: bodies of thoracic vertebrae
    • Anterior border: sternum
  37. Superior and inferior halves of mediastinum
    • Superior half: Inferior border: upper level of pericardium
    • Inferior half: Below superior half; Sub-divided into anterior, middle, and posterior
  38. Important structures in mediastinum
    • Trachea
    • Esophagus
    • Great vessels of heart and heart
    • Phrenic nerve
    • Thymus
    • Thoracic duct: Largest structure of lymphatic system; Drains into brachiocephalic vein
    • Lymph nodes of central chest
  39. Position of the heart
    • Angled just left of midline
    • Sits on top of diaphragm
    • Apex of heart is in bottom left corner
  40. Surfaces of the heart
    • Diphragmatic surface: Inferior surface of heart; in contact with diaphragm
    • Right and Left Pulmonary surfaces: Right and left sides of heart, in contact with right and left lungs respectively
    • Costosternal surface: Anterior surface of heart, in contact with sternum
    • Base of the heart: Posterior surface
    • Anterior view of heart: Seeing mostly the right ventricle
  41. What are the two types of valves in the heart?
    • Atrioventricular valves
    • Semilunar valves
  42. What are the 2 atrioventricular valves?
    • Tricuspid valve: Between right atrium and ventricle (ri= right)
    • Bicuspid (Mitral) Valve: Between left atrium and left ventricle
  43. What are the 2 semilunar valves?
    • Pulmonary Valve: Between right ventricle and pulmonary artery
    • Aortic Valve: Between left ventricle and aorta
  44. What vessels form the superior vena cava?
    • Right and Left Brachiocephalic veins converge and form superior vena cava
    • External and Internal jugular veins drain into brachiocephalic on both sides
  45. Pulmonary trunk and pulmonary veins
    • Pulmonary trunk: Splits into Right and Left pulmonary artery to lungs (deoxygenated blood)
    • Pulmonary veins: Superior and Inferior pulmonary veins on both sides into left atrium
  46. What are the 3 branches (anterior to posterior)?
    • Brachiocephalic trunk: Splits into right common carotid and right subclavian arteries
    • Left common carotid: Directly from aorta
    • Left subclavian artery: Directly from aorta
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