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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
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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
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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
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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
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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
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Parts of Sternum
- Manubrium
- Body
- Xiphoid process
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Pleural cavities and mediastinum
- 2 pleural cavities that contain lungs
- Mediastinum: Between pleural cavities
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Where is the sternoclavicular joint?
Proximal end of clavicles and manubrium of sternum also 1st costal cartilage
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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
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What surrounds the sternoclavicular joint?
- Joint capsule that surrounds it because it is a synovial joint
- Lined with synovial membranes
- Strengthened by ligaments
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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
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What are the 4 ligaments that strengthen the sternoclavicular joint?
- Interclavicular ligament
- Anterior Sternoclavicular ligaments
- Posterior sternoclavicular ligaments
- Costoclavicular ligament
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Movements of the sternoclavicular joint
- Anterior/posterior
- Superior/inferior
- Very small rotational movement
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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
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Sternal angle (Angle of Louis)
- Angle between manubrium and body of sternum
- Level of disc between T4-T5
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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)
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What are the 3 muscles that are outside of the thoracic cage?
- Serratus anterior
- Serratus posterior superior
- Serratus anterior inferior
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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
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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
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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
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Intercostal spaces
- 3 layers, innervated by intercostal nerves T1-T11
- External intercostal
- Internal intercostal
- Innermost intercostal
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External intercostal muscles
- Fibers oriented inferiorly and medially
- Forms aponeurosis called external intercostal membrane medially
- Inspiration
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Internal intercostal muscles
- Fibers oriented superiorly and medially (opposite to external)
- Connect directly to sternum
- Assist in expiration
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Innermost intercostal
- Fibers oriented superiorly and medially (opposite to external)
- Expiration
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Mnemonic for intercostal muscle fiber directions
- hands in pockEts (direction of external intercostal muscles)
- hands on tIts (direction of internal and innermost intercostal muscles)
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Endothoracic fascia
- Deep to inner most intercostal muscles
- Separates intercostal muscles from pleural cavities
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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
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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
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Minor muscles of thoracic cage
- Levatores costarum muscles
- Subcostales muscles
- Transversus thoracis muscles
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Levatores costarum muscles
- 12 pairs of muscles from transverse processes of vertebrae to rib below it
- Elevation of ribcage
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Subcostales muscles
- Rib to 2 ribs below it
- Internal surface of ribs
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Transversus thoracis muscles
- O: Inferiorly on body of sternum and xiphoid process
- I: Internally on costal cartilages 2-6
- A: Pull ribs down
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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)
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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
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Great vessels
- immediately lead to/from heart
- Superior vena cava
- Inferior vena cava
- Pulmonary artery (Pulmonary trunk)
- Pulmonary Vein
- Aorta
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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
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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
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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
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Position of the heart
- Angled just left of midline
- Sits on top of diaphragm
- Apex of heart is in bottom left corner
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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
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What are the two types of valves in the heart?
- Atrioventricular valves
- Semilunar valves
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What are the 2 atrioventricular valves?
- Tricuspid valve: Between right atrium and ventricle (ri= right)
- Bicuspid (Mitral) Valve: Between left atrium and left ventricle
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What are the 2 semilunar valves?
- Pulmonary Valve: Between right ventricle and pulmonary artery
- Aortic Valve: Between left ventricle and aorta
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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
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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
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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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