Thoracic wall

Question 1

difference between upper, middle, floating ribs

Answer 1

rib 1 and 2 - somewhat square, flat, irregular, bumpy shape
rib 3 thru 10 - gently curved, has costal heads and tubercles projecting notably
rib 11 and 12 - floating ribs; dont connect to sternum, subtle tuberosity

Question 2

which ribs attach to the sternum through individual costal cartilages

Answer 2

1-7

Question 3

what ribs attach to cartilage of rib 7

Answer 3

8-10

Question 4

what ribs do not attach to sternum but are tipped by cartilage?

Answer 4

11 and 12

Question 5

what ligament attaches the head of the rib to vertebral facets/demifacets?

Answer 5

radiate ligament

Question 6

what ligament attaches from the neck of rib to transverse process at the same level and one level above?

Answer 6

costotransverse ligaments

Question 7

how do ribs 1 and 2 move during inspiration?

Answer 7

they elevate

Question 8

how do ribs 3-10 move during inspiration?

Answer 8

laterally (bucket-handle)

Question 9

how do ribs 11 and 12 move?

Answer 9

swing laterally (pincers)

Question 10

the movement of ribs causes the sternum to move how?

Answer 10

anteriorly

Question 11

what part of the body is responsible for most of the movement during inspiration?

Answer 11

diaphragm

Question 12

what is the purpose of ribs?

Answer 12

protection
expansion

Question 13

what 2 things can damage the long thoracic nerve and/or lateral thoracic artery?

Answer 13

surgery
breast cancer

Question 14

external intercostal muscles have what type of direction?

Answer 14

inferomedial (hands in pockets)

Question 15

internal intercostal muscles run in what type of direction?

Answer 15

superomedial direction

Question 16

innermost intercostal muscles run in what type of direction?

Answer 16

parallel to internal intercostal

Question 17

where are the innermost intercostals only present in?

Answer 17

lateral region between ribs

Question 18

what part forms the floor of the thoracic cavity?

Answer 18

diaphragm

Question 19

where does the diaphragm attach?

Answer 19

bilaterally from xyphoid process around costal arch to 12th thoracic and upper lumber vertebrae

Question 20

what 3 structures run through the diaphragm

Answer 20

inferior vena cava
aorta
esophagus

Question 21

what type of hernia can occur near the diaphragm?

Answer 21

parastomal hernia

Question 22

name the muscles involved during inspiration

Answer 22

diaphragm
ext. intercostals
int. intercostals (parasternal portion)
scalene muscle

Question 23

name the muscles involved during forced expiration

Answer 23

int. intercostals (lateral portion)
innermost intercostals
abdominal obliques
rectus abdominis
transversus thoracic

Question 24

what is relaxed expiration a result of?

Answer 24

recoil of soft tissue

Question 25

what happens to the muscles of COPD or emphysema patients when respiration is forced?

Answer 25

abnormal hypertrophy

Question 26

what is the function of the trapeizus, levator scapulae, and rhomboids during respiration

Answer 26

stabilizes/fix the scapula so that other muscles can work on the ribcage

Question 27

what is the function of scalenes during respiration

Answer 27

elevate 1 & 2

Question 28

what is the function of the pectoralis muscles?

Answer 28

elevate anterior ribcage if scapula is fixed; uses scapula as an anchor

Question 29

what is the function of the serratus anterior?

Answer 29

elevates lateral ribcage if scapula is fixed; uses scapula as an anchor

Question 30

what is the main blood supply of the thoracic wall

Answer 30

intercostal arteries

Question 31

where do the intercostal arteries originate and where do they run?

Answer 31

internal thoracic artery and aorta within each intercostal space

Question 32

innervation of thoracic wall

Answer 32

intercostal nerves, anterior rami from each spinal level T1-T12

Question 33

what artery supplies the serratus anterior muscle?

Answer 33

thoracic artery - branch of axillary a.

Question 34

innervation of serratus anterior muscle

Answer 34

long thoracic nerve

Question 35

both intercostal nerves and arteries have what branches?

Answer 35

lateral cutaneous anterior cutaneous

Question 36

where do intercostal veins drain to?

Answer 36

internal thoracic veins anteriorly azygos system posteriorly

Question 37

what is the drainage pattern from the R. side azygos vein?

Answer 37

receives R. intercostal veins and R. ascending lumbar vein draining into superior vena cava carrying deoxygenated blood

Question 38

what is the drainage pattern of the L. side hemiazygos vein?

Answer 38

receives from lower L. intercostal veins and L. ascending lumbar vein connecting to azygos and accessory hemiazygos vein

Question 39

what veins does the accessory hemiazygos vein receive from?

Answer 39

upper L. intercostal veins connecting to L. brachiocephalic vein

Question 40

what is the order of the 3 intercostal supply starting from most superior

Answer 40

Vein Artery Nerve

Question 41

what is a thoracocentesis

Answer 41

receiving fluid in pleural cavity

Question 42

what is a intercostal nerve block?

Answer 42

superficial injection of anesthetic between intercostals avoiding underside of rib to avoid arteries

Question 43

what are the subdivisions inside of the thorax?

Answer 43

two pleural cavities midline mediastinum

Question 44

the superior mediastinum contains what

Answer 44

greater vessels - superior vena cava, brachiocephalic veins, arch of aorta nerves - vagus, phrenic, left recurrent laryngeal thoracic duct trachea esophagus thymus (10 things)

Question 45

what are the subdivisions of the inferior mediastinum

Answer 45

anterior middle posteior

Question 46

what is in the anterior mediastinum

Answer 46

thymus lymph nodes fat and CT

Question 47

what is in the middle meiastinum

Answer 47

pericardium and heart roots of great vessels arch of azygos vein primary bronchi

Question 48

what is in the posterior mediastinum

Answer 48

esophagus aorta azygos and hemiazygos veins thoracic duct vagus nerves sympathetic trunk splanchnic nerves

Question 49

the transverse thoracic plane separates the mediastinum how?

Answer 49

superior and inferior

Question 50

how is the thymus gland an important immune organ?

Answer 50

where T cells mature and become active

Question 51

what happens to the thymus as we age

Answer 51

gets smaller and atrophies

Question 52

how is the thymus in children?

Answer 52

large in children sometimes mistaken as a tumor in radiology

Question 53

what cervical nerves are responsible for the diaphragm?

Answer 53

c3, c4, c5

Question 54

what part of the pulmonary circulation carries deoxygenated blood

Answer 54

pulmonary trunk blood from the heart to lungs

Question 55

what part of the pulmonary circulation carries oxygenated blood

Answer 55

pulmonary veins blood from lungs to heart

Question 56

what CN is mainly responsible for parasympathetic action

Answer 56

let vagus nerve branches of the vagus descends down to the esophagus

Question 57

what nerve travels on its own

Answer 57

thoracic splanchnic nerve

Question 58

what vein carries deoxygenated blood from the lower and middle part of the body back to the heart?

Answer 58

inferior vena cava

Question 59

the multiple lobules from the breast make milk which drains through where?

Answer 59

lactiferous ducts to lactiferous sinuses to nipple

Question 60

where is the retromammary space

Answer 60

between breast and pectoralis major

Question 61

what are suspensory ligaments

Answer 61

ligaments between lobules that extend from thoracic wall and attach to skin of breast

Question 62

what are 2 indications/signs of breast cancer

Answer 62

"orange peel" - retracts the skin during inflammation asymmetry - cancers can adhere to the body wall, passing through retromammary space and even invade pectoralis major, fixing the breast

Question 63

what are the primary vessel that supply the breast

Answer 63

internal thoracic lateral thoracic small contributions from lateral cutaneous branches of intercostal artery and vein

Question 64

about 3/4 lymphatic flow from the breast travel to where?

Answer 64

axillary lymph nodes

Question 65

where does lymph first pass through before reaching to its main lymph node

Answer 65

interpectoral nodes first, then pectoral axillary lymph nodes

Question 66

where do the remaining 1/4 lymph flow drain to?

Answer 66

parasternal nodes draining to mediastinum and crossing to opposite breast

Question 67

what is the major route for cancer?

Answer 67

lymph channels

Question 68

if the lymph flow from the breast is going more medially, what node is it going to

Answer 68

parasternal nodes

Question 69

if the lymph flow from the breast is going more laterally, what node is it going to

Answer 69

pectoral axillary nodes

Question 70

what part of the intercostal arteries anastomoses with each other

Answer 70

anterior and posterior intercostal arteries

Question 71

where do posterior intercostal arteries and nerves run?

Answer 71

in the plane between internal intercostal and innermost intercostal muscles