Thoracic wall

Question 0

inferior thoracic aperture

Answer 0

anatomical thoracic outlet
diaphragm closes it
much larger than superior
bounded:
posteriorly by T12 vertebra
posterolaterally by 11th and 12th pairs of ribs
anterolaterally by joined costalcartilages of ribs 7-10 forming the costal margin
anteriorly by the xiphisternal joint

Question 1

superior thoracic aperture

Answer 1

anatomical thoracic inlet
trachea, esophagus, vessels and nerves pass
adult: 6.5 cm anteroposteriorly and 11 cm traversely
bounded:
posteriorly by T1 vertebra
laterally by first pair of ribs and costal cartilages
anteriorly by superior border of manubrium

Question 2

three types of ribs

Answer 2

true (verbrosternal) ribs: 1-7
false (verbrochondral) ribs: 8-10
floating: 11-12

Question 3

typical ribs

Answer 3

3rd to 9th
head: two facets and crest of head
neck
tubercle: articular and non articular parts
body or shaft:angle. costal groove

Question 4

atypical ribs

Answer 4

1, 2, 10, 11, 12

Question 5

1st rib

Answer 5

broad, shortest and most sharply curved of true rib
more to roof than wall of thoracic cavity
two shallow horizontal grooves crossing its superior surface for the subclavian vessels separated by scalene tubercle and ridge
articulates with T1 vertebrae

Question 6

2nd rib

Answer 6

thinner and more typical

formations for attachment of serratus anterior and posterior scalene

Question 7

10th through 12th ribs

Answer 7

only one facet on their head

Question 8

11th and 12th ribs

Answer 8

short and have no necks or tubercles

Question 9

costal spaces

Answer 9

11 intercostal

1 subcostal

Question 10

subcostal nerve

Answer 10

anterior ramus of T12

Question 11

characteristic features of thoracic vertebra

Answer 11

bilateral superior and inferior costal or demi facets on bodies (1, 10-12 have one whole costal facets)
costal facets on transverse processes exceept for inferior two or three
long inferiorly slanting spinous processes

Question 12

manubrium

Answer 12

trapezoidal bone
at level of bodies of T3 and T4 vertebrae
jugular notch, 2 clavicular notches

Question 13

sternal angle of Louis

Answer 13

between manubrium and sternum

opposite second pair of costal cartilages at the level f the IV disc between the T4 and T5 vertebrae

Question 14

body of sternum

Answer 14

T5-T9 vertebral level

scalloping of lateral borders by costal notches

Question 15

xiphoid process

Answer 15

T10 vertebral level
smallest
cartilaginous in young people but more or less ossified in people older than 40
may fuse with sternal body in elderly

Question 16

xiphisternal joint

Answer 16

primary cartilaginous (synchondrosis)
articulation between xiphoid process and body of sternum
often fuses and becomes synostosis in older people
T9 vertebral level
midline marker for superior level of liver, central tendon of diaphragm and inferior border of heart

Question 17

intervertebral joint

Answer 17

symphysis (secondary cartilaginous)
adjacent vertebral bodies bound together by intervertebral disc
anterior and posterior longitudinal ligaments

Question 18

costovertebral joints of head of ribs

Answer 18

synovial plane joint
head of rib with costal facets: superior of its number, inferior of one above
radiate and intra-articular ligaments of head of rib
1st, 10th, 11th, 12th, only with its vertebral body

Question 19

costotransverse joint

Answer 19

synovial plane joint
articulation of tubercle of rib with transverse process of corresponding vertebra
lateral and superior costotransverse ligaments
11th and 12th do not

Question 20

sternocostal joints

Answer 20

1st:primary cartilaginous, 1st costal cartilage with manubrium
2nd-7th: synovial plane joint, 2-7 costal cartilages with sternum
anterior and posterior radiate sternocosta ligaments

Question 21

sternoclavicular

Answer 21

saddle type of synovial joint
sternal end of clavicle with manubrium and 1st costal cartilage
anterior and posterior sternoclavicular ligaments
costoclavicular ligament
joint divided into two compartments by articular disc

Question 22

costochondral joint

Answer 22

primary cartilaginous
articulation of lateral end of costal cartilage with sternal end of rib
cartilage and bone, bound together by periosteum
normally no movements occur]

Question 23

interchondral

Answer 23

synovial plane joint
articulation between costal cartilages of 6/7, 7/8 and 8/9 ribs
interchondral ligaments
articulatin between costal cartilages of 9th and 10th ribs is fibrous

Question 24

manubriosternal

Answer 24

secondary cartilaginous joint (symphysis)
articulation between manubrium and body of sternum
often fuse and become synostosis in older people

Question 25

flail chest

Answer 25

sizeable segment of anterior or lateral thoracic wall moves freely because of multiple rib fractures
painful and impairs ventilation

Question 26

cervical ribs

Answer 26

1% of people
articulate with C7vertebra
may compress spinal nerves C8 and T1 or the inferior trunk of the brachial plexus
may also compress subclavian artery,resulting in ischemic muscle pain

Question 27

sternal biopsies

Answer 27

sternal body often used for bone marrow needle biopsy

Question 28

posterior thoracotomy

Answer 28

upperlimb fully abducted
access as high as 4th intercostal space
posterolateral aspects of 5th to 7th intercostal spaces

Question 29

thoracic outlet syndrome

Answer 29

costoclavicular syndrome: pallor and coldness of skin of upper limb and diminished radial pulse resulting from compresion of subclavian artery

Question 30

axillary process or tail of Spence

Answer 30

small part of breast may extend along inferolateral edge of pectoralis major toward axillary fossa

Question 31

resting of breast

Answer 31

2/3 on pectoral fascia

1/3 on serratus anterior fascia

Question 32

retromammary space

Answer 32

between breast and deep pectoral fascia: loose connective tissue plane

Question 33

nerves of breast

Answer 33

derive from anterior and lateral cutaneous branches of 4th to 6th intercostal nerves

Question 34

intercostal nerves

Answer 34

formed by anterior rami of T1-T11 spinal nerves

Question 35

subcostal nerve

Answer 35

anterior rami of T12

Question 36

typical intercostal nerves

Answer 36

3rd through 6th: run interior to interior intercostal muscles
collateral branches arise near angles of ribs and run along superior border of rib beow
continue and give rise to latral cutaneous branches at midaxillary line
turn anteriorly near the sternum and enter subcutaneous tissue as anterior cutaneous branches

Question 37

atypical intercostal nerves`

Answer 37

1&2, 7-11
1&2 pass on internal surfaces of ribs instead of costal grooves
7-11th continue to supply abdominal skin and muscles after giving rise to lateral cutaneous branchs

Question 38

posterior intercostal arteries

Answer 38

originate from supereme intercostal arteries (intercostal spaces 1 and 2) and thoracic aorta (remaining intercostal spaces)
pass between internal and innermost intercostal muscles
distributed to intercostal muscles and overlying skin, parietal pleura

Question 39

anterior intercostal arteries

Answer 39

originate from internal thoracic arteries (intercostal spaces 1-6) and musculophrenic arteries (intercostal spaces 7-9)
pass between internal and innermost intercostal muscles
distributed to intercostal muscles and overlying skin, parietal pleura

Question 40

internal thoracic artery

Answer 40

originates from subclavian artery
passes inferiorly, lateral to sternum, between costal cartilages and internal intercostal muscles to divide into superior epigastric and musculophrenic arteries
disribution: by way of anterior intercostals to intercostal spaces 1-6 and musculophrenic arteries to intercostal spaces 7-9

Question 41

herpes zoster

Answer 41

shingles

dermatomally distributed skin lesion. viral disease of spinal ganglia