Thoracic Flashcards

1
Q

Characteristics of a true rib

A

1-7,
Attach directly to the sternum,
Own cartilage connects to the sternum

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2
Q

Characteristics of a false rib

A

8-10,
Indirect sternal attachment,
Cartilage connects to the cartilage of the rib above

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3
Q

Characteristics of a floating rib

A

11-12,
No sternal attachment

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4
Q

Characteristics of a typical rib

A

3-9,
Has a head, neck, tubercle, and body

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5
Q

Characteristics of an atypical rib

A

1, 2, 10-12;
Has additional factors that make the rib atypical

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6
Q

Characteristics of 1st rib

A

Shortest and broadest,
Only attaches to T1,
has grooves for subclavian artery and vein

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7
Q

Characteristics of 2nd rib

A

Longer than first,
has tuberosity for attachment of serratus anterior

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8
Q

Characteristics of 11th and 12th ribs

A

short,
have no neck or tubercle,
Head only for 1 attachment

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9
Q

3 spaces of the thoracic cavity

A

Mediastinum, right and left pulmonary cavities

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10
Q

What is located in the mediastinum cavity?

A

Thoracic viscera besides lungs,
(Heart and major vessels and tubes)

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11
Q

What is located in the right and left pulmonary cavities

A

The right and left lungs

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12
Q

What is the function of the thoracic cage?

A

Provide protection;
Resist negative pressure from inspiration; provide attachment for upper limb muscles; attachment for muscles of neck, abdomen, back, and respiration

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13
Q

What are intercostal spaces?

A

Separate ribs from each other;
11 spaces and 11 intercostal nerves;
(+ subcostal nerve)

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14
Q

How are intercostal spaces named?

A

Named by the rib superior to them

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15
Q

What lives in intercostal spaces?

A

Intercostal muscles, membranes, blood vessels, and nerves

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16
Q

Which ribs are true ribs?

A

1-7

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17
Q

Which ribs are false ribs?

A

8-10

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18
Q

Which ribs are floating?

A

11 and 12

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19
Q

What are the normal features of a vertebrae?

A

Body,
2 pedicles,
2 lamina,
vertebral arch,
2 Transvers process,
Spinous process,
Superior/inferior facets,
Zygapophysial joint

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20
Q

What are the unique features of thoracic vertebrae?

A

Bilateral costal facets
-superior and inferior

Costal facets on transverse process

Long slanting spinous processes

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21
Q

What are the 3 parts of the sternum?

A

Manubrium
Body
Xiphoid

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22
Q

What structure is the xiphisternal point a marker for?

A

Marks inferior limit of central part of thoracic cavity

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23
Q

What structures is the infrasternal angle a marker for?

A

Marks midline for superior limit of the liver

central tendon of the Diaphragm

Inferior boarder of the heart

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24
Q

What are the contents of the Superior Thoracic Aperture?

A

Trachea

Esophagus

Nerves and vessels supplying and draining head, neck, and upper limbs

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25
Q

What is contained in the Inferior Thoracic Aperture?

A

Diaphragm
- separates thoracic and abdominal cavities

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26
Q

Intervertebral Joint
T1-T12

A

Articulation: adjacent vertebral bodies bound by intervertebral disc

27
Q

Costovertebral

A

Joints of heads of ribs - number of rib is determined by vertebrae inferior to it

A: Head of each rib w/ superior demi- or costal facet of vertebral body of same number rib and inferior demi- or costal facet of vertebral body superior to it and intervertebral disc b/w them

C: Heads of 1st, 11th, and 12th ribs (sometimes 10th) articulate ONLY w/ vertebral body of same number rib

28
Q

Costochondral

A

Sternal end of rib attaching to cartilage coming from sternum

A: Lateral end of costal cartilage w/ sternal end of rib (Rib and Transverse Process)

C: No movement normally occurs here

29
Q

Interchondral

A

Cartilage that attaches the 6th, 7th, 8th, 9th, and 10th ribs together

A: b/w costal cartilages of 6th & 7th, 7th & 8th, and 8th & 9th ribs

C: articulation b/w costal cartilages of 9th & 10th ribs is fibrous

30
Q

Sternocostal (1st)

A

Attachment of first rib to the manubrium of the sternum

A: articulation of 1st costal cartilages w/ manubrium of sternum

31
Q

Sternocostal (2nd - 7th)

A

Attachment of the 2nd-7th ribs to the body of the sternum
A: 2nd - 7th pairs of costal cartilages w/ sternum

C: Articular cavities usually absent, fibrocartilage covers articular surfaces

32
Q

Sternoclavicular

A

Clavicle attachment at the manubrium of the sternum

A: Sternal end of clavicle w/ manubrium and 1st costal cartilage

C: joint is divided into 2 compartments by articular disc

33
Q

Manubriosternal

A

Joint between the manubrium and body of the sternum

A: b/w manubrium and body of sternum

34
Q

Xiphisternal

A

Joint between body of the sternum and xiphoid process

A: b/w xiphoid process and body of sternum

35
Q

What do the manubriosternal and xiphisternal joints do in older individuals?

A

Fuse together and become synostoses

36
Q

Which ribs move in a “pump handle” fashion?

A

Ribs 1-6

37
Q

What movement do the inferior ends move in and around what axis do “pump handle” ribs move around?

A

Anterior and posterior type movement and around a transverse axis

38
Q

What ribs move in a “bucket handle” fashion?

A

Ribs 7-10

39
Q

What kind of movement do the ribs of the “bucket handle” engage in?

A

Lateral movements that are more so up and out

40
Q

What do the “pump handle” and “bucket handle” movements help with in the thoracic cage?

A

They increase diameter and volume of the thoracic cavity

41
Q

What are axio-appendicular muscles?

A

They attach to or cover the thoracic cage

Also move the upper limb BUT can also move bones in thoracic cage

42
Q

What are the main muscles of the thoracic cavity?

A

Serratus Posterior Superior
Serratus Posterior Inferior
Levator Costarum

43
Q

What are the major muscles for inspiration?

A

Diaphragm and external intercostals

44
Q

Innervation of the Diaphragm

A

Phrenic Nerve (C3-C5)

Sensory to Peripheral parts - Intercostal nerves 6-11

45
Q

Openings in Diaphragm

A

Opening for Vena Cava
Aortic Hiatus
Esophageal hiatus

46
Q

Functions/ movements for Diaphragm

A

Contracts (descends) during inspiration

47
Q

Which dome is higher on the Diaphragm?

A

Right

Due to liver directly inferior and heart presence on left side of thoracic cavity

48
Q

What is innervated by the Anterior rami of the 12 pairs of thoracic nerves?

A

Usually muscles under dermatomes anteriorly

T1 - T11: Intercostal Nerves
T12: Subcostal nerve

49
Q

What is innervated by the Posterior rami of the 12 pairs of thoracic nerves?

A

Joints
Deep back muscles (myotomes)
Skin of the back

50
Q

Dermatome landmarks of the thoracic region (Anterior & Posterior)

A

Posterior - lines up with corresponding vertebrae

Anterior - Runs inferiorly

Common spots anteriorly:
T2 - Subclavicular region
T5 - Nipple region
T10 - Umbilical region

51
Q

What are the atypical intercostal nerves

A

T1 & T2 (sometimes T3)

52
Q

Why is T1 an atypical intercostal nerve?

A

Splits into superior and inferior parts

Superior: joins brachial plexus
Interior: becomes first intercostal nerve

53
Q

Why is T2 (& sometimes T3) an atypical intercostal nerve?

A

T2 is considered the Intercostobrachial Nerve
- supplies skin and cutaneous tissue of axilla floor

T3 sometimes gives rise to a second intercostobrachial nerve

54
Q

Where does the vasculature to the thoracic cage come from?

A

Thoracic aorta
Subclavian artery
Axillary artery

55
Q

What is the difference between Mammary glands and Mamillary bodies?

A

Mammary glands: milk producing glands of the breasts in women

Mamillary bodies: pair of round, small bodies located on the undersurface of the brain in diencephalon

56
Q

Flow of lymph from the breast to venous circulation?

A

Nipples/Areola/Lobules -> subareolar lymphatic plexus -> 1) 75% to axillary lymph nodes, 2) 25% to parasternal lymph nodes, 3) abdominal nodes ->

1) -> clavicular lymph nodes -> subclavian lymphatic trunk

2) -> Bronchomediastinal lymphatic trunk

ALL lead either to -> Jugular lymphatic trunk or Right/Left venous angles to R/L Brachiocephalic veins

*could also go to other breast

57
Q

Important landmarks for palpation on thorax

A

Clavicles
Sternum
Jugular notch
Manubrium
Sternal angle
Xiphoid process
Costal Margins
Ribs/intercostal spaces

58
Q

Difference between “slipping rib” or “rib separation”?

A

Slipping rib: displacement of costal cartilage from sternum
- (sternocostal joint or interchondral joints)

Rib separation: Dislocation of costochondral junction b/w rib & its costal cartilage
-usually ribs 3-10 and tears perichondrium and periosteum

59
Q

Dsypnea

A

Difficulty breathing

Leaning on knees usually helps to fix pectoral girdle and allow muscles to expand thorax by acting on rib attachments

60
Q

Cause and Effect of Thoracic Outlet Syndrome

A

Cause: Neurovascular structures are compressed when passing through Superior Thoracic Aperture
-usually involves structures outside of superior thoracic aperture like pec. minor & costoclavicular space

Effect: Symptoms - pain, paresthesias (pins and needles) in upper arms

61
Q

What happens to the paralyzed side of the diaphragm during breathing?

A

Inspiration: ascends due to pressure of abdominal viscera coming from other side of diaphragm

Expiration: Descends due to positive pressure in lungs

62
Q

How does Herpes Zoster happen?

A

(AKA Shingles)

Viral disease of spinal ganglia

usually occurs in 60yrs or older individual

63
Q

Why does Herpes Zoster appear in these locations?

A

Viral infection is present in the spinal ganglia that these dermatomes supply

Become present on the skin as a result