X

Board Review Series Gross Anatomy (pain, pressure, touch, temperature)

THORAX

Neurons
Nerves - motor, sensory
- somatic (voluntary), visceral (involuntary)
preganglionic sympathetic neurons; X – motor neurons; * sensory neurons

Filum Terminale

31 Pairs of Spinal Nerves

Intercostal Nerves

30 Dermatomes
Segmental Innervation
Intercostal Nerve Block
Herpes Zoster

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 T2

T4-T5

T9

Autonomic Nervous System

2 neuron chain
Thoracolumbar outflow – Sympathetic
Craniosacral outflow – Parasympathetic
Visceral Afferents
Pain travel with sympathetics
Monitoring travel with parasympathetic
Referred Pain – somatic/visceral afferents
relay information to same
segment of spinal cord

Frequent Site
Of Fractures

Costal Groove
begins at angle of rib

Anastomotic Connections
Coarctation of Aorta

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 24 Presacral Vertebrae
Synovial Joints
Intervertebral Discs
Curvatures
Primary (thoracic, sacral)
Secondary (cervical, lumbar)
Kyphosis
Lordosis
Scoliosis

Prevents Hyperextension
Posterior Longitudinal Ligament
Prevents Hyperflexion

Nucleus Pulposus

Annulus Fibrosus

Lamina

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 Spinal Nerve

Dura Mater
Meningitis: Infections (of pia and arachnoid) reach meninges
via blood vessels in choroid plexus or via valveless
venous plexi or via nasal mucosa Arachnoid Mater
Vertebral Level L2 in adults
Pain due to increased intracranial pressure, stretching L3 in children
of meninges and stimulation of afferent fibers of
Cr. V3 Dorsal Roots

Lumbar Cistern L2 – S2 Denticulate Ligament

Spinal tap in adults: L3 – L4
Ventral Roots
Spinal tap in child: L4 – L5 Ventral Roots

Pia Mater

(normal drainage route)

Valveless Plexus
Spread of Infection to
Dural Venous Sinuses

*Spinal cord injuries are the

most severe and frequent in the
cervical region.

Pleurisy – pain referred over

shoulder (Phrenic N.)

Most true“pain” associated with

the lungs is usually associated with
the pleura.
Costodiaphragmatic Recess

Multiple Potential Physical Effects of Spinal Cord Injuries

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 T2 – T4

T5 – T7
4th costal cartilage Left Lung

6th costal cartilage

(Anatomic Base)
Right Lung Clinical Base

4th – 5th
Intercostal Space

Primary Bronchus

Secondary Bronchus

Tertiary Bronchus (bronchopulmonary

segment)
Bronchiole

Terminal Bronchiole

Respiratory Bronchiole

Alveolar Ducts

Alveolar Sacs

Relative position of left recurrent laryngeal nerve

SVC)

Enlarged lymph nodes:

-shortness of breath
-deviation of carina •Also receive
-unexplained hoarseness drainage from inferior LEFT lobe

Superior Vena Cava Syndrome

Bronchogenic carcinoma (tumor derived from mucosal epithelium)
~ compress trachea = dyspnea
~ hoarseness = recurrent laryngeal nerve
~ constricted pupil, anhydrosis, ptosis = compression of stellate ganglion

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Parasympathetics – constriction of smooth muscle;
secretory activity of glands
Sympathetics – vasculature
Visceral Afferents – Vagus (irritant, juxta-capillary
stretch receptors)
Pain – associated with parietal pleura

Metastatic Spread
Retromammary Space
Ligaments of Cooper
Peau d’Orange

To Inferior Deep
Cervical Nodes

Landmark for levels of lymph nodes

Pectoralis minor muscle
1 = lateral
2 = deep
3 = medial

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Azygos venous system can
serve as an alternative pathway
for venous return when IVC
is blocked.

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Thoracic Splanchnic Nerves
Contain:
Preganglionic sympathetics
Visceral afferents

Esophageal Plexus – vagal trunks

Relationship of Fibrous
Pericardium to Pleurae

Pericarditis
Cardiac Tamponade
Pericardiocentesis

Relationship of Phrenic Nerves

to Fibrous Pericardium
(pleuropericardial folds)

Relationship of Esophagus to
Transverse Sinus and Left Atrium

Transverse and Oblique Sinuses as landmarks

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 Heart Murmurs
Intensity, Pitch, Timing
Causes:
Disease
Congenital Defects
Papillary Muscle Dysfunction
Rupture of Chordae Tendineae

Base of Heart

“Dominant” Coronary
Artery

Apex of Heart

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 Relationship of Conducting System
to the Interventricular Septum

Parasympathetics – decrease heart rate; reduce

force of beat
Sympathetics – increase rate and force of heart beat;
increase flow in coronary vessels
Visceral Afferents – Vagus: monitor cardiac output
blood pressure, blood chemistry
Pain: travels with sympathetics;
referred over dermatomes T1 - T5.

Baroreceptors in pulmonary vv monitor cardiac output

and blood pressure Example of defective transmission of impulse from SA node
Chemoreceptors in aortic body monitor blood chemistry is atrial fibrillation due to atrial enlargement secondary to
rheumatic fever and mitral valve stenosis = irregularly irregular tachycardia with systolic murmur and shortness of breath

Go For It !

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