S1_L1: Thoracic Wall Flashcards
1
Q
The region between the neck and abdomen that is also known as chest or breastplate. It is flat in front and back but slightly round at the sides.
A
Thorax
2
Q
Determine the corresponding structures that make the boundaries of the thorax
- Thoracic part of the vertebral column
- Neck
- Sternum and costal cartilages
- Intercostal spaces
- Diaphragm
A. Anterior
B. Posterior
C. Superior
D. Inferior
E. Lateral
A
- B
- C
- A
- E
- D
3
Q
This structure is bounded by T1 body posteriorly, medial edges of 1st rib and its costal cartilages laterally, and the superior margin of the manubrium of the sternum anteriorly. It communicates with the root of the neck for communication of the head and the thorax.
A
Superior thoracic aperture (thoracic outlet)
4
Q
This structure is bounded by T12 posteriorly, 12th rib, end of the 11th rib, the costal margin laterally, and the xiphoid process of the sternum (xiphisternal joint) anteriorly. It is large and expandible; it is largely filled by the diaphragm.
A
Inferior thoracic aperture
5
Q
Determine the corresponding descriptions of the lines of orientation of the thorax
- Vertical line at the anterior axillary fold
- Vertical line down the posterior wall of the thorax passing the inferior angle of scapula
- Median plane over sternum
- Vertical line at the posterior axillary fold
- Vertical line from midpoint of clavicle
- Line between anterior and posterior axillary folds
A. Midsternal line
B. Midclavicular line
C. Anterior axillary line
D. Posterior axillary line
E. Midaxillary line
F. Scapular line
A
- C
- F
- A
- D
- B
- E
6
Q
A flat bone also known as the breastbone found at the center of the anterior chest wall
A
Sternum
7
Q
Determine the corresponding descriptions of the parts of the sternum
- Made of hyaline cartilage in children that becomes ossified in adult life
- Articulates with clavicle and first and upper costal cartilages
- It is opposite T3-4
- Has attachments / notches for the costal cartilages of the ribs
- Lowest and smallest part of sternum
- Articulates with 2nd to 7th costal cartilages
A. Manubrium
B. Body
C. Xiphoid process
A
- C
- A
- A
- B
- C
- B
8
Q
The thorax acts as a ___ for structures passing between neck and abdomen and provides support for the UE.
A
conduit
9
Q
Determine the corresponding classification for the ribs / descriptions
- Rib 10
- Rib 4
- Rib 8
- Rib 7
- Attach anteriorly to each other and to the 7th rib by means of their costal cartilages
- Rib 11
A. True rib
B. False rib
C. Floating rib
A
- B
- A
- B
- A
- B
- C
10
Q
Determine the corresponding classification for the ribs / descriptions
- Rib 12
- Has a direct attachment to the sternum
- Rib 6
- Rib 3
- Rib 9
- Has no attachment to the sternum at all
A. True rib
B. False rib
C. Floating rib
A
- C
- A
- A
- A
- B
- C
11
Q
TRUE OR FALSE: In the thoracic cage, only cartilaginous (false) and plane (synovial) joints can be found.
A
True
12
Q
The space in front of the heart.
A
Precardiac space
13
Q
The space overlying the stomach. This space is found anteriorly in the thorax.
A
Traube’s (Semilunar) space
14
Q
The space between the scapulae.
A
Interscapular space
15
Q
The head of rib 10 has how many facets for articulation with T10?
A
a single facet
16
Q
TRUE OR FALSE: The 11th and 12th ribs
have tubercles or necks.
A
False.
They have none and therefore do not attach to the transverse process
17
Q
TRUE OR FALSE: The 1st, 10th, 11th, and 12th ribs
are only attached to their respective thoracic vertebrae (single attachment).
A
True
They are unlike the 2nd - 9th ribs which are attached to 2 thoracic vertebrae.
18
Q
These are made up of hyaline cartilage connecting the upper seven ribs to the lateral edge of sternum and the 8th to 10th ribs and act as shock absorbers. These make the rib and/or wall more elastic and allows for mobility.
A
Costal Cartilages
19
Q
TRUE OR FALSE: The esophagus passes through both superior and inferior thoracic apertures.
A
True
Additionally, structures that pass through the superior TA: trachea, vessels, nerves, apices of the lungs & pleura
Additionally, structures that pass through the inferior TA: large vessels & nerves
20
Q
TRUE OR FALSE: When performing medical procedures, it is better to insert needles below the superior border of the rib to avoid damaging the nerve.
A
False, above the superior border
21
Q
Arrange the contents of the neurovascular bundle from above going downwards
Choices: Nerve, Vein, Artery
A
- Vein
- Artery
- Nerve
22
Q
Anterior ramus of T12 is referred to as the ___
A
subcostal nerve
23
Q
Determine the corresponding descriptions of the openings of the diaphragm
- Found on the anterior of the T12 body; the aorta, thoracic duct, and azygos vein pass through it
- The central tendon, inferior vena cava, and terminal branches of the right phrenic nerve pass through it
- Esophagus, vagus nerves, esophageal branch of left gastric vessel, and lymphatics from lower esophagus pass through it
- Same level as T10 vertebra
- Same level as T8 vertebra
- Not a true opening but a gap behind the posterior margin of the diaphragm
A. Caval opening
B. Esophageal opening
C. Aortic opening
A
- C
- A
- B
- B
- A
- C
24
Q
TRUE OR FALSE: The first rib and costal cartilages are fixed and immobile.
A
True
25
Nerve roots of the phrenic nerve
C3, C4, C5
26
It is the dome-shaped primary muscle of inspiration that consists of 3 parts: sternal, costal, and vertebral parts. It is the main structure that divides the thorax and abdomen, and assists in raising intra-abdominal pressure.
Diaphragm
27
Determine the corresponding descriptions of the parts of the diaphragm
1. Comes from the sides of bodies of L1-3
2. Arises from deep surface of lower six ribs and costal cartilages
3. The insertion of diaphragm; muscle fibers of the diaphragm that converge in the center
4. Arises from the xiphoid process
5. Arises from the vertebral column
6. Comes from bodies of L1-2
A. Sternal part
B. Costal part
C. Vertebral part
D. Central tendon
E. Left crus
F. Right crus
1. F
2. B
3. D
4. A
5. C
6. E
28
The right diaphragm reaches the (1)___ border of 5th rib because the liver pushes the right diaphragm up; the left diaphragm reaches the (2)___ border of 5th rib.
1. upper
2. lower
29
Determine the corresponding structures passing through the openings of the diaphragm
1. Sympathetic trunk
2. Superior epigastric vessel
3. Left phrenic nerve
4. Passage of greater, lesser and lowest splanchnic nerves
A. Crura
B. Medial arcuate ligament
C. Between sternal and costal origin
D. Left dome
1. B
2. C
3. D
4. A
30
TRUE OR FALSE: The strength of the intercostal muscles protect the lung by preventing the sucking in or blowing out of the lung tissues during changes in intrathoracic pressure.
True
31
Determine the corresponding vertebrae levels of the following structures
1. Central tendon
2. Xiphisternal joint
3. Sternal angle of Louis
A. intervertebral disc of T4-T5
B. T9
1. B
2. B
3. A
32
Determine the corresponding type of the following joints
1. Joint of tubercle and transverse process
2. Sternal Joint / Manubriosternal joint or sternal angle of Louis
3. Costochondral
4. Xiphisternal joint
5. 2nd to 7th Sternochondral / chondrosternal / sternocostal
6. Costovertebral
7. 1st rib to manubrium Sternochondral / chondrosternal / sternocostal
A. Synovial, Plane
B. Cartilaginous
1. A
2. B
3. B
4. B
5. A
6. A
7. B
33
Determine the corresponding articulation / landmark of the following joints
1. Xiphoid process and body of sternum
2. Attachment of 2nd costal cartilage
3. Rib and costal cartilage
4. Head of rib to costal facet
5. Costal cartilage and sternum
A. Sternal Joint / Manubriosternal joint or sternal angle of Louis
B. Costovertebral
C. Costochondral
D. Sternochondral / chondrosternal / sternocostal joints
E. Xiphisternal joint
F. Joint of tubercle and transverse process
1. E
2. A
3. C
4. B
5. D
34
For naming typical ribs,
* the rib attached to the (1)___ costal facet of the vertebra
* the vertebra attached to (2)___ facet of the rib head
* transverse process of the vertebra attached to the (3)___
1. superior
2. inferior
3. rib tubercle
35
Determine the corresponding descriptions of the following structures
1. Marks the plane of separation of superior and inferior mediastinum
2. Inner surface of chest wall
3. Ascending aorta ends, arch of aorta starts and ends, and the descending aorta begins at this level
4. Sac or space between visceral and parietal pleura, has fluid that lubricates and protects the lung when it expands
5. Articular surface on the posterolateral aspect of the body at the junction of body and pedicle; located in superior and inferior sides
6. Thin membrane covering the lungs
A. Visceral pleura
B. Parietal pleura
C. Pleural cavity
D. Sternal Angle of Louis / Manubriosternal Joint
E. Demifacets
1. D
2. B
3. D
4. C
5. E
6. A
36
Determine the corresponding descriptions of the following vascular structures
1. Pericardiacophrenic & musculophrenic arteries (branches of internal thoracic arteries)
2. Right superior intercostal azygos
3. Brachiocephalic (neck), azygos system or abdominal veins
4. Anterior intercostal arteries from lateral branches of internal thoracic
5. Superior phrenic (from thoracic aorta) and inferior phrenic (abdominal aorta)
6. Left superior thoracic brachiocephalic
A. Arterial supply of intercostal nerves
B. Arterial supply of diaphragm
C. Venous drainage of intercostal nerves
D. Venous drainage of diaphragm
1. B
2. C
3. D
4. A
5. B
6. C
37
Enumerate the 5 attachments of the diaphragm
1. Xiphoid process
2. Costal margin
3. Ends of ribs 11 & 12
4. Lumbar vertebrae
5. Ligaments that span across structures of the posterior abdominal wall
38
The intercostal nerves carry somatic motor innervation to thoracic wall, sensory innervation to skin and parietal pleura, and postganglionic sympathetic fibers to the periphery. These nerves come from the anterior rami of what spinal levels?
T1-11
39
Anterior ramus of T1 forms part of the ___
brachial plexus
40
The lateral cutaneous branch of the ___ intercostal contributes to sensation of upper arm
2nd
41
TRUE OR FALSE: The lower intercostal nerve supplies the muscle, skin, and peritoneum of the abdominal wall
True
42
Where do the intercostal nerves, arteries and vein lie?
Costal groove
43
A condition caused by the compression of the brachial plexus nerves (C5,6,7,8 & T1), subclavian artery and vein as it exits between first rib and clavicle. The neurovascular bundle may also be impinged.
Thoracic Outlet Syndrome
44
TRUE OR FALSE: The tubercle of the rib has 2 parts, an articular part which is a medial oval facet for articulation of transverse process of associated vertebrae, and a non-articular part which is roughened by attachment of ligaments.
True
45
Determine the corresponding descriptions of the parts of typical ribs
1. Has 2 costal facets separated by a crest
2. Articulates with the transverse costal facets
3. Long, thin, flat and twisted on long axis from tubercle to sternal end
4. Posterior vertebral end
5. Flat slightly constricted region separating head from tubercle
6. Prominence in the outer posterior surface at junction of the neck and body
A. Head
B. Neck
C. Tubercle
D. Shaft / Body
1. A
2. C
3. D
4. A
5. B
6. C
46
Determine the corresponding descriptions of the parts of typical ribs
1. Sharp and thin
2. Where the costal cartilage is attached
3. Smooth and round
4. Found in the inferior internal surface of the shaft of rib
5. The part where the body sharply turns and the most common site of fracture
A. Superior margin
B. Costal groove
C. Angle of the ribs
D. Sternal end
E. Inferior margin
1. E
2. D
3. A
4. B
5. C
47
TRUE OR FALSE: The inferior facet of the rib head is larger and wider than the superior facet. It articulates with the superior costal facet of its own vertebrae, serving as the main attachment.
True
48
Ribs are counted from this level to downwards
Sternal Angle of Louis / Manubriosternal Joint
NOTE: 2nd rib lies at sternal angle
49
TRUE OR FALSE: The trachea divides into 2 principal bronchi at the level of the Sternal Angle of Louis. The cardiac plexuses are also situated at this level.
True
50
TRUE OR FALSE: The pulmonary trunk divides into 2 pulmonary arteries below the level of the Sternal Angle of Louis.
True
51
TRUE OR FALSE: The Sternal Angle of Louis marks the lower limit of the base of the heart.
False
It marks the upper limit
52
TRUE OR FALSE: The azygos vein arches over the roof of the Right Lung and opens in the Superior Vena Cava at the level of the Sternal Angle of Louis.
True
53
TRUE OR FALSE: The thoracic duct crosses from the right to the left side and reaches the left side at the level of the Sternal Angle of Louis.
True
54
Determine the corresponding descriptions of the atypical ribs
1. Short, a little curved, and pointed anteriorly
2. Has a scalene tubercle (on superior surface) which separates two smooth grooves crossing the rib at the shaft
3. Flat but twice as long as first rib
4. Attached to T1 and T2
5. Has a close relation to the lower nerves of brachial plexus and subclavian artery and vein
6. Has a subclavian groove
A. 1st rib
B. 2nd rib
C. 10th rib
D. 11th and 12th ribs
1. D
2. A
3. B
4. B
5. A
6. A
55
Determine the corresponding descriptions of the special tests for TOS
1. PT draws the patient's shoulder down and back as the patient lifts their chest in an exaggerated "at attention" posture.
2. PT flexes the patient's elbow to 90 degrees while the shoulder is extended horizontally and rotated laterally. The patient is asked to turn their head away from the tested arm.
3. PT palpates the radial pulse while moving the upper extremity in abd, ext, and ER; patient then is asked to rotate her head toward the involved side while taking a deep breath and holding it.
A. Allen test
B. Adson’s test
C. Costoclavicular maneuver (hyperabduction)
1. C
2. A
3. B
56
The 1st rib has shallow subclavian grooves. Its (1)___ groove transmits the subclavian vein and its (2)___ groove is where lower trunk of brachial plexus and subclavian artery cross the rib and lie in contact with the bone.
1. Anterior
2. Posterior
57
Determine the corresponding descriptions of the causes of TOS
1. Beneath pectoralis minor
2. Extra rib from C7
3. Between the anterior & middle scalene
4. Between clavicle & 1st rib
A. Cervical rib
B. Scalene syndrome
C. Costoclavicular syndrome
D. Hyperabduction syndrome
1. D
2. A
3. B
4. C
58
The space between adjacent ribs that contains the muscles of respiration
Intercostal Space
59
Determine the corresponding descriptions of the intercostal muscles
1. Directed down and backward
2. Posterior intercostal membrane
3. Incomplete muscle layer
4. Anterior intercostal membrane
5. Directed down and forward
6. Deepest layer, related to endothoracic fascia and parietal pleura
A. External intercostal
B. Internal intercostal
C. Innermost intercostal
1. B
2. A
3. C
4. C
5. A
6. C
60
Arrange the structures most pronounced in the lateral aspect of thoracic wall from superficial to deep.
Choices: Intercostal membrane, Extrapleural fatty layer, Superficial fascia, Endothoracic fascia, Skin, Parietal pleura, Deep fascia
1. Skin
2. Superficial fascia
3. Deep fascia
4. Intercostal membrane
5. Endothoracic fascia
6. Extrapleural fatty layer
7. Parietal pleura
These are the layers needed to be penetrated by a needle.
61
Common site of fracture of the rib
a. Head
b. Neck
c. Costochondral junction
d. Angle
e. Tubercle
d. Angle
62
The Xiphisternal joint is located approximately at this level
a. body of L1
b. between T4-5 intervertebral disc
c. opposite T9 body
d. at the level of L5
e. body of T12
c. opposite T9 body
63
Plane synovial joints in the thoracic cage are:
a. between tubercle of rib and transverse process
b. between costal facet of thoracic body and head of rib
c. 1st costal cartilage and the manubrium
d. A and B
e. all
d. A and B
64
True regarding the subcostales
a. comes from internal surface of upper rib (at angle)
b. inserts 2-3 ribs below
c. is an expiratory muscle
d. A and B only
b. inserts 2-3 ribs below
65
The following pass through the esophageal opening in the diaphragm except
a. vagus nerve
b. lymphatics from lower 3rd of esophagus
c. left gastric vessel
d. None
d. None
66
Cartilaginous joints in the thoracic cage are:
a. manubriosternal joint
b. xiphisternal joint
c. costovertebral joint
d. A and B
e. all
d. A and B
67
Atypical ribs EXCEPT:
a. 1st rib
b. 2nd rib
c. 11th rib
d. 10th rib
e. none
e. none
68
Causes of thoracic outlet syndrome
a. costoclavicular syndrome
b. scalene syndrome
c. cervical rib
d. A and C
e. all of the above
e. all of the above
69
The levatores costarum comes from
a. superior border of rib
b. transverse process of the vertebrae
c. inferior border of rib
d. xiphoid process
e. body of the thoracic vertebra
b. transverse process of the vertebrae
70
The following are true about the Sternal angle of Louis, EXCEPT
a. Opposite T4 intervertebral disc
b. where 2nd rib is attached
c. is a synovial plane joint
d. A and B
e. A and C
c. is a synovial plane joint
71
The following are inspiratory muscles:
a. levatores costarum
b. transversus thoracis
c. serratus posterior inferior
d. A and B only
e. all
a. levatores costarum
72
The space anteriorly below the costal margin on the left
where the stomach, spleen is located is called:
a. Traube's space
b. Vermiforme
c. Louis's space
d. umbilical space
e. pericardial space
a. Traube's space
73
True regarding the costal cartilage:
a. are bars connecting the upper seven ribs to the edge of the sternum
b. the 8th to the 10th attach to the cartilage immediately above
c. the cartilages of the 11th and 12th ribs end in the abdominal musculature
d. A and B only
e. all of the above
e. all of the above
74
The head of Rib 10 articulates with thoracic vertebrae demifacets of 9th and 10 vertebrae. The tubercle of this rib is attached to the transverse process of thoracic 10.
a. First statement is true and 2nd is false
b. First statement is false and 2nd is true
c. Both statements are true
d. Both statements are false
b. First statement is false and 2nd is true
75
The diaphragm flattens when it contracts during inspiration. The right cupulae of the diaphragm is higher than the left.
a. first statement is true and 2nd is false
b. first statement is false and 2nd is true
c. both statements are true
d. both statements are false
c. both statements are true
76
The innermost intercostal muscle
a. Deepest layer found in the intercostal space
b. Is incomplete and crosses more than one intercostal space
c. Is divided into 3 portions: (anterior part) transversus thoracis, (lateral part) innermost intercostal, (posterior part) subcostales
d. only A and C are true
e. all are true
e. all are true
77
The roots (and trunk) most commonly affected in thoracic
outlet syndrome is the
a. C5-6 root (upper trunk)
b. C7 root (middle trunk)
c. C8-T1 (lower trunk)
c. C8-T1 (lower trunk)
78
Boundaries of the superior thoracic aperture include:
a. superior border 1st rib
b. first rib and its costal cartilage
c. Clavicle
d. A and B only
e. all
d. A and B only
79
Features of the 12th rib
a. called floating rib
b. has no tubercle and head
c. has a single attachment to body of T12
d. A and C only
e. All
d. A and C only
80
The following pass through the thoracic outlet
a. Trachea
b. Esophagus
c. Arch of the aorta
d. A and B only
e. All of the above
d. A and B only
81
TRUE OR FALSE: The central tendon is at the level of 10th thoracic vertebra.
False
82
TRUE OR FALSE: The central tendon of the diaphragm supports the heart.
True
83
TRUE OR FALSE: During the descent of the diaphragm, the pressure change compresses the blood in the inferior vena cava to the right atrium.
True
84
TRUE OR FALSE: The diaphragm is the most important muscle for inspiration.
True
85
TRUE OR FALSE: Left phrenic nerve enters through the caval opening.
False
