Resp anatomy

Question 1

How do the ribs connect to the sternum, which ribs don’t?

Answer 1

Ribs 1-7 connect via costal cartilages
Ribs 8-10 connect to costal cartilages above
Ribs 11+12 are “floating ribs”

Question 2

What are the typical characteristics of the following parts of the rib?

a) Head
b) Neck
c) Body

Answer 2

a) Head: wedge-shaped, 2 articular facets (one with corresponding vertebra and one with the vertebra above)
b) Neck: no bony prominence, connects head with body
c) Body: flat and curved with a groove in the shaft for nervous supply of the thorax

Question 3

What are the 3 parts of the sternum in order of superior-inferior

Answer 3

Manubrium, body, xiphoid

Question 4

How do the ribs articulate with a vertebrae’s transverse process?

Answer 4

There’s a tubercle where the head meets the body of the rib that has an articular facet (articulates with the transverse process of the corresponding vertebra)

Question 5

How many intercostal spaces are there? How are they numbered?

Answer 5

11 in total, numbered to the rib# above

Question 6

Which ribs are Atypical? Why?

Answer 6

Rib 1: shorter, wider, only has ONE facet for articulation and the superior surface is marked by 2 grooves for the subclavian vessels

Rib 2: thinner and longer than one, serratus anterior attaches

Rib 10: One facet for the corresponding vertebra

Rib 11 and 12: NO neck, only one facet (corresponding vertebra)

Question 7

What are the 2 joints between ribs and vertebra?

Answer 7

Costotransverse joint: between tubercle of rib and transverse costal facet of the corresponding vertebra

Costovertebral joint: between the head of rib and superior costal facet of the corresponding vertebra and the above vertebra’s inferior costal facet

Question 8

What do intercostal arteries supply? Which intercostal spaces DON’T have anterior intercostal arteries?

Answer 8

They supply the intercostal muscles, the parietal pleura and the overlying skin

The last 2 Intercostal spaces don’t have anterior intercostal arteries

Question 9

Name the layers you’d have to go through to perform a chest drain

Answer 9

1. Skin
2. Superficial fascia
3. Fat
4. Muscles (external, internal, innermost)
5. Parietal pleura
6. Pleural space

The needle doesn’t need to go further as you have reached the fluid, the following layers would be visceral pleura and then the lungs

Question 10

What are the posterior, lateral and anterior boundaries of the thoracic inlet?

Answer 10

Posterior: T1
Lateral: 1st pair of ribs
Anterior: manubrium and 1st rib costal cartilages

Question 11

Which lung has a horizontal fissure, where is it? What other fissure is there?

Answer 11

The R lung’s upper and middle lobe are separated by the horizontal fissure. The oblique fissure separates the middle and lower lobe

Question 12

Where do both pleural cavities touch?

Answer 12

Behind the angle of Louis/sternoclavicular joint

Question 13

When does the trachea bifurcate?

Answer 13

Behind the angle of Louis (T4-T6)

Question 14

How many pulmonary arteries and veins does each lung have?

Answer 14

1 pulmonary artery, 2 pulmonary veins

Question 15

What does the pleural fluid allow for?

Name 4 things that can pathologically collect in the pleural cavity

Answer 15

allows for movement of the lung against the chest wall

1. Air: pneumothorax
2. Fluid: fluid effusion (limits lung expansion)
3. Blood: hemothorax
4. Pus: Empyema

Question 16

What is the angle between the L and R main bronchi called?

Answer 16

Carina

Question 17

What is the mediastinum and what covers it?

Answer 17

The region in the thorax between the 2 pleural sacs, covered by the mediastinal pleura

Question 18

What happens in a diaphragmatic hernia?

Answer 18

Birth defect where there is a hole in the diaphragm and abdominal organs move through

Question 19

Where do the 2 L and 1 R bronchial artery(ies) arise from?

Answer 19

2 L bronchial arteries arise from the thoracic aorta

1 R bronchial artery arises from the 3rd intercostal artery

Question 20

What are the 3 diaphragm attachment points?

Answer 20

1. Sternal part: attaches posteriorly to the xyphoid
2. Costal part: attaches to the internal surfaces of lower costal cartilages 7-12
3. Lumbar part: attaches to the medial and lateral arcuate ligament and body of vertebra L1-L3 + the anterior longitudinal ligament

Question 21

What are the 3 openings in the diaphragm? Which structures pass through each?

Answer 21

1. Caval hiatus (opens in the central diaphragmatic tendon)
   inferior vena cava, branch of R phrenic
2. Esophagus hiatus: R and L vagus, esophagus, lymphatics
3. Aortic hiatus: aorta, thoracic duct, azygous vein

Question 22

What gives nervous supply to most of the diaphragm (what are the roots)?
What supplies the peripheral parts of the diaphragm?

Answer 22

The Phrenic N (L and R) does most (C3-C5), the peripheral parts are supplied by the 6-11th intercostal nerves

Question 23

Why can referred pain happen between the diaphragm and shoulder?

Answer 23

The region of the shoulder and diaphragm share a common nerve supply (C3-C4) which are shared by the phrenic and supraclavicular nerves, so diaphragmatic pain can also be felt at the tip of the shoulder

Question 24

Which arteries arise from the pulmonary trunk?

Answer 24

Pulmonary arteries - lobar arteries - segmental arteries

Question 25

Where is the apex of the lung, and what are the lung’s 3 boarders and surfaces?

Answer 25

Apex is above the 1st rib
3 surfaces: diaphragmatic, costal, mediastinal
3 boarders: inferior, posterior, anterior

Question 26

What are the 4 ‘tubes’ in the posterior mediastinum?

Answer 26

1. thoracic duct
2. esophagus
3. azygous vein
4. descending thoracic aorta