Lecture 1: Thoracic wall

Question 1

What four components make up the bony rim of the superior thoracic aperature?

Answer 1

T1 body Rib 1 Manubrium Jugular notch?

Question 2

What two things do structures passing between the thorax and upper limb pass over?

Answer 2

Grooves for subclavian vein and artery, separated by scalene tubercle.

Question 3

What structure attaches to the margins of and close off the inferior thoracic aperture?

Answer 3

Diaphragm

Question 4

What are the medial and lateral branches that supply the breast tissue?

Answer 4

• Medial mammary branches from INTERNAL thoracic art. - Lateral mammary branches from lateral thoracic art.

Question 5

What nerve innervates the nipple specifically?

Answer 5

Fourth thoracic intercostal nerve i.e T4 level

Question 6

What are the primary and secondary lymphatic drainage sites for the breast?

Answer 6

Axillary lymph nodes (75%) Parasternal lymph nodes (rest)

Question 7

What are the features of a typical rib?

Answer 7

• Head (3 articulations) - Tubercle (articulation and costotransverse lig) - Costal angle - Costal groove (int. inf. protects intercostal vessels +nerves)

Question 8

What features are found on rib one?

Answer 8

The SCALENE tubercle separates the two grooves on the surface of rib one. Anterior groove for: Subclavian vein Post groove for: Subclavian artery

Question 9

What ribs are typical?

Answer 9

3-9

Question 10

Which structure divides the joint with the head of rib into two seperate joint cavaties?

Answer 10

Intra-articular ligment from crest to vertebral body

Question 11

What ribs are typical?

Answer 11

3-9

Question 12

What are the structures of the sternum?

Answer 12

Manubrium Mesosternum Xiphoid process

Question 13

What are the two chest wall deformities to be aware of?

Answer 13

Pectus excavatum (ditch) Pectus carinatum (peak)

Question 14

What structures are in the superior thoracic aperature?

Answer 14

• Oesophagus - Trachea - Vagus / phrenic nerve - Sympathetic chain - Major arteries off the aorta - Major veins to the heart - Apex of lungs (very imp. for central line placement) - Other nerves / vessels

Question 15

What is the primary muscle for respiration at rest?

Answer 15

Diaphragm

Question 16

What are some major structures passing through the diaphragm and at what levels?

Answer 16

IVC (@T8 b.c vena cava = 8 letters) Oesophagus (T10 b.c 10 letters) Aorta (@T12 b.c Aortic hiatus = 12 letters) Vagus (cardiac plexus) Splanchnic nerves (abdo plexus) Thoracic duct

Question 17

What are the muscles of the thoracic wall?

Answer 17

• Intercostal muscles - (Subcostal and transversus thoracis)

Question 18

What are the three muscle layers of the thoracic wall?

Answer 18

External intercostal Internal intercostal and innermost intercostal (neurovascular plane)

Question 19

What are the intercostal nerves?

Answer 19

• Anterior rami - MOTOR AND SENSORY - 12th nerve is subcostal otherwise one per an intercostal space

Question 20

What sort of action do the ribs have during breathing?

Answer 20

Upper ribs: More lateral axis; “pump handle’ movement Lower ribs: More post. axis “Bucket handle movements”

Question 21

What are the anterior intercostal arteries?

Answer 21

Ribs 1-6; Internal thoracic (divides into musculophrenic and sup. epigas) Ribs 7-9; Musculophrenic

Question 22

What are the posterior intercostal arteries?

Answer 22

1&2 from supreme intercostal a. (branch of costocervical trunk from subclavian art.) 3-11 and subcostal from thoracic aorta

Question 23

Where do anterior and posterior intercostal veins drain?

Answer 23

Ant -> Internal thoracic vein Post -> Azygous/Hemiazygous venous system

Question 24

When describing the intercostal spaces, how many vessels / nerves are there?

Answer 24

2 arteries (ant and post) 2 veins (ant. and post.) one nerve.

Question 25

What can be an issue of scoliosis?

Answer 25

Asymmetry in the lung cavities therefore differences in their size?

Question 26

What exists between the ribs and sternum?

Answer 26

Costal cartilage

Question 27

Answer 27

Question 28

Answer 28

Question 29

Answer 29

Question 30

Answer 30