Lecture 14: Thoracic Osteology and Wall Structure Flashcards

1
Q

What are the components of the thoracic cage?

A

twelve thoracic vertebrae
twelve pairs of ribs and their costal cartilages
sternum
intercostal muscles

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2
Q

What defines the superior boundary of the thoracic cage?

A

first thoracic vertebrae
first pair of ribs and costal cartilage
manubrium

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3
Q

What defines the inferior boundary of the thoracic cage?

A

twelfth thoracic vertebrae
twelfth pair of ribs and costal cartilages
xiphisternal joint

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4
Q

What does the manubium articulate with?

A

superior aspect of body or sternum at sternal angle

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5
Q

What are the features of the manubrium

A

jugular notch
concave surface for clavicle
concave surface for first rib

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6
Q

What type of joint is the manubriosternal joint?

A

symphysis

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7
Q

When does ossification of the sternum occur?

A

third trimester

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8
Q

What is the xiphoid process?

A

fibrocartilage extension of sternum into abdominal musculature

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9
Q

What does the xiphoid process mark?

A

dermatome 6

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10
Q

What does costa mean?

A

rib bone + its cartilage

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11
Q

What ribs are vertebrosternal?

A

ribs 1-7

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12
Q

What ribs are vetrebrochondral?

A

8-10

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13
Q

What ribs are vertebral (floating)?

A

11-12

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14
Q

What are the parts of a rib?

A
head
neck
tubercle
shaft 
costal cartilage
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15
Q

What does the tubercle of a rib articulate with?

A

transverse process of vertebra with same number

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16
Q

Why is the first rib important?

A

its relation to nerves of the brachial plexus and subclavian vessels

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17
Q

What is the scalene tubercle?

A

for insertion of scalenus anterior muscle

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18
Q

Where is the shallow groove for the subclavian vein on the first rib?

A

anterior to the tubercle

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19
Q

Where is the shallow groove for subclavian artery on first rib?

A

posterior to tubercle

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20
Q

What spinous process is most prominent?

A

T1

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21
Q

What spinous process is the first process to be palpated

A

C7

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22
Q

Why is T1 atypical?

A

superior costal facet is not a demifacet

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23
Q

Why is T10 atypical?

A

one pair of costal facets located partly on body and partly on pedicle

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24
Q

Why is T11 and T12 atypical?

A

one pair of costal facets located on pedicles

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25
Q

In typical rib articulation, the tubercle articulates with ______

A

transverse process of same number vertebra

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26
Q

What does the sternal angle mark and lie?

A

marks rib 2

lies at level of T4-5 IV disc

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27
Q

Where can you hear the apex heart beat?

A

fifth intercostal space along midclavicular line about 8.5 cm from the adult midline

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28
Q

Where can you hear the aortic valve heart sound?

A

at seance intercostal space on right side of sternum

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29
Q

Where can you hear the pulmonary valve heart sound?

A

second intercostal space along the left side of the sternum

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30
Q

Where is the tricuspid valve projected?

A

fifth intercostal space on the right side of the sternum

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31
Q

Where is the bicuspid valve heart sound projected?

A

fifth intercostal space about 10 cm to the left of the sternal midline

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32
Q

Where is the bifurcation of the trachea?

A

between sternal angle and T4/5 vertebral level

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33
Q

Where is the scapular spine at?

A

level of 3rd rib and T2 vertebra

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34
Q

Where is the inferior scapular angle at?

A

level of 7th rib, spine of T7 or the body of T9

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35
Q

Where is the superior part of the costal margin marked?

inferior?

A

superior: 7th cartilage
inferior: 10th cartilage

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36
Q

What is the infrasternal angle

A

depression between the infrasternal fossa, important for CPR
xiphisternal joint within the fossa is at the level of the body of T9

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37
Q

Where is the midsternal line?

A

in the middle of the sternum

38
Q

Where is the midclavicular line?

A

in the middle of the clavicles (there are two)

39
Q

Where is the scapular line?

A

running through the inferior angle of the scapula

40
Q

Where is the anterior axillary line?

A

projects downward from anterior axillary fold

formed by lower border of pec major

41
Q

Where is the posterior axillary line?

A

projects downward from posterior axillary fold

formed by tendon of lat dorsi

42
Q

Where is the midaxillary line?

A

between anterior and posterior axillary line

43
Q

What cutaneously innervates the clavicular and scapular regions of upper thorax?

A

C3-4

44
Q

What cutaneously innervates the upper thorax?

A

T1-5

45
Q

What cutaneously innervates the xiphoid process region?

A

T6

46
Q

What cutaneously innervates the lower parts of thorax and lateral/anterior abdominal wall?

A

T7-12

47
Q

Pectoralis major origin

A

Clavicular and stenocostal attachments:
ant surface of medial 1/2 of clavicle
ant surface of sternum and superior 6 costal cartilages

48
Q

Pectoralis major inseriton

A

lateral lip of inter tubercular sulcus

49
Q

Pectoralis major blood supply

A

pectoral branches of thoracoacromial arterial trunk

50
Q

Pectoralis major innervation

A

lateral and medial pectoral nerves (C5-C8, T1)

51
Q

Pectoralis major actions

A

adducts and medially rotates humerus
draws scapula anteriorly and inferiorly via clavicle
clavicular portion flexes humerus
sternal portion can extend humerus from the flexed position

52
Q

Pectoralis minor origin

A

3-5 ribs near costal cartilages

53
Q

Pectoralis minor insertion

A

coracoid process of scapula

54
Q

Pectoralis minor blood supply

A

pectoral branches of thorachoacromial trunk

55
Q

Pectoralis minor innervation

A

medial pectoral nerve (C8-T1)

56
Q

Pectoralis minor actions

A

stabilizes scalpa by pulling it anteriorly and inferiorly against posterior thoracic wall
if scapula is fixed- elevates ribs and assists in inspiration

57
Q

Subclavius origin

A

junction of first rib and its costal cartilage

58
Q

Subclavius insertion

A

inferior surface of middle third of clavicle

59
Q

Subclavius blood supply

A

clavicular branch of thoracromial arterial trunk

60
Q

Subclavius innervation

A

nerve to subclavius (C5,6)

61
Q

Subclavius action

A

anchors and depresses clavicle

62
Q

Serratus anterior origin

A

external surfaces of lateral parts of ribs 1-9

63
Q

Serratus anterior insertion

A

anterior surface of medial borer of scapula

64
Q

Serratus anterior blood supply

A

superior thoracic and lateral thoracic arteries

65
Q

Serratus anterior innervaton

A

long thoracic nerve (C5-7)

66
Q

Serratus anterior actions

A

protracts scapula
rotates scapula upwards
holds scapula against thorax (prevents winging)

67
Q

What is the pectoral region supplied by?

A

axillary artery and its branches

68
Q

What does the basilic vein continue as?

A

axillary vein

69
Q

What does the cephalic vein drain into?

A

axillary vein

70
Q

Describe the external intercostals

A

extend from vertebrae posterity to junction of ribs and intercostal cartilages
fiber direction is inferiorly and anteriorly ( hands in front pocket)

71
Q

Describe the internal intercostals

A

begin at lateral edge of sternum and extend toward vertebral column
fibers direction is inferiorly and posteriorly (hands in back pocket)

72
Q

Describe the innermost intercostal

A

incomplete layers with fibers arranged in a more horizontal direction

73
Q

Describe the transverse thoracis

A

four or five slips that originate form the inferior sternum and extend superolaterally to internal surface of upper ribs

74
Q

What are the contents of the intercostal space?

A
intercostal vein
intercostal arteries (posterior and anterior)
intercostal nerve
75
Q

Where do posterior intercostal arteries 1-2 arise from? 3-12?

A

1-2: costocervical trunk

3-12: segmental branches from descending aorta

76
Q

What do posterior intercostal arteries give off?

A

lateral cutaneous branches

77
Q

What are the anterior intercostal arteries branches of?

A

internal thoracic

78
Q

What do the anterior intercostal arteries give off?

A

anterior cutaneous branches

79
Q

The mammary glands are modified ______ glands

A

sweat

80
Q

Breasts extend from ______ rib superiorly to _____ costal cartilage inferiorly

A

2-3; 6-7

81
Q

What is the retromammary space?

A

potential space between breast and pectoral fascia

82
Q

What is the sinus mammarumis?

A

space between the two glands

83
Q

What is the mammary gland innervated by?

A

intercostal nerves (4-6)

84
Q

What is the fibrous tela subcutanea?

A

connective tissue layer surround entire mammary gland

85
Q

What is the fatty tela subcutanea?

A

adipose tissue deep to fibrous layer

86
Q

What are the suspensory ligament of Cooper?

A

bundles of collagen fibers in dermis and hypodermis

87
Q

What is the arterial supply to the breast?

A

anterior perforating arteries
medial mammary rami
lateral mammary artery
lateral mammary rami

88
Q

Where does the nipple, areola and lactiferous lobules drain into?

A

subareolar lymph node

89
Q

Where does 75% of lymph from breast drain into

A

axillary lymph nodes

90
Q

Where does the remaining 25% of lymph drain into?

A

parasternal and abdominal lymph nodes

91
Q

What is the innervation of the breast tissue?

A

lateral mammary nerve
anterior branches of lateral cutaneous branches of intercostal nerve
medial mammary nerve
lateral branches of anterior cutaneous branches of intercostal nerves
supraclavicular nerves

92
Q

What is polymastia? polythelia?

A

supernumerary breast or nipples