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Exam 2 > Thoracic Wall > Flashcards

Thoracic Wall Flashcards

1
Q

What thoracic vertebrae are considered atypical

A

Vertebrae 1, 2, 9, 10, 11, 12

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2
Q

What is the thoracic wall composed of

A

Bones
Muscles and fascia
Supportive structures
skin

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3
Q

What are the bones of the thoracic wall

A

vertebrae
ribs
sternum

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4
Q

What are the functions of the thoracic wall

A

protection of organs
aid in respiration
Support of upper limb

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5
Q

What vertebral level is scapular spine

A

T3

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6
Q

What vertebral level is inferior angle of scapula

A

T7

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7
Q

What vertebral level is 12th rib

A

T12

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8
Q

What will result form dysfunction of the thoracic vertebrae

A

Impacts ribs and breathing

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9
Q

What thoracic vertebrae are considered typical

A

2-8

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10
Q

What are the features of vertebrae 2-9 that make them typical

A

costal demifacets and facet for tubercle of rib

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11
Q

How do ribs articulate with vertebrae in typical scenarios

A

articulates with 2 vertebral bodies and the facet on transverse process

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12
Q

Where does the rib articulate with the transverse process

A

tubercle of rib

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13
Q

How is the first vertebrae atypical

A

full facet on top and demifacet on bottom

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14
Q

How is 9th vertebrae atypical

A

demifacet on superior and nothing on inferior

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15
Q

How are 10-12th vertebrae atypical

A

full facets on superior part, nothing on inferior part

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16
Q

Describe the course of ribs in relation to articulation in front and vertebral level

A

few spinal levels lower in the front than the back as they travel anterior and inferior to meet the sternum

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17
Q

Which ribs are considered typical

A

3-9

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18
Q

Which ribs are considered atypical

A

1,2,10,11,12

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19
Q

How are ribs 3-9 typical ribs

A

2 spots on head for articulation with demifacet
neck has tubercle for articulation with transverse process
Costal groove for VAN

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20
Q

How is rib 1 atypical

A

strong curve
flat
lacks angle seen in typical ribs
Tubercle for attachment of scalene muscles
2 grooves for subclavian vein, artery, and brachial plexus

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21
Q

What is the clinical relationship of cervical ribs

A

can compress subclavian vessels and brachial plexus

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22
Q

What are the borders of the scalene triangle

A

anterior scalene
middle scalene
rib 1

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23
Q

What structures are contained in the scalene triangle

A

brachial plexus
subclavian artery

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24
Q

Where do the phrenic nerve and subclavian vein run in relationship to the scalene triangle

A

in front of anterior scalene

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25
Q

What are signs and symptoms of dysfunction the anterior scalene muscle

A

abnormal tone lifting first rib impacts blood flow to the limb and innervation

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26
Q

What type of joint is the costovertebral articulation

A

synovial plane

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27
Q

What type of the joint is the articulation between the first rib and the sternum

A

primary cartilaginous (synchondrosis fibrocartialginous joint)

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28
Q

What type of movement does the rib 1 allow

A

not a lot of movement; where pump handle movement originates.

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29
Q

When the first rib moves, what occurs

A

the whole rib cage moves

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30
Q

What type of joints are the sternocostal articulations (except rib 1)

A

synovial plane

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31
Q

What type of joints are costochondral joints

A

primary cartilaginous

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32
Q

What type of joints are interchondral joints

A

synovial plane

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33
Q

What type of joint is the manurial sternal joint

A

secondary cartilaginous; symphysis

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34
Q

What are the lines of reference regarding the thorax

A

mid-axillary
mid-clavicular
scapular

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35
Q

What are the intercostal muscle types

A

external intercostal
internal intercostal
innermost intercostals

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36
Q

What direction are the fibers of the external intercostal muscles

A

hands in pocket (superior, posterior, inferior anterior)

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37
Q

What direction are the fibers of the internal intercostal muscles

A

perpendicular to external intercostals (inferior to superior)

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38
Q

What direction are the fibers of the innermost intercostal muscles

A

same as the internal intercostals

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39
Q

How many ribs do the subcostal muscles span and where are they found

A

spans 2 ribs
posterior wall of thoracic cage

40
Q

Where is the transverses thoracis muscle found

A

posterior side of anterior thoracic wall

41
Q

What is the function of transverses thoracis

A

depresses the ribs

42
Q

What is the innervation of transverses thoracis

A

intercostal nerves

43
Q

List the order of layers starting at external intercostals to inside

A

External intercostals
Internal intercostals
VAN
Innermost intercostals
Endothoracic fascia

44
Q

In the VAN network of the thoracic wall, list from superior to inferior. Which is most exposed

A

intercostal vein
intercostal artery
intercostal nerve–most exposed

45
Q

What is the function of the elevator costarum

A

elevates the ribs

46
Q

What is the innervation of elevator costarum

A

posterior rami

47
Q

What is contained within the right crus of the diaphragm

A

Esophageal hiatus– esophagus and vagus nerve pass through

48
Q

What is the vertebrocostal trigone

A

weakened spot of the diaphragm where hernias can occur

49
Q

Why do hernias occur most common at vertebrocostal trigone

A

no muscle, just fascia

50
Q

On what side of the diaphragm do hernias occur most often

A

left side

51
Q

What will pass under the median arcuate ligament of the diaphragm

A

aorta

52
Q

What are the functions of the medial and lateral arcuate ligaments of the diaphragm

A

allow muscles and other structures to pass from thoracic to abdominal cavity

53
Q

What innervates the diaphragm

A 
phrenic nerve (C3-C5) (all the motor) 
intercostals do some sensory on periphery
54
Q

What passes through the canal hiatus

A

IVC and phrenic nerve

55
Q

What level is the caval hiatus

A

T8

56
Q

What passes through the esophageal hiatus

A

esophagus
vagus nerve
left gastric artery

57
Q

What level is the esophageal hiatus

A

T10

58
Q

What passes through the aortic hiatus

A

Aorta
Azygos vein
Thoracic duct

59
Q

What level is the aortic hiatus

A

T12

60
Q

What are the different parts of the diaphragm

A

central tendon
right crus
left crus
medial arcuate ligament
lateral arcuate ligament
median arcuate ligament

61
Q

What structures transverse the diaphragm at TV8

A

IVC and phrenic nerve

62
Q

What structures transverse the diaphragm at TV10

A

esophagus
vagus nerve
left gastric artery

63
Q

What structures traverse the diaphragm at TV12

A

aorta
azygos vein
thoracic duct

64
Q

Where will pain from the diaphragm refer to

A

C3-C5 dermatomal regions

(Shoulder)

65
Q

What is the blood supply to the diaphragm

A

Inferior phrenic arteries (from aorta)

66
Q

What does the diaphragm do during inspiration

A

diaphragm contracts, increases volume and decreases thoracic pressure causing air to flow into the lungs

67
Q

What does the diaphragm do during expiration

A

diaphragm relaxes decreasing volume and increases pressure causing air to flow out of the lungs

68
Q

What are the two main respiratory movements of the thoracic cage

A

Pump handle
Bucket handle

69
Q

What does the pump handle motion of the ribs allow

A

increase in AP diameter

70
Q

What ribs do pump handle motion

A

those attached directly to ribs

71
Q

What does the bucket handle motion allow

A

increases side to side diameter

72
Q

What ribs do bucket handle motion

A

ribs 7-12

73
Q

What are the accessory muscles of respiration

A

serrates posterior inferior and superior
SCM
Pec minor
Serratus anterior
Scalenes

74
Q

What are the boundaries of the superior thoracic aperature

A

rib 1, manubrium, first vertebral body

75
Q

What are the boundaries of the inferior thoracic aperture

A

bound by ribs and diaphragm

76
Q

What is the pattern of arterial support to intercostal spaces

A

posterior intercostal artery in posterior to sides
anterior intercostals

77
Q

Where do posterior intercostal arteries come from

A

posterior aorta

78
Q

Where do anterior intercostal arteries come from

A

inferior thoracic artery

79
Q

Where does the inferior thoracic artery branch from

A

subclavian artery

80
Q

What is the first intercostal space supplied by

A

right supreme intercostal artery

81
Q

Where does the right supreme intercostal artery come from

A

costocervical trunk

82
Q

What supplies the space below the 12th rib

A

subcostal arteries

83
Q

What is the venous drainage of the thorax

A

azygos vein on right will drain into SVC

heme-azygous and accessory semi-azygos on left drain to azygos vein (which goes to SVC)

84
Q

What occurs when SVC is blocked

A

congestion in the territory of the SVC

85
Q

What regions of the body drain to the right jugulovenous angle

A

right of head, right neck, right UL, and right thorax

86
Q

What regions of the body drain to the left jugulovenous angle

A

everything else not drained by the right side

87
Q

What lymphatic vessel drains into the right jugulovenous angle

A

right lymphatic duct

88
Q

What lymphatic vessel drains into the left jugulovenous angle

A

thoracic duct

89
Q

Where will the left side of the body drain

A

into thoracic duct

90
Q

What is the innervation to the intercostal spaces

A

intercostal nerves from spinal nerve

91
Q

Do intercostal nerves contain sympathetics

A

yes

92
Q

What would happen if the intercostal nerve was damaged

A

numbness in dermatomal pattern
weakness in intercostal muscles that the segment innervates

93
Q

What layers would be traversed to perform an intercostal nerve block

A

skin
fascia
external intercostal
internal intercostal

94
Q

Between which muscles are the intercostal VAN found

A

internal intercostal and innermost intercostal

95
Q

What structures are at risk with a fractured 1st rib

A

subclavian artery and vein

Exam 2 (14 decks)

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