Bones of the thorax

Question 1

Label the following diagram:

Answer 1

Question 2

How many ribs are there and what are their classifications?

Answer 2

12 pairs

1-7 are true ribs as they reach the sternum

8-10 are false ribs as they reach the costal cartilage above

11 and 12 are floating as they lack anterior attachment

Question 3

What structures do the ribs articulate with?

Answer 3

Vertebral column via head and tubercle

Costal cartilages

Question 4

Palpate the jugular notch

Answer 4

Depression on the upper border of the manubrium, between medial ends of clavicles

Question 5

Palpate the sternal angle (of Louis) and describe its significance

Answer 5

Run your index finger from jugular notch downwards until a blunt ridge is felt at the manubriosternal joint

At the sternal angle (T4/5):

trachea bifurcates

aortic arch begins and ends

2nd costal cartilage attaches

Question 6

Palpate the 2nd costal cartilage

Answer 6

Palpate lateral to sternal border at sternal angle

Question 7

Palpate the 2nd intercostal space

Answer 7

First, overlay your finger along the 2nd costal cartilage

Then, move it inferiorly into the 2nd intercostal space

Then you can overlay the finger along the third costal cartilage, etc.

Question 8

Where is the base of the female breast?

Answer 8

It extends vertically between 2nd and 6th ribs

Question 9

Where is the xiphisternum?

Answer 9

T9

Flexible cartilage at the lower end of sternum, may ossify in old age

Question 10

What is the costal margin and how may it be identified?

Answer 10

Lower limit of thoracic cage

Ask subject to lie supine, and relax abdomen by flexing the thigh and knee

Laterally, the lowest border of costal margin is the 10th costal cartilage (L2)

Question 11

How may rectus abdominis be seen/palpated, and what are its attachments?

Answer 11

The lateral border of rectus abdominis muscle meets the costal margin at the tip of the 9th costal cartilage (L1)

The outline of the rectus abdominis can be seen/palpated if the supine subject is asked to raise his/her fully extended lower limb, by flexing the hip joint

Question 12

Palpate the spine of C7

Answer 12

Ask the subject to flex the neck

First palpable spine at the root of neck

C7 = vertebra prominens

Spine of T1 can then be palpated below

From C7, the spines of thoracic vertebrae can be palpated but it is not always easy to keep track beyond T5 or T6

The tips of the thoracic spines lie about one space below their body

Question 13

What are the bony landmarks for T2, T3 and T7?

Answer 13

Superior angle of scapula- at the level of T2 spine

Spine of scapula- medial end at the level of T3 spine; laterally the spine ends at acromion

Medial border of scapula (the entire medial border is palpable)

Inferior angle of scapula- at the level of T7 spine

Question 14

Palpate the trachea

Answer 14

Stand facing the subject, who should be sitting over the edge of the couch

Palpate with index finger from the jugular notch

The trachea extends from lower part of larynx into the thorax, ending at sternal angle

It lies in the midline of the neck and is palpable along most of its length

Any significant deviation from the midline position indicates a pathological process in the lung or mediastinum

It is therefore vital to establish its position accurately at the jugular (suprasternal) notch