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Thorax > The Thoracic Wall > Flashcards

The Thoracic Wall Flashcards

1
Q

what is the thorax

A

a truncated dome-shaped structure, formed by the sternum, costal cartilages, ribs and thoracic vertebrae

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2
Q

where does the thorax extend

A

from the root of the neck to the abdomen

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3
Q

what are the basic boundaries of the thorax

A
  • superior thoracic aperture
  • inferior thoracic aperture
  • thoracic wall
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4
Q

contents of the thorax

A
  • lungs
  • heart
  • mediastinum
  • trachea
  • bronchi
  • oesophagus
  • vagus and phrenic nerves
  • major systemic and pulmonary vessels
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5
Q

another name for the superior thoracic aperture

A

thoracic inlet

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6
Q

margins of superior thoracic aperture

A
  • superiorly - upper first rib, costal cartilage, manubrium
  • posteriorly - 1st thoracic vertebra
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7
Q

what is present between the margins of the superior thoracic aperture

A

apexes of each lung covered by the suprapleural membrane

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8
Q

what is another name for the suprapleural membrane

A

sibson’s fascia

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9
Q

superior thoracic aperture function

A

allows important structures to pass in and out thorax

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10
Q

five important structures that pass through the superior thoracic aperture

A
  • trachea
  • oesophagus
  • subclavian artery and vein
  • common carotid artery
  • internal jugular vei
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11
Q

shape and size of superior thoracic aperture

A
  • 5cm in length
  • 10cm transversely
  • slopes down from posterior aspect to anterior aspect
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12
Q

another name for inferior thoracic aperture

A

thoracic outlet

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13
Q

what is the inferior thoracic aperture composed of

A

diaphragm

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14
Q

margins of the inferior thoracic aperture

A
  • T12 posteriorly
  • costal margins of ribs 7-12 mediolaterally
  • xiphoid process anteriorly
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15
Q

name three important structures that pass through the inferior thoracic aperture

A
  • oesophagus
  • descending aorta
  • inferior vena cava
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16
Q

name 1

A

lung

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17
Q

name 2

A

pleural cavity

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18
Q

name 3

A

visceral pleura

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19
Q

name 4

A

parietal pleura

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20
Q

name 5

A

intercostal vein

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21
Q

name 6

A

intercostal artery

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22
Q

name 7

A

intercostal nerve

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23
Q

name 9

A

collateral branches

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24
Q

name 10

A

endothoracic fascia

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25
Q

name 11

A

serratus anterior muscle

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26
Q

name 12

A

external intercostal muscle

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27
Q

name 13

A

internal intercostal muscle

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28
Q

name 14

A

innermost intercostal muscle

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29
Q

name 15

A

skin

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30
Q

name 16

A

superficial fascia

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31
Q

four functions of the thorax

A
  • respiration
  • protection of vital organs
  • conduit
  • support for breast tissue
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32
Q

explain respiration as a function of the thorax

A

movements of the thoracic wall increase/decrease intra-thoracic volume. this results in inspiration and expiration

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33
Q

what vital organs does the thorax protect

A
  • heart and lungs
  • abdominal organs - liver, spleen, kidneys
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34
Q

what is the primary function of the thorax

A

respiration

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35
Q

why are thoracic lines important

A

for the placement of ecg leads

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36
Q

name the three anterior thoracic lines

A
  • midsternal line
  • midclavicular lines
  • lateral sternal lines
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37
Q

where does the mid sternal line run

A

bisects the middle part of the sternum

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38
Q

where do the midclavicular lines run

A

run vertically from the centre of the jugular notch to the tip of the acromiom of scapula

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39
Q

where do the lateral sternal lines run

A

lateral margins of sternum

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40
Q

name the two posterior thoracic lines

A
  • midvertebral line
  • scapular lines
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41
Q

where does the midvertebral line run

A

straight down the middle of the spine

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42
Q

clinical consideration for the midvertebral line

A

scoliosis will cause it to be crooked

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43
Q

where do the scapular lines run

A

down through the inferior margins of the scapula

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44
Q

name the two lateral thoracic lines

A
  • axillary lines (posterior and anterior)
  • midaxillary line
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45
Q

where do the axillary lines run

A

vertical lines which correspond to the anterior and posterior axillary folds

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46
Q

what are the axillary folds

A
  • frame axilla
  • formed anteriorly by lateral border of pec major
  • formed posteriorly by the borders of latissimus dorsi and teris major
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47
Q

where does the midaxillary line run

A

bisects the axillary lines

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48
Q

what is another name for the suprasternal notch

A

jugular notch

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49
Q

where is the suprasternal notch located

A

above the manubrium and below the clavicles, at the vertebral disc between T2 and T3

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50
Q

clinical consideration of the suprasternal notch

A

The superior vena cava passes directly behind the manubrium returning blood from the head and neck - notch means we can measure jugular venous pressure to help form a differential diagnosis of congestive heart failur

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51
Q

another name for the sternal angle

A

angle of louis

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52
Q

where is the angle of louis located

A
  • at manubriosternal junction - at the vertebral disc between T4 and T5
  • It’s the point at which the 2nd rib and costal cartilage attach to the sternum
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53
Q

where is the xiphosternal joint located

A

at the level of the ninth thoracic vertebra

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54
Q

what is 1

cardiac auscultations

A

aortic area: second right intercostal space

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55
Q

what is 2

cardiac auscultations

A

pulmonary area: second left intercostal space

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56
Q

what is 3

cardiac auscultations

A

erb’s point: third left intercostal space (left sternal border)

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57
Q

what is 4

cardiac auscultations

A

tricuspid area: fourth left intercostal space (left lower sternal border)

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58
Q

what is 5

cardiac auscultations

A

mitral area or apex: fifth left intercostal space (midclavicular line)

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59
Q

how many chest leads are there in a 12 lead ECG

A

6

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60
Q

V1/V2

A

fourth left and right intercostal spaces

61
Q

V4

A

fifth intercostal space at the midclavicular line

62
Q

V3

A

midway between V2 and V4

63
Q

V5

A

fifth intercostal space at the anterior axillary line

64
Q

V6

A

fifth intercostal space at the midaxillary line

65
Q

what is the sternum made up of

A

manubrium, body and xiphoid process

66
Q

where are intercostal spaces

A

spaces in between the ribs

67
Q

what do intercostal spaces contain

A

three layers of muscle and the neurovascular bundle

68
Q

where specifically is the neurovascular bundle within the intercostal space

A

the costal groove

69
Q

where does the thoracic wall thicken

A

at the apex of each lung as the suprapleural membrane (sibson’s fascia) atttaches to the internal border of the first rib and the transverse processes of C7

70
Q

what are the components of the thoracic cage

A
  • 12 thoracic vertebrae
  • 12 pairs of ribs
  • sternum
71
Q

which are the true ribs

72
Q

what are true ribs

A

those which have a direct connection to the sternum anteriorly

73
Q

which are the false ribs

74
Q

what are false ribs

A

their costal cartilages are connected to the rib above them not the sternum directly

75
Q

which are the floating ribs

76
Q

what are floating ribs

A

no cartilaginous connection to the sternum

77
Q

main features of typical thoracic vertebrae

A
  • heart shaped body
  • superior and inferior demi-facets on both sides of the body
  • costal facets on transverse processes
  • long downward slanting spinous processes
78
Q

purpose of demi-facits on thoracic vertebrae

A

articulation with ribs

79
Q

main feature of atypical thoracic vertebrae

A

do not contain 2 demi-facets

80
Q

puporse of the expanded head at the end of a rib

A
  • articulates with demi-facets of thoracic vertebrae
  • apex of head articulates with intervertebral disc between the two vertebrae
81
Q

shape of rib 1

A

short and wide

82
Q

features of rib 1

A
  • only has 1 facet
  • only articulates with manubrium
  • superior surface is marked with two grooves which make way for subclavian vein and artery
83
Q

shape of rib 2

A

thin and long

84
Q

main feature of rib 2

A

has a rough edge where the serratus anterior muscle originates from

85
Q

where are the sternocostal joints

A

between true ribs

86
Q

classification of the sternocostal joint at the first rib

A

primary cartilaginous

87
Q

classification of sternocostal joints at ribs 2-7

A

plane synovial

88
Q

is the plane synovial joint at rib 2 single or double

89
Q

are the plane synovial joints at ribs 3-7 double or single

90
Q

what are sternocostal joints stabilised by

A

sternocostal ligaments and thin capsules

91
Q

what kind of movement do sternocostal joints allow for

A

slight, gliding movements

92
Q

where are costochondral joints found

A

between costal cartilages and ribs

93
Q

classification of costochondral joints

A

primary cartilaginous

94
Q

another name for primary cartilaginous

A

synchondrosis

95
Q

what kind of movement do costochondral joints allow for

A

no movement

96
Q

clinical consideration for costochondral joints

A

may become inflamed - costochondritis

97
Q

where are interchondal joints

A

between ribs 8-10

98
Q

classification of interchondral joints

A

plane synovial

99
Q

what are interchondral joints stabilised by

A

interchondral ligaments and thin capsules

100
Q

classification of xiphersternal joint

A

secondary cartilaginous

101
Q

another name for secondary cartilaginous

102
Q

classification of manubriosterna joint or angle of louis

A

secondary cartilaginous

103
Q

measurement of angle of louis

A

162 degrees

104
Q

what kind of movement does the angle of louis allow for

A

little movement

105
Q

sternoclavicular joint classification

A

synovial saddle joint

106
Q

what is the sternoclavicular joint stabilised by

A

anterior and posterior sternoclavicular, interclavicular and costoclavicular ligaments

107
Q

costovertebral joint location

A

articulations of the demi-facets in the head of each rib with the bodies of the corresponding vertebra and that of the vertebra above

108
Q

costovertebral joint classification

A

2 plane synovial

109
Q

what kind of movements do costovertebral joints allow for

A

gliding movements

110
Q

what are costovertebral joints stabilised by

A

capsular, radiate, intra-articular ligaments

111
Q

costotransverse joint locations

A

articulations between rib facets and the transverse process of their corresponding vertebra

112
Q

costotransverse joints classification

A

2 plane synovial

113
Q

what kind of movement do costotransverse joints allow for

A

simple, rotational and sliding movements

114
Q

what are costotransverse joints stabilised by

A

capsular, inferior costotransverse, superior costotransverse and lateral costotransverse ligaments

115
Q

which thoracic joint usually ossifies late in life

A

xiphosternal joint

116
Q

the movements of which two thoracic joints occur simultaneously

A

costovertebral and costotransverse joints

117
Q

primary respiratory muscles for inhalation

A

diaphragm
external intercostal muscles

118
Q

accessory respiratory muscles for inhalation

A
  • sternocleidomastoid muscle
  • scalene muscles
  • pectoralis minor
  • serratus anterior muscle
119
Q

accessory respiratory muscles for expiration

A
  • internal intercostal muscles
  • transverse thoracis muscle
  • external oblique muscle
  • rectus abdominus
  • internal oblique muscle
120
Q

why are there no primary respiratory muscles for expiration

A

because it is usually a passive process

121
Q

where are the intercostal muscles found

A

intercostal space between ribs

122
Q

name the three intercostal muscles

A
  • external intercostal muscle
  • internal intercostal muscle
  • innnermost intercostal muscle
123
Q

external intercostal muscle function

A
  • inspiration
  • contraction causes teh adjacent rib to rise and seperate - thus increasing thorax volume
124
Q

internal intercostal muscle function

A
  • expiration
  • contraction pulls ribs together, compressing the thorax - this reducing thorax volume
125
Q

what is the transverse thoracis group

A
  • innermost part of thoracic wall
  • help with articulation of the ribs and sternum
126
Q

three muscles that make up the transverse thoracis group

A
  • subcostalis posteriorly
  • transverse thoracic (sternocostalis) anteriorly
  • innermost intercostal laterally
127
Q

what artery supplies teh 1st and 2nd intercostal spaces dorsally

A

the superior intercostal artery from the costocervical trunk

128
Q

what artery supplies all the intercostal spaces bar 1&2 dorsally

A

the descending aorta

129
Q

what artery supplies the upper six intercostal spaces anteriorly

A

branches of the internal thoracic artery

130
Q

what artery supplies intercostal spaces 7-9 anteriorly

A

the musculophrenic branch of the internal thoracic artery

131
Q

how many veins in each intercostal space

A
  • one posterior intercostal
  • two anterior intercostal
  • one collateral
132
Q

where do anterior veins drain into

A

the musculophrenic and internal thoracic veins

133
Q

where do posterior veins drain into

A

into the azygos vein on the right and the hemiazygos and accessory hemiazygos on the left

134
Q

name 7 simple clinical considerations for the thoracic wall

A
  • Costovertebral dislocation (at any level)
  • Transverse rib fracture
  • Oblique rib fracture
  • Overriding rib fracture
  • Costochondral separation
  • Chostosternal separation
  • Sternal fracture
135
Q

name 5 complicated clinical considerations for the thorax

A
  • Traumatisation of pleura and of lung
  • Multiple rib fractures
  • Tear of blood vessels (hemothorax)
  • Compound by missile or by puncture wound
  • Injury to heart or to great vessels
136
Q

three examples of traumatisation of pleura and of lung

A
  • Pneumothorax
  • Lung contusion
  • Subcutaneous emphysema
137
Q

what is 1

A

costovertebral dislocation

138
Q

what is 2

A

tranverse rib fracture

139
Q

what is 3

A

oblique rib fracture

140
Q

what is 4.

A

overriding rib fracture

141
Q

what is 5.

A

chondral fracture

142
Q

what is 6

A

chostochondral seperation

143
Q

what is 7

A

chondosternal seperation

144
Q

what is 8

A

sternal fracture

145
Q

what is 9

A

traumatisation of pleura and of lung

146
Q

what is 10

A

multiple rib fractures

147
Q

what is 11

A

tear of blood vessels

148
Q

what is 12

A

compound by missile or by puncture wound

Thorax (9 decks)

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