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SMP - Cardiopulmonary Lab Practical > Osteology of the Thorax > Flashcards

Osteology of the Thorax Flashcards

1
Q

What does the thoracic skeleton protect?

A
  1. Thoracic organs
  2. GI organs
  3. Genitourinary system (kidneys)
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2
Q

5 bones of thorax?

A
  1. Clavicle
  2. Scapula
  3. Ribs
  4. Sternum
  5. Thoracic vertebrae
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3
Q

3 components of superior thoracic aperture?

A
  1. Body of T1 vertebra posteriorly
  2. Medial margin of ribs 1 laterally
  3. Manubrium anteriorly
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4
Q

Vertebral level of superior margin of manubrium?

A

T2/T3

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5
Q

Plane of superior thoracic aperture?

A

Oblique because ribs 1 slope inferiorly

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6
Q

Position of pleura at thoracic aperture?

A

Superior aspects of pleural cavities lie on either side of the entrance to the mediastinum

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7
Q

Where do the structures that pass between upper limb and thorax pass in relation to the ribs and lungs?

A

Over ribs 1 and superior part of pleural cavities

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8
Q

Is the superior thoracic aperture expandable?

A

NOPE

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9
Q

Is the inferior thoracic aperture expandable?

A

YUP

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10
Q

How do structures pass from the abdomen to the thorax?

A

Either through or posterior to the diaphragm

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11
Q

What types of elements forms the inferior thoracic aperture?

A

Bones, cartilage, and ligaments

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12
Q

Skeletal elements of the inferior thoracic aperture?

A
  1. Body of vertebra 12 posteriorly
  2. Ribs 12 and distal ends of ribs 11 posterolaterally
  3. Distal cartilaginous ends of ribs 7 to 10 forming to costal margin anterolaterally
  4. Xiphoid process anteriorly
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13
Q

What types of elements forms the superior thoracic aperture?

A

Skeletal elements only

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14
Q

Vertebral level of joint between costal margin and xiphoid process?

A

T9/T10

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15
Q

Is the posterior margin of the inferior thoracic aperture superior or inferior to the anterior margin?

A

Inferior

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16
Q

When viewed anteriorly, is the inferior thoracic aperture tilted superiorly or inferiorly?

A

Superiorly

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17
Q

Most superior edge of the manubrium?

A

Jugular notch

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18
Q

Are both thoracic apertures open?

A

Nope, only the inlet, the outlet is closed by diaphragm

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19
Q

What is the acromion?

A

Most superior edge of the scapula that articulates with the clavicle

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20
Q

In what manner do muscle fibers of the diaphragm arise?

A

Radially, from the margins of the inferior thoracic aperture to converge into a large central tendon

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21
Q

Is the posterior attachment of the diaphragm superior or inferior to the anterior attachment?

A

Inferior

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22
Q

Which diaphragm dome reaches higher? To what rib level?

A

Right one is higher, up to rib 5

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23
Q

Which 7 structures penetrate the diaphragm? At what vertebral level?

A
  1. Esophagus (T10 to left of midline)
  2. IVC (T8) in central tendinous portion
  3. Anterior and posterior vagal trunks (with esophagus)
  4. Right phrenic nerve (with IVC)
  5. Left phrenic nerve (through muscular part anterior to central tendon on left side)
  6. Right pericardiacophrenic artery (with IVC)
  7. Esophageal branches of left gastric artery (with esophagus)
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24
Q

Which structure passes posteriorly to the diaphragm from the thorax? At what vertebral level or position?

A
  1. Aorta (T12) posterior to median arcuate ligament
  2. Thoracic duct (with aorta)
  3. Sympathetic trunks (posterior to medial arcuate ligament)
  4. Optional azygos vein (with aorta)
  5. Greater, lesser, and least splanchnics (through crura)
  6. Hemiazygos vein (through left crus)
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25
Q

Do all ribs have a costal cartilage?

A

YUP, but small on ribs 11 and 12

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26
Q

Do all ribs articulate with the vertebral column?

A

YUP

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27
Q

True ribs? Why?

A

1-7

Because they articulate with the sternum with their own costal cartilage

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28
Q

False ribs? Why?

A

8-10: because their costal cartilages articulate anteriorly with the costal cartilage of the rib above them

11-12: because they do not articulate with the sternum = floating ribs

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29
Q

Characteristics of posterior end of ribs? Describe each

A
  1. Head: 2 articular surfaces separated by a crest
  2. Neck: short flat region that separates head and tubercle
  3. Tubercle: projects posteriorly from junction of neck and shaft and has 2 regions
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30
Q

Which ribs have a different connection to the vertebral column than the others?

A

Rib 1, 10, 11, and 12

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31
Q

Which rib cannot be palpated?

A

Rib 1

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32
Q

Typical ribs?

A

3-10

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33
Q

Atypical ribs?

A

1, 2, 11, 12

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34
Q

Other name for dorsal view of ribs?

A

Superior view

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35
Q

Describe the 2 articular surfaces of the head of typical ribs.

A
  1. Smaller superior surface articulates with inferior costal demifacet on the body of the vertebra above
  2. Larger inferior facet articulates with the superior costal demifacet of its own vertebra body
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36
Q

Describe the 2 regions of the tubercle of typical ribs.

A
  1. Articular part: medial with oval facet for articulation with oval facet on transverse process of associated vertebra
  2. Raised nonarticular part: roughened by ligament attachments
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37
Q

How many surfaces does the shaft of a typical rib have?

A

2: interior and exterior

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38
Q

Describe the superior and inferior margins of typical ribs.

A

Superior: rounded and smooth
Inferior: sharp

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39
Q

At what point does the shaft of typical ribs bends?

A

The angle: site lateral to the tubercle

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40
Q

Describe the twist of the shaft of typical ribs.

A

Gentle twist causing the external surface of the ribs to face somewhat superiorly

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41
Q

What is found in the costal groove of the ribs?

A

VAN:
Vein
Artery
Nerve

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42
Q

Describe the shape of rib 1.

A

Flat in horizontal plane

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43
Q

How many articular surfaces does rib 1 have?

A

2: 1 on the head (the inferior one) and one of the tubercle

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44
Q

Does rib 1 have a tubercle that articulates?

A

YUP, but it has another tubercle, the scalene tubercle on the superior surface of the rib, which separates 2 smooth grooves that cross the rib midway along the shaft

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45
Q

What are the 2 grooves of rib 1 caused by?

A
  1. Anterior groove: subclavian vein

2. Posterior groove: subclavian artery

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46
Q

Describe the shaft of rib 1 other than where its grooves are.

A

Roughened by muscles and ligaments

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47
Q

Describe the shape of rib 2.

A

Same as rib 1 but twice as long

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48
Q

What is particular about the shape of ribs 11 and 12?

A

They do not have tubercles or necks

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49
Q

In what direction do ribs 11 and 12 point?

A

Anteriorly

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50
Q

What attachments does the manubrium of the sternum have?

A
  1. Oval fossa for articulation with clavicle
  2. Facet for articulation to costal cartilage of rib 1
  3. Demifacet for articulation to upper half costal cartilage of rib 2
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51
Q

Describe the anterior surface of the body of the sternum.

A

Has transverse ridges that come from embryologic development

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52
Q

What attachments does the body of the sternum have?

A
  1. Demifacet for articulation to lower half costal cartilage of rib 2
  2. 4 more facets for articulation to costal cartilages of ribs 3, 4, 5, and 6
  3. Demifacet for articulation to upper half costal cartilage of rib 7
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53
Q

Which portion of the sternum is variable in shape?

A

Xiphoid process

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54
Q

Can the xiphoid process be perforated?

A

YUP

55
Q

Describe the xiphoid process at birth. How does it change?

A

Cartilaginous structure which later ossifies

56
Q

What attachments does the xiphoid process of the sternum have?

A

Demifacet for articulation to lower half costal cartilage of rib 7

57
Q

What connects to the sternum posteriorly?

A

Pericardium

58
Q

Bone used for bone marrow aspiration?

A

Sternum in its internal aka medullary cavity

59
Q

Describe the 8 structures of a typical thoracic vertebra.

A
  1. Heart shaped body with roughly equal dimensions in transverse and anteroposterior directions
  2. Spinous process extending posterioly and inferiorly (more inferior than vertebral disc)
  3. 2 transverse processes club-shaped and extending posterolaterally
  4. 2 laminae connecting spinous processes to transverse processes
  5. 2 superior articular processes off of laminae that are flat and face posteriorly
  6. 2 inferior articular processes off of laminae facing anteriorly
  7. 2 pedicles connecting the upper half of body to the transverse processes
  8. Inferior and superior vertebral notches (rounded portions of pedicles)
60
Q

What is the INTERvertebral foramen? What passes in it?

A

Circular hole between body and processes of vertebra formed by superior notch of one vertebra and inferior notch of another

Spinal nerves pass through

61
Q

Which part of the thoracic vertebrae overlap with the the same structures of the vertebra below?

A

Laminae

62
Q

List the 6 sites of articulations with ribs of each thoracic vertebra. What does each articulate with?

A
  1. 2 superior costal demifacets off of the superior processes to articulate with head of own rib
  2. 2 inferior costal demifacets off of the inferior processes to articulate with head of rib below
  3. 2 transverse costal oval facets on inferior side of transverse process to articulate with tubercle of own rib
63
Q

Which thoracic vertebrae lack inferior costal demifacets to articulate with head of rib below?

A

T10, T11, and T12: only have a single complete facet on each side of their body on the superior processes to articulate with own rib

64
Q

Which rib lacks a smaller superior surface to articulate with inferior costal facet on the body of the vertebra above?

A

Rib 1

65
Q

Which thoracic vertebrae lack transverse costal oval facets at end of transverse process to articulate with tubercle of own rib?

A

T11 and T12

66
Q

How to tell difference between superior and inferior view of vertebrae?

A

Superior: spinous process looks like it’s going into picture

Inferior: spinous process looks like it’s coming out of the picture

This is because the spinous process extends inferiorly

67
Q

What can you palpate on a patient’s spine?

A

Spinous processes of vertebrae

68
Q

How do thoracic vertebrae articulate with each other?

A

Through the superior and inferior articulation processes

69
Q

How do ribs 2-9 articulate with thoracic vertebrae?

A
  1. Smaller superior surface articulates with inferior costal demifacet on the body of the vertebra above
  2. Larger inferior facet articulates with the superior costal demifacet of its own vertebra body
  3. Articular part of tubercle articulates with oval facet on transverse process of associated vertebra
70
Q

What does the sternal angle plane separate?

A
  1. Superior and inferior mediastinum
  2. Trachia branching out into bronchi
  3. Boundaries of the aortic arch
  4. Vertebral level between T4 and T5
  5. Second rib joins sternum
  6. Azygos vein drains to SVC
  7. Manubrium and body of sternum join
  8. Uppermost level of the pericardium
  9. Superior limit of pulmonary trunk
71
Q

Attachments of the diaphragm?

A
  1. Xiphoid process
  2. Costal margin
  3. Ends of ribs 11 and 12
  4. Ligaments that span across structures of the posterior abdominal wall
  5. Vertebrae of the lumbar region
  6. Pericardium through central tendon
72
Q

What is the posterior attachment of the diaphragm called? What does it attach to?

A

Median arcuate ligament to T8/T9

73
Q

Blood supply of diaphragm? Which part is the largest blood supply?

A
  1. Superiorly: pericardiacophrenic and musculophrenic arteries (branching from the internal thoracic arteries), superior phrenic arteries (from thoracic aorta), and intercostal arteries
  2. Inferiorly: inferior phrenic arteries*** branching from the abdominal aorta
74
Q

Describe the venous drainage of the diaphragm.

A

Veins parallel arteries and drain into:

  1. Brachiocephalic veins
  2. Azygos system of veins
  3. Abdominal veins: left suprasternal vein and IVC
75
Q

Innervation of diaphragm? Why?

A

Phrenic nerves that innervate it from its abdominal surface + peripheral areas are innervated by intercostal nerves

Because the tissues that initially give rise to diaphragm are in anterior position on embryological disc before the head fold develops

76
Q

What is the coracoid process?

A

Small knob below the acromion of the scapula

77
Q

Can you see the transverse costal facets on a superior or an inferior view of a vertebra?

A

Inferior view

78
Q

Name of joint between body and of sternum and xiphoid process?

A

Xiphisternal joint

79
Q

When looking at osteology of thorax from the anterior view, how to recognize T1?

A

It’s the vertebra visible right above the jugular notch

80
Q

Is the jugular notch palpable on a cadaver?

A

Nope only the living

81
Q

Shape of clavicle?

A

S

82
Q

What is the tissue you see in ICS if all the intercostal structures are removed?

A

Parietal pleura

83
Q

How is the diaphragm anchored to the lumbar vertebrae?

A

Musculotendinous crura which blend with the anterior longitudinal ligament of the vertebral column (2 of them: L and R)

84
Q

Which diaphragmatic crura is longest and broadest?

A

Right crus

85
Q

Attachement of right crus of diaphragm?

A

L1 to L3 and intervening vertebral discs

86
Q

Attachement of left crus of diaphragm?

A

L1 to L2 and intervening vertebral discs

87
Q

What connects the diaphragmatic crura? Relation to aorta?

A

Median arcuate ligament, anterior to the aorta

88
Q

Origins of the diaphragm?

A
  1. Sternum and xiphoid process anteriorly
  2. L1 to L3 lumbar vertebrae and the arcuate ligaments posteriorly
  3. Costal margin peripherally
89
Q

What are the 3 ligaments of the diaphragm?

A
  1. Median arcuate ligament
  2. Medial arcuate ligament
  3. Lateral arcuate ligament
90
Q

What is the medial arcuate ligament? Attachments?

A

Tendinous arch formed by the fascia covering the upper part of the psoas major muscle

Attachments:

  • Medially: sides of L1 and L2
  • Laterally: transverse process of L1
91
Q

Position of medial arcuate ligament relative to the diaphragmatic crura?

A

Lateral

92
Q

What is the lateral arcuate ligament? Attachments?

A

Tendinous arch formed by a thickening of fascia covering the quadratus lomborum

Attachments:

  • Medially: transverse process of L1
  • Laterally: rib 12
93
Q

What are the domes of the diaphragm produced by?

A
  1. Liver on right + some contribution from right kidney and right suprarenal gland
  2. Fundus of stomach and spleen on left with contribution from left kidney and left suprarenal gland
94
Q

Surface projection of right dome of diaphragm during expiration?

A

Rib 5

95
Q

Surface projection of left dome of diaphragm during expiration?

A

5th ICS

96
Q

Which structure passes anteriorly to the diaphragm from the thorax? Position relative to ribs?

A

Superior epigastric vessels (just deep to the ribs)

97
Q

What membrane covers the ribs?

A

Periosteum

98
Q

What can the mobility of the ribs be exploited for?

A

To access the thoracic cavity during thoracotomy

99
Q

What kind of patients have more elastic rib costal cartilage? What is a consequence of this?

A

Children

Compression may cause injury to the organs without fracturing the ribs

100
Q

Which rib is the least likely to be fractured? Why?

A

1 because it is broad and flat and protected by the clavicle

101
Q

Which ribs are most likely to be fractured?

A

2-7

102
Q

What can happen to the ribs with old age? Consequence of this?

A

Ossification of costal cartilages which become radio-opaque and cause confusion in chest films (looks like cancer) and loss of rib resiliency

103
Q

What can be a complication of flail chest? Explain.

A

Broken rib punctures the lining of the lung pleura: pneumothorax

104
Q

How long after pneuomothorax can you live for?

A

30 min

105
Q

Is the sternum often fractured? Why/Why not?

A

NOPE because of resiliency of costal cartilages

106
Q

What is the rate of mortality of sternal fractures? Why?

A

25-45%

Due to potential heart injurt

107
Q

What are the 3 diameters of the thoracic cavity? What is each changed by? How is each increased during inspiration?

A
  1. Vertical: diaphragm moves inferiorly and pushes down on abdominal organs
  2. Antero-posterior: fixed 1st rib - external intercostals as chest moves outward
  3. Transverse: fixed 1st rib - external intercostals: bucket handle arrangement
108
Q

Which ribs are NOT mobile?

A

Ribs 11 and 12

109
Q

Is the clavicle palpable across its entire length?

A

YUP

110
Q

Describe the 2 ends of the clavicle.

A
  1. Acromial end is flat with an oval facet for articulation with acromion of scapula
  2. Sternal end is more robust with a larger facet for articulation with manubrium and 1st costal cartilage
111
Q

Describe the 2 parts of the inferior surface of the lateral third of the clavicle. Purpose?

A
  1. Trapezoid line = lateral roughening
  2. Conoid tubercle

Purpose = attachment of coracoclavicular ligament

112
Q

Which surface of the clavicle is smoother: superior or inferior?

A

Superior

113
Q

What 5 portions of the scapula can be palpated on a patient?

A
  1. Spine
  2. Acromion
  3. Tip of coracoid process
  4. Inferior angle
  5. Medial border
114
Q

Shape of sternoclavicular joint?

A

Saddle shaped

115
Q

How many ligaments in the sternoclavicular joint? Describe them.

A
  1. Anterior and posterior sternoclavicular ligaments
  2. Interclavicular ligament: links ends of 2 clavicles on superior surface of manubrium
  3. Costoclavicular ligament: between clavicle and 1st costal cartilage and rib
116
Q

Describe the parts of the scapula.

A
  1. 3 angles
  2. 3 borders
  3. 2 surfaces
117
Q

Clinical significance of xiphoid process?

A

It adults around age 40 and patient may become aware of it

118
Q

If you needed to make an incision in an intercostal space, where in the space in terms of height, would make the incision, high or low in the space?

A

Low in the intercostal space

119
Q

Name of joint between transverse process and tubercle?

A

Costotransverse joint

120
Q

How are intervertebral discs named?

A

By the vertebra above them

121
Q

What would black areas on skin and tips of fingers indicate? What bone structure in the thorax can cause this? Treatment?

A

Platelet emboli = clots carried from a source to reside in small vessels which they may occlude

Cervical ribs can cause these as they are found on the undersurface of the distal portion of the subclavian artery and reduce the diameter and cause eddy currents => atheroma => blood clot which gets dislodged and flow distally to block blood flow to fingers/hands => DISTAL EMBOLIZATION

Treatment: surgical excision of cervical ribs

122
Q

What happens if you have an infected emboli in the heart?

A

Bacteria will grow on the valve and will be showered into the peripheral circulation

123
Q

Other than distal emboli, what 2 other diseases can cervical ribs cause?

A
  1. Tension in T1 nerve => sensory disturbance over medial aspect of forearm + wasting of intrinsic muscles of the hand
  2. Compression of subclavian vein => axillary vein thrombosis
124
Q

What is the distal end of a rib?

A

Anterior end = costal cartilage

125
Q

Describe the joint at the head of each rib.

A

Joint is divided into 2 synovial compartments by an intra-articular ligament, which attaches the crest of the rib head to the adjacent intervertebral disc and also separates the two articular surfaces on the head of the rib

Whole joint is surrounding by one single joint capsule attached to the outer margins of the combined articular surfaces of head and vertebral column

126
Q

Describe the costotransverse joint.

A

Synovial joint stabilized by 2 ligaments:

  1. Costotransverse ligament: medial to the joint and attaches the neck of the rib and to the transverse process
  2. Lateral costotranverse ligament: lateral to the joint and attaches the tip of transverse process to nonarticular part of tubercle
127
Q

What is the superior costotransverse ligament?

A

Ligament connective superior surface of rib neck to superior transverse process (of above vertebra)

128
Q

Are are sternocostal joints synovial?

A

No, not the 1st one: fibrocartilaginous connection, but other ones are until 7th

129
Q

Which sternocostal joint has 2 compartments? Describe it.

A

Joint with 2nd costal cartilage has an intrarticular ligament

130
Q

What kind of joints are the manubriosternal and xiphisternal ones?

A

Symphysis

131
Q

What are interchondral joints?

A

Synovial joints between costal cartilages of ribs 7 to 10 (sometimes 5 and 6 too)

132
Q

Which joints for the costal margin?

A

Interchondral joints

133
Q

What separates the ICS/ribs from pleura?

A

Endothoracic fascia

134
Q

What are cervical ribs? Implications?

A

Accessory rib articulating with C7 and attaching anteriorly to anterior aspect of rib 1 via a cervical band (not visualized on radiography) => structures that normally pass over rib 1 now pass over the cervical rib and its band

SMP - Cardiopulmonary Lab Practical (11 decks)

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