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ACEM Primary Written > Respiratory: Anatomy - Overview of the thorax > Flashcards

Respiratory: Anatomy - Overview of the thorax Flashcards

1
Q

Three major spaces of the thoracic cavity

A
  1. Mediastinum (central compartment)
  2. Right pulmonary cavity
  3. Left pulmonary cavity
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2
Q

What are the three main components of the thoracic wall?

A

Of the anterolateral aspect only (posterior aspect considered part of the back):
1. Thoracic cage
2. Intercostal muscles
3. Skin, subcutaneous tissue, muscle and fascia

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3
Q

Three types of ribs

A
  1. True: attached directly to sternum via costal cartilage (ribs 1-7)
  2. False: indirectly attached to sternum via costal cartilage of the rib above (ribs 8-10)
  3. Floating: end in posterior abdominal musculature without attaching to sternum (ribs 11-12, sometimes 10)
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4
Q

Four main features of a typical rib

A
  1. Head with superior facet (articulates with inferior costal demifacet of vertebral body above) and inferior facet (articulates with superior costal demifacet of vertebral body below, which shares the same number as the rib)
  2. Neck with tubercle (tubercle has articular part for attachment to transverse process of vertebra, and non-articular part for attachment of costotransverse ligament)
  3. Body with costal angle (marks lateral limit of deep back muscles)
  4. Costal groove on inferior internal surface of rib for neurovascular bundle
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5
Q

Describe the appearance and three unique features of the first rib

A

Appearance: broad, shortest, most sharply curved rib
Unique features:
- Single facet for articulation with T1
- Transverse grooves running across superior surface for subclavian artery (lateral) and vein (medial)
- Grooves separated by scalene tubercle (for attachment of anterior scalene)

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6
Q

Which ribs are considered typical and which are atypical?

A

Typical: ribs 3-9
Atypical: ribs 1-2, 10-12

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7
Q

Describe the appearance and one unique feature of the second rib

A

Appearance: larger, thinner, less curved than rib 1
Unique feature:
- Tuberosity for serratus anterior on superior surface

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8
Q

Describe the unique feature of ribs 10-12

A

Single facet only (T10-12 only have single facets on vertebral body/pedicle)

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9
Q

Describe the unique features of ribs 11-12

A

Short with no neck or tubercle
Single facet only

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10
Q

7 joints of the ribs and sternum, and brief description of each. Which are synovial and which are not?

A
  1. Joint of head of rib*: to superior and inferior (or single for T1 and T10-12) costal demifacets on vertebral bodies
  2. Costotransverse joint*: between rib tubercle and articular facet on transverse process; involves lateral and superior (to vertebral body above) costotransverse ligaments, and radiate ligament (to vertebral body above and below, and hypochordal bow)
  3. Costochondral joint**: between each rib and its costal cartilage
  4. Interchondral joint*: between adjacent costal cartilages of ribs 6-7, 7-8 and 8-9
  5. Sternocostal: first is primary cartilaginous** to manubrium, second* is synovial to manubrium and sternal body, ribs 3-7* are synovial to sternal body
  6. Manubriosternal***: between manubrium and sternal body, creates the Angle of Louis
  7. Xyphisternal***: between sternal body and xyphoid process
  • synovial
    ** primary cartilaginous
    *** secondary cartilaginous
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11
Q

Are ribs numbered for the vertebral body above or below their point of attachment?

A

Below

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12
Q

When do the three parts of the sternum ossify?

A

Middle to late adulthood

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13
Q

Vertebral level of jugular notch

A

Inferior border T2

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14
Q

What is the relationship between the clavicles and the superior zones of lymphatic drainage?

A

Above clavicles: lymphatic drainage to inferior jugular lymph nodes
Below clavicles: parietal lymph (from body wall and upper limbs) drains to axillary lymph nodes

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15
Q

Vertebral level of manubrium

A

T3/4

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16
Q

How long is the manubrium?

A

4cm

17
Q

Vertebral and costal level of sternal angle

A

T4/5 IV disc
2nd costal cartilages

18
Q

At what landmark does the SVC enter the RA?

A

Opposite the R 3rd costal cartilage

19
Q

Vertebral level of sternal body. What structures lies behind the sternal body?

A

T5-9
Sternal body is anterior to R heart border

20
Q

How long is the sternal body?

A

10cm

21
Q

At what landmark does the right brachiocephalic vein enter the SVC?

A

1 fingerbreadth to the R of the manubrium

22
Q

Vertebral level of the xyphisternal joint

A

Inferior border of T9

23
Q

Anatomical landmark corresponding to level of the nipple in men

A

4th intercostal space

24
Q

Vertebral level of umbilicus

A

T10

25
Q

How long is the oesophagus?

A

28cm

26
Q

Describe the boundaries of the superior thoracic aperture

A

Anterior: superior border of manubrium
Lateral: 1st ribs and costal cartilages
Posterior: T1 vertebral body

27
Q

Contents of the superior thoracic aperture

A
  1. Trachea
  2. Oesophagus
  3. Nerves: phrenic, recurrent laryngeal, vagus, sympathetic trunk
  4. Arteries: common carotid and subclavian, brachiocephalic trunk
  5. Veins: internal jugular, brachiocephalic, subclavian
  6. Lymphatics including thoracic duct
  7. Apices of the lung
28
Q

What are the dimensions of the superior thoracic aperture?

A

6.5cm AP and 11cm transverse

29
Q

Describe the boundaries of the inferior thoracic aperture

A

Anterior: xyphisternal joint
Anterolateral: fused costal cartilages ribs 7-10
Posterolateral: ribs 11-12
Posterior: T12 vertebral body

30
Q

Are intercostal spaces numbered for the rib above or below the space?

A

Above

31
Q

Seven groups of thoracic lymph nodes. Which of these drain to the bronchomediastinal trunks?

A
  1. Parasternal (interior thoracic)*
  2. Intercostal
  3. Diaphragmatic
  4. Posterior mediastinal
  5. Tracheobronchial
  6. Paratracheal*
  7. Brachiocephalic*
  • drain to the bronchomediastinal trunks
32
Q

Which group of lymph nodes does the thoracic wall drain to?

A

Axillary

33
Q

Which groups of thoracic lymph nodes drain to the bronchomediastinal trunks?

A

Parasternal
Paratracheal
Brachiocephalic

34
Q

Describe the course of the bronchomediastinal trunks

A

R drains to R lymphatic duct
L drains to thoracic duct
(or both may drain directly into junction of internal jugular and subclavian veins)

35
Q

What are the boundaries of the breast bed?

A

From lateral sternum to mid-axillary line
From ribs 2-6

36
Q

What are the three arteries supplying the breast?

A
  1. Medial mammary branches (from subclavian via anterior intercostal from internal thoracic)
  2. Lateral thoracic and thoraco-acromial (from axillary)
  3. Posterior intercostal (in 2nd to 4th intercostal spaces)
37
Q

Describe the venous drainage of the breast

A

Mostly to axillary vein, some to internal thoracic vein

38
Q

What nerves supply the breast?

A

Nerves derived from the anterior and lateral cutaneous branches of 4th to 6th intercostal nerves

ACEM Primary Written (160 decks)

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