Instructions for Side by Side Printing
- Print the notecards
- Fold each page in half along the solid vertical line
- Cut out the notecards by cutting along each horizontal dotted line
- Optional: Glue, tape or staple the ends of each notecard together
Module 3: the thorax
front 1 during a PE, what should you focus on "thorax" wise? | back 1
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front 2 identify:
| back 2  look at picture |
front 3 how do you find and palpate the second rib? | back 3 you find the sternal angle ridge on your pt and then feel sideways to feel the ribs and the intercostal spaces...if you move your fingers up and down you can feel the 1st and 2nd rib above and below |
front 4 what is the bifurcation of the trachea called? what does it divide into? | back 4 carina...divides into R and L primary bronchi |
front 5 the beginning and ending of the aortic arch is found where? | back 5 the sternal angle |
front 6 what do we want symmetry between when we look at the ribs? | back 6 the costal margin and the subcostal angle |
front 7 how to count vertebrae, whats the easiest to do? | back 7 find C7 which is the biggest bump and then count down in that direction |
front 8  | back 8 look at picture |
front 9  Identify 2 bony landmarks of the posterior thorax
| back 9  Spinous processes of thoracic vertebrae 1 -12 Costovertebral angle (CVA)
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front 10 name the 2 anterior vertical lines and describe them? the 2nd one is a little medial to what? | back 10  Anterior median (midsternal) line...vertical line through sternum in mid-sagittal plane Midclavicular lines (MCL)...vertical through midpoints of the clavicles, parallel to median line...medial to the nipple |
front 11 name the 3 lateral vertical lines and describe them? which one is formed by the pec major? which one goes right through the armpit? which one is formed by the latissimus dorsi and teres major? | back 11  Anterior axillary line...vertical line along anterior axillary fold (formed by pec major) Mid axillary line...vertical line though apex of axilla (armpit) Posterior axillary line...vertical line through posterior axillary fold (formed by latissimus dorsi and teres major) |
front 12 name the 2 posterior vertical lines and describe them? another 2 names for the 1st one? | back 12  Posterior median (midspinal or midvertebral) line ...vertical line through spinous processes of vertebrae in mid-saggital plane Scapular lines...vertical lines that pass through inferior angles of the scapula, line is parallel to posterior median line posterior median line goes through the inferior angle of the scapula...look for it in the picture and try to picture the bottom of the scapula along the line |
front 13 what is the auscultation alley? | back 13
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front 14 point out these spaces: R/L 2nd ICS | back 14  look at picture
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front 15 which space listed above can you use to hear the aortic and pulmonary valves? how about if you wanted to listen to the mitral valve? tricuspid valve? | back 15  right (aortic) and left 2nd ICS (pulmonic) left 5th ICS 4th or 5th ICS |
front 16 name the 3 bones of the thoracic wall? their function? | back 16
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front 17  Identify the structures of the sternum
| back 17  M up top Body in middle X point at bottom jugular notch at top two facets next to that is articulation sites for the clavicle |
front 18 identify the sub-divisions of the ribs (true, false and floating) and describe them? | back 18 
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front 19 describe typical vs. atypical ribs? | back 19 
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front 20  Identify the landmarks of a typical rib? | back 20 look at picture |
front 21 the head of a typical rib has what that do what? what does the tubercle articulate with? how would you describe the shaft/body region? what is the costal angle a common site for?why is that? | back 21 Have facets (F) that articulate with two different vertebrae Tubercle (T)...articulates with transverse process Shaft/body (S/B)...thin, flat portion Costal angle (CA)...common site of rib fracture, weakest point of the rib |
front 22 Identify the landmarks thoracic vertebrae 1-12 | back 22  |
front 23  study picture | back 23 look at picture |
front 24 what do the costal facets have along the vertebral bodies, except for where? what is the transverse costal facets along? except for where? | back 24 Costal facets along vertebral bodies (CF)...Pairs of inferior (ICF) and superior (SCF) on vertebrae except lower 4 thoracic vertebrae Transverse costal facets (TCF)..along transverse processes except lower 2 thoracic vertebrae...notice how T12 in pic does have a transverse costal facet |
front 25 in theory, typical ribs should articulate with what? | back 25 2 vertebrae |
front 26  show what the superior thoracic aperture and inferior thoracic aperture are? | back 26  notice how in the first picture the esophagus and trachea, nerves and BV's are popping through |
front 27 what does the superior thoracic aperture contain? what does the inferior thoracic aperture allow? | back 27
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front 28 describe what these joints articulate with?
| back 28 
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front 29 Identify/describe the joints of the anterior thorax...what are they articulations with?
| back 29  Costochondral joints...Rib articulation with costal cartilage
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front 30 Identify/describe the joints of the anterior thorax and what they articulate with?
| back 30  Interchondral joints (ICJ)...“articulation” between costal cartilages of lower ribs Manubriosternal joint (sternal angle – SA...manubrium and sternal body meet) Xiphisternal joint (XS)...junction of xiphoid and sternum |
front 31 essentially, the interchondral joints is where what articulates with what? | back 31 where the false ribs articulate with the cartilage above it |
front 32  what 3 things to assess during a PE with patterns of ventilation? what 2 things should we look for in inspiration? | back 32  Physical exam ...assess rate, symmetry, quality of movement, etc… Inspiration ...increase in AP and lateral diameter due to “bucket
handle” motion of ribs look at pictures to help visualize |
front 33  describe what the external intercostal muscles do during inhalation? what do the ribs do? what does the sternum do? what does the diaphragm do? | back 33 the external muscles contract causing the expansion of the chest cavity and an influx of air into the lungs ribs elevate sternum flares diaphragm moves inferiorly during contraction |
front 34 inspiration while at rest and not exercising involves what 2 muscles? with exercise what 3 muscles can help out with inspiration? | back 34 diaphragm and external intercostals accessory muscles like the SCM and scalenes can help...pecs can also help |
front 35 expiration while at rest and not exercising involves what? with exercise what muscles get recruited to help with expiration? | back 35
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front 36 what is one abnormal movement pattern of ventilation? who typically displays this? name another abnormal ventilation quality? when do you typically see this with? | back 36  “Shrug” shoulders...Patients with COPD and other pulmonary disease may display this type of breathing pattern Asymmetry... see this with trauma/pathology to one lung
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front 37 identify the actions of these muscles and their relationship to each other in space?
| back 37  External intercostals (E)...inspiration...most superficial Internal intercostals (I)...expiration Innermost intercostals (IM)...elevate?…not completely understood...most deep |
front 38 what is between the internal intercostals and the innermost intercostals? which muscle is on top? when looking at a picture how do you identify these muscles, what should you look for? | back 38  BV's and nerves in between them internal intercostal on top basically, look for the innermost muscle and if its muscle colored it is the innermost intercostals...if it looks like a layer was peeled and you see nerves traveling horizontal, it indicates that you are looking at the internal intercostals |
front 39  notice the external intercostal muscles | back 39 look at picture |
front 40  what muscle do you see here and how do you know? | back 40  innermost intercostals because you can see the nerve and vessels driving into the muscle indicating that you can see the innermost intercostals (you are looking inside the chest so the IM are the deepest muscles inside) |
front 41  action and location of the: transversus thoracis? subcostal muscles? | back 41  Transversus thoracis (TT) (in front)...expiration (depress
ribs)...located on internal anterior thoracic cage...in 1st
picure |
front 42  Identify/describe actions of the following muscles
basically, what do the SPS and SPI do? | back 42  Levator costarum (lc)...inspiration (elevate the ribs)...the very
small slanted muscles down the posterior spine in the 1st
pic...opposite of "/") Serratus posterior superior (SPS)...inspiration (elevates the
ribs)...on top in second picture they anchor onto the ribs and spine and either bring it up or down |
front 43 what nerve supplies the diaphragm? what 2 components does it provide? this nerve comes out of which vertebrae? | back 43 phrenic nerve (C3-C5) motor and sensory components |
front 44  the diaphragm is the major muscle of ____________? contraction will "________" the diaphragm causing _________ changes that increase what into the lungs? what is the diaphragm shaped like? name 3 regions of the diaphragm? | back 44 inspiration flatten pressure increase air into the lungs parachute sternal, costal and lumbar regions |
front 45  the phrenic nerve passes over what as it goes down to the diaphragm? notice the R and L phrenic nerve going down to attach to the diaphragm | back 45 the anterior scalene |
front 46  looking inside the diaphragm what can you see in the middle? what color is it? what does it serve as? name the 3 openings of inside the diaphragm? point them out in picture which hole opens through the central tendon? | back 46 central tendon white muscles all converge here on this central circle central tendon is the upside down C caval foramen is the big hole...opens up through the central tendon esophageal hiatus is the oval oblong hole in center and inferior aortic hiatus is the hole where you can even see part of the aorta coming through...most posterior of the 3 openings |
front 47 what passes through these openings in the diaphragm? | back 47 Openings:
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front 48 the sternal region of the diaphragm has attachments where? the costal part has attachments where? the lumbar part has attachments where? | back 48  Regions:
in picture: all regions form around the central tendon...small spot above is the sternal part...two huge kidney shapes on sides of central tendon are the costal regions...and the lumbar region is the space underneath the central tendon |
front 49  what is the: costodiaphragmatic recess (CDR)...what is it a potential site for? costomediastinal recess (CMR) | back 49 Potential pleural space located “between” the junction of diaphragm
and ribs Potential pleural space located anteriorly “between” the junction of diaphragm and mediastimum in picture you are looking from the top down...the CDR is wrapped around the 2 mickey mouse ears on the side where the ribs and diaphragm meet...the CMR is the small corners below the front circle on either side (slightly more yellow in color) |
front 50  notice how the lung doesnt go all the way down and how there is a small corner where there can be an accumulation of fluid in the CDR notice the cardiac notch in the CMR and how that can leave more space for the heart | back 50  the CDR is on the bottom of the lung in the kiddie-corner the CMR is seen when you look down on the diaphragm from the top and see a small space in front |
front 51 _______ thoracic spinal nerves exit the spinal IVF? what supplies the intercostal spaces? what is the spacial relationship of these things that enter the intercostal space? | back 51 12 “VAN” – vein, artery, nerve bundle entering the intercostal space (from top to bottom) |
front 52  what are these nerves that are going horizontal? follow how it curves around and notice how it splits and then goes to the front and back | back 52 intercostal nerves |
front 53  what is herpes zoster? another name for it? what do you get/features? where is it very common? where else can you see it? | back 53 its a dormant virus in a single segmental nerve that will become active later on in life painful, red, vesicular lesion in dermatome pattern Shingles very common in thoracic region but is not limited to
thoracic region |
front 54 
| back 54 aorta and subclavian artery Anterior and posterior intercostal arteries notice how branches from the aorta go around and supply the rib cage the internal thoracic artery |
front 55  look at picture | back 55 study picture |
front 56 Identify/describe the intercostal artery pathway?
| back 56 superior aspect inferior inferior |
front 57  go back and rememeber the subclavian artery and how it had the VA, the thyrocervical trun and the costocervical trunk.....one branch from the costcervical trunk that went up to the skull was the deep cervical artery....what is the branch of this trunk that goes down? what then branches from the artery? | back 57  the supreme intercostal artery the 1st and 2nd posterior intercostal arteries notice the subclavian, the costcervical trunk and the deep cervical artery and the supreme intercostal artery...then notice how it splits off into 2 branches under the clavicle |
front 58 the 3rd through the 11th intercostal arteries branch off from what? notice it in the picture? | back 58  from the aorta |
front 59 Posterior intercostal arteries:
| back 59  the 11 intercostal spaces subcostal artery the 12th rib notice how in the picture you can see the subcostal artery down below the ribs as it branches from the aorta |
front 60 Anterior intercostal arteries:
| back 60 internal thoracic artery
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front 61  the internal thoracic artery comes from the ____________ vein and then runs behind the anterior ________? | back 61 subclavian vein anterior sternum notice the internal thoracic artery coming down right near the sternum |
front 62  The Anterior intercostal arteries supply which intercostal spaces?
| back 62 1-9 posterior intercostal arteries notice how the intercostal arteries run superior and inferior in the intercostal spaces |
front 63  look at all the arteries and their relationship | back 63  |
front 64  look at how the posterior intercostal arteries come from the back and wrap around the intercostal spaces from the back | back 64 look at picture |
front 65 what artery may be used as a bypass graft? | back 65 the left internal thoracic artery |
front 66 the intercostal spaces are drained via what? | back 66 via the intercostal veins |
front 67 Intercostal veins drain __________ into azygos system and ________ into internal thoracic veins? so overall the intercostal veins are coming back towards the center (arteries go out latterally) and go inside what? | back 67 posteriorly anteriorly the azygos vein |
front 68  point out the azygos vein, the accesorry hemi-azygos vein and the hemi-azygos vein? | back 68 the azygos vein is on the right side under the big "faucet" going up you can see a divit on the left side where the accessory hemi and hemi azygos travel behind and into the right side the accessory hemi-azygos vein is the vein on the left side connecting the intercostal spaces from above the divit (on top) the hemi-azygos vein is below the divit (on bottom) |
front 69  overall, the "azygos system":
| back 69 the back & thoracoabdominal walls azygos, hemi-azygos and accessory hemi-azygos veins trunk and lower extremities the IVC (inferior vena cava) |
front 70  accessory hemi-azygos vein:
| back 70 left side 5th - 8th the azgos vein left brachiocephalic vein look at picture |
front 71 hemi-azygos vein:
| back 71 left side 9th - 11th intercostal spaces abdominal/pelvic trunk and lower extremity azgos vein look at picture |
front 72 how is the lumbar veins a plan B? | back 72 they are a plan B in case there is some sort of obstruction in the inferior vena cava (look at ascending lumbar vein in picture) |
front 73 what do the right and left common illiac veins take care of? | back 73 the legs |
front 74 azygos vein: | back 74 right side intercostals hemiazygos & accessory hemiazygos veins also receives blood from right abdominal/pelvic trunk and lower extremity SVC (superior vena cava) notice how it gets blood from the hemi azygos and accessory azygos and how it travels up into the SVC |
front 75  describe whats in the intercostal spaces from superior to inferior? These travel in intercostal space together just ________ to rib
| back 75
inferior superior notice in picture how the vein artery and nerve (VAN) is just below the rib and then more down in the intercostal space just above the rib are the collateral vessels |
front 76  vein, artery and nerves are located just ______ each rib? what is a thoracentesis? what do you want to avoid when you insert the needle? overall, where do you wanna put the needle? | back 76 below
put the needle on the superior margin of the rib...avoids hitting the VAN's |
front 77  the bronchial arteries come from where? what will you commonly see with these? | back 77 from the aorta you will see them coming from variable pathways from the aorta |
front 78  in this person, what bronchial arteries can you point out? | back 78 you can point out the right bronchial artery and then on the other side, the left superior bronchial artery and the left inferior bronchial artery both going to the same bronchi tube on bottom |
front 79  Bronchial veins:
| back 79 azygos vein accessory azygos vein in picture, you can see the azygos vein on the left and the small vessel (right bronchial vein) draining into the azygos on the other side you see the small left bronchial vein draining into the accessory hemi-azygos |
front 80  pulmonary circulation: how many pulmonary veins are there? show the pulmonary trunk, 2 pulmonary arteries and 4 pulmonary veins in the picture? | back 80 4....2 on the right and 2 on the left big blue tube in middle is the pulmonary trunk...two blue pathways going in either direction from this are your right and left pulmonary arteries...then you can see the 4 little red vessels coming in from the sides going back to the heart (pulmonary veins) |
front 81 briefly summarize the pulmonary circulation | back 81
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front 82  notice the hilum of the lungs and the pulmonary trunk and the superior and inferior vena cava and the aortic arch | back 82 look at picture |