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Anatomy > Chest Wall > Flashcards

Chest Wall Flashcards

1
Q

How many ribs do humans have?

A

24 (12 pairs - 1 on either side)

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2
Q

Where are the intercostal spaces?

A

Space between ribs

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3
Q

Name the 3 regions of the sternum.

A

-Manubrium
-Body
-Xiphoid process

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4
Q

Label this image of the sternum.

A
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5
Q

What is the jugular notch of sternum?

A

Midline of sternum - @ inferior/base aspect of neck - between sternal ends of clavicles (each side)

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6
Q

What are clavicular notches of sternum?

A

Where clavicle joins to sternum

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7
Q

What are costal notches of sternum?

A

Where ribs join to sternum

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8
Q

How many costal notches are there on either side of sternum?

A

7

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9
Q

Why are there only 7 costal notches on either side of sternum, but 12 ribs?

A

-Ribs 1-7 join directly to sternum via costal notches
-Ribs 8-10 join to costal notch of rib 7 - as ribs 7,8,9,10 share the same costal cartilage
-Ribs 11-12 = floating ribs - don’t articulate/join w/ sternum

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10
Q

What lines up with the second costal notch of sternum?

A

Between manubrium & body of sternum - sternal angle

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11
Q

Where is the sternal angle of sternum?

A

Between manubrium & body - T4/5

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12
Q

What is the name of the opening of the thoracic cage cavity?

A

Thoracic inlet/superior thoracic aperture

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13
Q

Role of the thoracic cage?

A

Protects underlying viscera & some superior viscera - of abdominal cavity

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14
Q

Facts about the manubrium of sternum?

A

-@ T3 & T4 vertebral bodies
-Thickest of sternum components
-Palpable landmark = jugular notch

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15
Q

Label this image of a ‘typical’ rib.

A
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16
Q

Which ribs are true ribs?

A

1-7

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17
Q

What are true ribs?

A

Connect directly to the sternum via ‘their own’ costal cartilages

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18
Q

Which ribs are false ribs?

A

8-10

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19
Q

What are false ribs?

A

Connects indirectly to sternum via costal cartilages of 7th rib

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20
Q

Which ribs are floating ribs?

A

11-12

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21
Q

What are floating ribs?

A

-Distal end has no attachment to sternum
-No costal cartilage
-Have a free anterior border

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22
Q

What does the head of a rib articulate with?

A

-2 successive thoracic vertebrae - superior & inferior demifacets of successive thoracic vertebrae
-Except: Ribs 1, 10, 11, & 12 = articulate with 1 vertebra

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23
Q

What part of rib articulates with thoracic vertebra?

A

= Facets - of head
-Superior = joins rib to superior vertebra
-Inferior = joins rib to inferior vertebra

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24
Q

What joins to anterior surface of ribs 1-7?

A

Costal cartilage - for articulation with sternum

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25
Q

What does the tubercle of the rib articulate with?

A

-Thoracic vertebra (transverse process) - of associated vertebra - no. same as no. of rib
-Except: Ribs 11 & 12 have NO transverse process articulation (floating ribs)

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26
Q

What does the neck of the rib join together?

A

Joins head to body/shaft of rib

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27
Q

Where is the costal groove on a rib?

A

Inferior surface - an indentation/depression here

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28
Q

Role of costal groove on rib?

A

Gives space for intercostal vein, artery, nerve (VAN) - intercostal neurovascular bundle - to run

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29
Q

Which vertebra would e.g., ribs 5 articulate with & why?

A

-Transverse process of vertebra 4 & 5 - as the head of rib has sup & inf facets
-This is for all x12 ribs (all ribs join to vertebra but only 10 join to sternum)

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30
Q

Label this image of a ‘typical’ rib.

A
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31
Q

What is the ‘bucket’ analogy in relation to the ribs?

A

Handle is fixed at either end - ant & post - like ribs are fixed ant to sternum (1-10) & post to vertebral column
–> so ribs can only move sup/post

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32
Q

What are the thoracic muscles?

A

-Intercostals
*External
*Internal
*Innermost
-Internal oblique
-External oblique
-Transversus thoracis
-Rectus abdominus
-Subclavius muscle

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33
Q

Role of external intercostal muscles?

A

In inspiration = move each rib up - to inc. vol in thorax
I -> E
E -> I

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34
Q

Direction of external intercostal muscle fibres?

A

Inferomedial (hands in pockets) = \\

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35
Q

Role of internal intercostal muscles?

A

In expiration = pulled in to dec. vol in thorax
I -> E
E -> I

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36
Q

Direction of internal intercostal muscle fibres?

A

Superomedial (hands in back pockets) - 90 degrees to external intercostal but same as innermost intercostal

37
Q

Role of innermost intercostal muscles?

A

Help w/ expiration & inspiration

38
Q

Direction of innermost intercostal muscle fibres?

A

Superomedial (hands in back pockets) - 90 degrees to external intercostal but same as internal intercostal

39
Q

Role of transversus thoracis?

A

Helps to depress ribs (as are joined to ribs)

40
Q

Role of subclavius muscle?

A

-Moves clavicles inferior
-Protects subclavian muscles below

41
Q

How many intercostal spaces are there, & why?

A

11 - as are 12 ribs - is only 11 ‘gaps’ between adjacent ribs!

42
Q

What is found in intercostal spaces?

A

*Intercostal neurovascular bundle (VAN)
-Intercostal vein (post)
-Intercostal artery (post)
-Intercostal nerve
*Intercostal muscles

43
Q

If rib 12 only articulates with rib 11, what does this mean for its structure?

A

Only has one facet on head - & has no costal groove or angle

44
Q

Where exactly is the intercostal neurovascular bundle?

A

-Between innermost & internal intercostal muscles
-In costal groove of ribs (protects VAN)

45
Q

Which label indicates the location of the thoracic outlet?

A

B

46
Q

What is the thoracic outlet?

A

The lower opening of the thoracic cavity & its edges are the lowermost ribs
-Is closed by the diaphragm, which separates the thoracic cavity from the abdominal cavity

47
Q

Which label indicates the location of the thoracic inlet?

A

A

48
Q

What is the thoracic inlet?

A

AKA = superior thoracic aperture
-Is the upper border of the 1st rib pair, the upper border of manubrium of sternum and the anterior border of vertebral body T1

49
Q

Name three structures that pass between the thorax and neck through the superior thoracic aperture.

A

-Trachea - to breath
-Oesophagus - to get to stomach for digestion
-Vascular supply and venous drainage - are several arteries & veins which pass through the inlet & nerves & lymphatics

50
Q

Label this image on the anatomy of the intercostal space.

A

A = Posterior intercostal vein
B = Posterior intercostal artery
C = Innermost intercostal muscle (often v. thin & lies deep to intercostal neurovascular plane)
D = Collateral intercostal vein (lies in a ‘neurovascular plane’ between internal & innermost intercostal muscles)
E = Internal intercostal muscle
F = External intercostal muscle

51
Q

Label this image of a ‘typical’ rib.

A

A = Head (posterior & articulates between 2 adjacent vertebrae)
B = Angle of rib (= its point of greatest curvature)
C = Costal groove (VAN here)
D = Shaft/body (flat &curved)
E = Neck (between head & tubercle posteriorly)
F = Tubercle (articulates w/ a facet on transverse process of corresponding vertebral body)

52
Q

What is F?

A

Costal margin

53
Q

Where in the intercostal space is the neurovascular bundle located and what are the consequences of this when inserting a chest drain?

A

-Neurovascular bundle = in costal groove - between innermost & internal intercostal muscles
-When inserting chest drain - must avoid neurovascular bundle
-Image shows what often call ‘above the rib below’ = means at the correct intercostal space you should go to the superior border of the lower rib

54
Q

Label the structures A-E in this cross section of the thorax.

A

A = Sternum (manubrium - as body would be smaller & more rectangular)
B = Internal intercostal muscle (between ribs & is more internal - on inside of rib cage than external intercostal muscle)
C = Transverse process of thoracic vertebra
D = Body of thoracic vertebra
E = Spinous process of thoracic vertebra

55
Q

What is the name of the membrane deep to the innermost intercostal muscle called?

A

Endothoracic fascia

56
Q

What is the order of the components of the intercostal neurovascular bundle?

A

VAN

57
Q

How does ultrasound work?

A

-Piece of crystal releases high frequency sound waves into body - then sent back to probe = image on screen
-Ultrasound jelly forms interface between probe & skin

58
Q

What must be aligned when doing ultrasound?

A

Align probe w/ screen

59
Q

What will you see in ultrasound of intercostal space?

A

-Pleura = brightest white line - pleura will continue behind ribs - but ultrasound can’t show due to high density of ribs (wave can’t pass through)
-Pleural memb = parietal pleura - lines chest wall
-Lungs under pleura
-Costal groove on post surface on inf part of rib

60
Q

What are typical ribs?

A

Follow similar pattern to one another

61
Q

What are atypical ribs?

A

Do not follow set structures - not similar to others

62
Q

Number of ribs & number of thoracic vertebra?

A

12 of both

63
Q

Direction of ribs from vertebrae to sternum?

A

Slope inferiorly (around thoracic cavity)

64
Q

Label this image of a vertebra.

A
65
Q

Label this image of a vertebra.

A

A = Superior costal/demi facet
B = Thoracic vertebral body
C = Inferior costal/demi facet
D = Inferior articular facet
E = Spinous process
F = Facet for rib articulation on the transverse process
G = Superior articular facet

66
Q

What does the head of each rib articulate with on the vertebra?

A

Head of each rib articulates with 2 vertebral body, one at the same level and one above it. For example, rib 6 articulates with Thoracic vertebral body (T6) and also T5 below
So, articulates with:
-Superior costal/demi facet
-Inferior costal/demi facet
(Except rib 12 - only has 1 costal/demi facet)

67
Q

Label this image of a vertebra.

A

A = Thoracic vertebral body
B = Pedicle (small process which connects vertebral body to neural arch, is thicker than lamina)
C = Transverse process (has a facet which articulates with the rib tubercle of the corresponding rib)
D = Lamina (between spinous process & transverse process - so each vertebra has left lamina & right one)
E = Spinous process (in thoracic region = oriented inferiorly)
F = Vertebral canal & the spinal cord runs through this canal

68
Q

Which parts of rib articulate with the:
-Superior costal/demi facet
-Inferior costal/demi facet

A

Both = articulate with head of rib - superior one with lower no. vertebrae - above & inferior one with higher no. vertebra - below

69
Q

What muscles on the model are accessory muscles of respiration?

A

-Internal intercostal muscles = act to depress the ribs
-Innermost intercostal muscles = act to depress the ribs
-External intercostal muscles CAN be considered accessory
(Sometimes - diaphragm is considered the only true muscle of respiration)

70
Q

True or false? The External Intercostal muscles continue anteriorly to attach to the sternum.

A

False! It is the aponeurosis that attaches to the sternum

71
Q

What muscles are immediately deep to the External Intercostal muscles?

A

The internal intercostal muscles

72
Q

What nerve innervates the diaphragm?

A

The phrenic nerve (C3 – 5)

73
Q

What is the function of the diaphragm during respiration?

A

As the diaphragm contracts, it flattens out to increase the volume of the thoracic cavity, decreasing the pressure = draws air into the lungs down a pressure gradient

74
Q

What is the order of the intercostal muscles from superficial to deep?

A

The external, the internal, the innermost

75
Q

In what direction do the fibres of the Internal Intercostal muscles travel?

A

Superomedially (or ‘hands on chest’)

76
Q

True or false? The Innermost Intercostal muscles pass in the same direction as the Internal Intercostal muscles.

A

True(ish)!

77
Q

Which muscles do the intercostal neurovascular bundles travel between?

A

The internal and innermost intercostal muscles

78
Q

What feature of the rib is the intercostal neurovascular bundle most associated with?

A

The subcostal groove – the neurovascular bundle is tucked into this groove to provide protection

79
Q

What muscles on the model are accessory muscles of respiration?

A

-Pectoralis major
-Pectoralis minor
-Subcostal muscles
-Transversus thoracis
-Subclavius muscles
-External intercostal muscles
-Internal intercostal muscles
-Innermost intercostal muscles

80
Q

How is inspiration caused?

A

-External intercostal muscles = contract
-Internal intercostal muscles = relax
-Innermost intercostal muscles = relax

= vol of thorax increases

81
Q

How is expiration caused?

A

-Internal intercostal muscles = contract - depresses ribs
-Innermost intercostal muscles = contract - depresses ribs
-External intercostal muscles = relax

= vol of thorax decreases

82
Q

Label this image of a typical vertebra.

A
83
Q

Label this image of a typical vertebra with all the facets and what they articulate with.

A
84
Q

What is a typical rib - which are they?

A

Ribs with usual features - 3,4,5,6,7,8,9

85
Q

What is an atypical rib - which are they?

A

Ribs with unusual features 1,2,10,11,12
-Rib 1 = flat & has distinct tubercles & grooves
-Rib 10 = only 1 articular facet on it’s head
-Ribs 11 & 12 = floating ribs

86
Q

What would a typical rib articulate with e.g., rib 7?

A

*Superior articular facets - w/ vertebra above = 6
*Superior demi facet - w/ head of rib (@ same level) = 7
*Inferior demi facets - w/ head of rib (@ same level) = 8
*Inferior articular facet - w/ vertebra below = 8 - this is the connection of vertebra not ribs!!!
*Facet - w/ tubercle of rib (@ same level) = 7

87
Q

What is the costotransverse joint between?

A

The facet of the tubercle of a rib & the adjacent transverse process (of a thoracic vertebra)

88
Q

What is the costovertebral joint between?

A

-Connects ribs to vertebral column
-Articulation of head of rib - connects head of rib to bodies of the thoracic vertebrae

Anatomy (21 decks)

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