Anatomy Topic 2 Case 1 Flashcards
- Surface Anatomy of the Thorax - Muscles of the Chest Wall - Thorax, its associated bones, joints and ligaments - Neurovascular Supply of the Thorax - Diaphragm
At which vertebral level is the jugular notch located?
- TII
The costal cartilage of which rib articulates with the sternum at the level of the sternal angle?
- Rib 2
What occurs at the vertebral level TIV/V?
- Costal cartilage of rib 2 articulates with sternum
- Superior mediastinum is separated from the inferior mediastinum
- Arch of the aorta begins
- Thoracic aorta begins
- Trachea bifurcates
What is the origin of the sternocleidomastoid?
- Sternal head, upper part of anterior surface of manubrium of sternum
- Clavicular head, superior surface of medial one third of clavicle
What is the insertion of the sternocleidomastoid?
- Sternal head, lateral one-half of superior nuchal line
- Clavicular head, lateral surface of mastoid process
What is the innervation of the sternocleidomastoid?
- Accessory Nerve [CNXI)
- Anterior Rami of C2, C3 and C4
What is the function of the sternocleidomastoid?
- Tilt head towards shoulder on same side
What is the origin of the anterior scalene?
- Anterior tubercles of transverse processes of C3 to C6
What is the insertion of the anterior scalene?
- Scalene tubercle and upper surface of rib 1
What is the innervation of the anterior scalene?
- Anterior rami of C4 to C7
What is the function of the anterior scalene?
- Elevation of rib 1
What is the origin of the middle scalene?
- Transverse processes of vertebrae C3 to C7
What is the origin of middle scalene?
- Upper surface of rib 1
What is the innervation of the middle scalene?
- Anterior rami of C3 to C7
What is the function of the middle scalene muscle?
- Elevation of rib 1
What is the origin of the posterior scalene?
- Posterior tubercles of transverse processes of C4 to C6
What is the insertion of the posterior scalene?
- Upper surface of rib 2
What is the innervation of the posterior scalene?
- Anterior rami of C5 to C7
What is the function of the posterior scalene?
- Elevation of rib 2
Identify three functions of the thorax
- Breathing
- Protection
- Conduit
What are the anterior, lateral and posterior margins of the superior thoracic aperture?
- Anterior: Manubrium
- Lateral: Rib 1
- Posterior: Vertebra T1
What are the anterior, anterolateral, posterolateral and lateral margins of the inferior thoracic aperture?
- Anterior: Xiphoid Process
- Anterolateral: Ribs 7-10
- Posterolateral: Ribs 10-12
- Posterior: Vertebra T12
What are the anterior, posterior and lateral margins of the thoracic wall?
- Anterior: Sternum
- Lateral: Ribs
- Posterior: Thoracic Vertebra
Identify the three articulations of each rib to the vertebral column
- Head: Facet to its own vertebral body and body above
- Angle: Transverse process of its own vertebra
What is a true rib?
Identify the true ribs
- Articulate with sternum
- Ribs 1 - 7
What is a false rib?
Identify the false ribs
- Articulate with costal cartilage above
- Ribs 8 - 10
What is a floating rib?
Identify the floating ribs
- No anterior connection
- Ribs 10 - 12
Describe the head of a rib
- Two articular facets
- Smaller superior facet for articulation with above rib
- Larger inferior facet for articulation with its own rib
Describe the neck of a rib
- Short flat region
- Separating the head from the tubercle
Describe the tubercle of a rib
- Between the neck and shaft
- Articulates with a facet on the transverse process of its own vertebrae
Why is Rib 1 considered an atypical rib?
- Flat in transverse plane
- Single facet
- Scalene tubercle (anterior by scalene vein, posterior scalene artery)
Why is Rib X considered an atypical rib?
- Single
Why are ribs XI and XII considered atypical ribs?
- Single facet
- No tubercles or necks
- Short and little curve
- Pointed anteriorly
Identify four bony landmarks of the manubrium of the sternum?
- Jugular notch
- Fossa for articulation with clavicle
- Facet for articulation with first costal cartilage
- Demi-facet for articulation with superior aspect of second costal cartilage
Identify four bony landmarks of the body of the sternum
- Transverse ridges
- Demi-facet for articulation with inferior aspect of second costal cartilage
- Four facets for articulation with ribs 3 - 6
- Demi-facet for articulation with the superior aspect of seventh costal cartilage
At which vertebral level is the xiphoid process located?
- T10
How does the xiphoid process differ in children and adults?
- Cartilaginous structure at birth
- Which becomes ossified in the adult
Identify one bony landmark on the xiphoid process
- Demi-facet for articulation with inferior aspect of seventh costal cartilage
Pump handle changes the dimensions of the thorax in which dimension?
- Anteroposterior dimension
Bucket handle changes the dimensions of the thorax in which dimension?
- Lateral dimension
Which types of movement do the costovertebral joints facilitate?
- Rotation in the upper ribs
- Ascension / descension, relative to vertebral column, in the lower ribs
Where are costotransverse joints located?
- Between tubercle of rib and the transverse process of its own vertebrae
Identify the three ligaments that support the costotransverse joints?
- Costotransverse ligament, medial to the joint
- Lateral costotransverse ligament, lateral to the joint
- Superior costotransverse ligament, attaches from transverse process of vertebra above
Where are the sternocostal joints located?
- Between the upper seven costal cartilages and the sternum
What type of joints are the sternocostal joints?
- Rib 1: Cartilaginous
- Ribs 2-7: Synovial
The sternocostal joint of which rib is divided into two compartments by an intra-articular ligament?
- Rib 2
Where are the interchondral joints located?
- Between ribs 8 to 10
What type of joints are the interchondral joints?
- Synovial joints
Identify two additional joints associated with the sternum
- Manubriosternal joint
- Xiphisternal joint
Describe the layers between the lung and skin from deep to superficial
- Visceral pleura
- Pleural cavity
- Parietal pleura
- Endothoracic fascia
- Innermost intercostal muscle
- Internal intercostal muscle
- External intercostal muscle
- Serratus anterior muscle
- Superficial fascia
Where are the intercostal vessels located?
- Costal groove
- Which is located between the innermost and internal intercostal muscles
- Vein is superior to artery which is superior to nerve
How many pairs of external and internal intercostal muscles are there?
- 11
The external intercostal muscles are most active during which process?
- Inspiration
Identify the superior and inferior attachments of the external intercostal muscles
- Inferior surface of rib above to superior margins of rib below
In which direction do the external intercostal muscles pass
- Obliquely in an anteroinferior direction
Identify the superior and inferior attachments of the internal intercostal muscles
- Inferior surface of rib above to superior margins of rib below
In which direction do the internal intercostal muscles pass
- Obliquely in a posteroinferior direction
The internal intercostal muscles are most active during which process?
- Expiration
Where do the anterior intercostal arteries arise from?
- Lateral branches of internal thoracic arteries
which descend vertically along the anterior thoracic wall
Identify the two terminal branches of the internal thoracic arteries?
- Superior epigastric artery
- Musculophrenic artery
Anterior intercostal arteries that supply the upper six intercostal spaces arise as lateral branches of which artery?
- Internal thoracic artery
Anterior intercostal arteries that supply the lower six intercostal spaces arise as lateral branches of which artery?
- Musculophrenic artery
The upper two posterior intercostal arteries are derived from which artery?
- Supreme intercostal artery
The lower nine pairs of posterior intercostal arteries are derived from which artery?
- Thoracic aorta
The posterior intercostal veins on the left side come together to form which vein?
Where does this vein drain?
- Left superior intercostal vein
- Left brachiocephalic vein
The posterior intercostal veins on the right side come together to form which vein?
- Right superior intercostal vein
- Azygos vein
Where do intercostal nodes in the upper thorax drain?
- Bronchomediastinal trunk
Where do intercostal nodes in the lower thorax drain?
- Thoracic duct
Where do superficial nodes of the thoracic wall drain?
- Axillary nodes
What are the intercostal nerves?
Where are they located?
- Anterior rami of T1 to T11
- Intercostal spaces
What is the subcostal nerve?
- Anterior rami of T12
- Inferior to rib 12
The lateral cutaneous branch divides into which branches?
- Anterior and posterior cutaneous branches
- Which supply the skin of the thoracic wall
Which nerve contributes to the brachial plexus?
- Anterior rami of T1
Which nerve contributes to cutaneous innervation of the of the medial surface of the upper arm?
- Intercostobrachial nerve
Lateral cutaneous branch of second intercostal nerve
Identify 3 attachments of the diaphragm
- XIphoid process
- Costal margins
- Ends of ribs XI and XII
Where do muscle fibres of the diaphragm converge?
- Central tendon
Where does the inferior vena cava pass through the diaphragm?
- Central tendon (T8)
Where do the phrenic nerves pass through the diaphragm?
- Central tendon (T8)
How does the oesophagus enter the abdominal cavity?
- Posterior to the diaphragm
- Oesophageal hiatus (T10)
Where does the vagus nerve pass through the diaphragm?
- Oesophageal hiatus (T10)
Where does the aorta pass through the diaphragm?
- Aortic hiatus (T12)
Where does the thoracic duct pass through the diaphragm?
- Aortic hiatus (T12)
Where does the azygos vein pass through the diaphragm?
- Aortic hiatus (T12)
Why is the left dome higher than the right dome?
The left dome reaches as high as which rib?
- Liver
- Rib 5
Identify four arteries that supply the diaphragm
- Pericardiacophrenic
- Musculophrenic
- Superior phrenic
- Inferior phrenic
The veins that drain the diaphragm drain into which vessels?
- Brachiocephalic veins
- Azygos system
- Inferior Vena Cava
- Left Suprarenal Vein
Which nerve innervates the diaphragm?
- Phrenic Nerve
- C3, C4 and C5
Identify the superior, inferior and medial boundaries of each pleural cavity
- Superiorly, above rib 1
- Medially, mediastinum
- Inferiorly, just above costal margin
Which type of cells line the pleural cavities?
- Mesothelium
What is contained within the pleural space?
- Serous fluid
What is the important of pleural recesses?
- Accommodate changes in lung pressure during breathing
Which functional division of the nervous system innervates the parietal pleura?
- Somatic
Which functional division of the nervous system innervates the visceral pleura?
- Autonomic
