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HS Exam 2 > Thoracic Wall > Flashcards

Thoracic Wall Flashcards

1
Q

what forms the sternal angle?

A

intersection of manibrium and sternum

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2
Q

where is the sternal angle?

A

rib 2, T4/5 vertebrae

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3
Q

where is the most common site for a rib fracture

A

angle of middle ribs

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4
Q

where is the most common site for a sternal fracture

A

sternal angle

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5
Q

how many ribs are articulated to 1 thoracic vertebra?

A

1.5

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6
Q

how many costal facets are on a thoracic vertebra?

A

3

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7
Q

where in the intercostal space is a needle inserted for a nerve block

A

superior to the rib edge to avoid the structures in the costal groove (VAN complex) while avoiding the collateral branches that run superior to rib
between the paravertebral line and the location anesthetic is needed
do multiple levels because of overlap

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8
Q

what portion of the mesoderm contributes to the parietal and visceral layers of a cavity

A

lateral mesoderm- forms the body cavities

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9
Q

name 3 parts of a somite differentiates and segregates into during development of the body wall

A

sclerotome
myotome
dermatome

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10
Q

what are true ribs

A

ribs 1-7, attach directly to the sternum via costal cartilage

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11
Q

what are false ribs

A

ribs 8-10, attach indirectly to the sternum via costal cartilage of the rib superior

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12
Q

what are floating ribs

A

ribs 11-12, end in abdominal musculature, no sternal attachment

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13
Q

what is the rib head

A

where it interacts with thoracic vertebra, has 2 costal facets

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14
Q

what is the rib neck

A

between the head and the tuberacle

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15
Q

where is the rib tubercle

A

on the inferior aspect, down from the head and neck

has a costal facet

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16
Q

where are costal facets located on a rib

A

2 on head

1 on tubercle

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17
Q

where is the rib angle

A

where rib turns anterolaterally (curved part

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18
Q

where is the costal groove

A

inferior edge of the rib

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19
Q

what is in the costal groove

A

neurovascular bundle

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20
Q

which ribs are typical

A

3-9

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21
Q

which ribs are atypical

A

1, 2, 10-12

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22
Q

describe rib 1

A

short and broad
1 articular facet- articulates with T1
scalene tubercle for attachment of scalene muscles
grooves for subclavian vessels

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23
Q

how are intercostal spaces numbered

A

rib superior to it

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24
Q

where is the subcostal space?

A

below rib 12

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25
Q

which rib is rarely fractured and why

A

rib 1- protected by clavical

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26
Q

what are supernumerary ribs and where are they found

A

extra ribs
can be in cervical area (rare)
more commonly in lumbar region

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27
Q

which articular facet is larger on the rib?

A

infeiror

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28
Q

what joint is formed between the rib and sternum

A

sternal costal interchondral joint

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29
Q

what joint is formed between the rib and thoracic vertebra?

A

costovertebral joint

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30
Q

what might bifid ribs be mistaken for

A

supernumerary ribs

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31
Q

what is thoracic outlet syndrome

A

compression of subclavian artery or brachial plexus (or any structure in the superior thoracic outlet)

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32
Q

what happens to costal cartilage with age?

A

cartilage becomes calcified and loses its elasticity, making it more likely to be fractured

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33
Q

what is the effect of an extra cervical rib?

A

thoracic outlet syndrome- extra rib compresses subclavian artery

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34
Q

what are the 3 parts of the sternum?

A

manibrium
body
xiphoid process

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35
Q

what does the location of the sternum make it good for?

A

getting bone marrow samples to detect blood diseases (leukemia)

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36
Q

what is the sternal cleft

A

fusion of bilateral pre-cartilage tissue at the midline during development

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37
Q

what are the 3 defects are related to sternal cleft

A

complete sternal cleft
partial cleft
sternal foramen

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38
Q

describe complete sternal cleft

A

the pre-cartilagenous tissue fails to fuse at all- rare

the heart may stick be on the outside of the body

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39
Q

describe partial cleft

A

manibrium/upper aspect of the sternum do not fuse

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40
Q

describe sternal foramen

A

small hole in the sternum that is not clinically significant

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41
Q

what happens if the sternal angle is fractured?

A

dislocation of the manibriosternal joint that may cause damage to underlying organs

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42
Q

how common are sternal fractures

A

rare

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43
Q

what anatomical structures are at the sternal angle

A 
bifurcation of the trachea
start of aortic arch
superior limit of pericardium
superior/inferior mediastinal boarder
arch of azygous vein
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44
Q

what is the joint between the manibrium and sternum?

A

manibriosternal joint

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45
Q

how many joints are in the costovertebral joint? what are they

A

2- thoracic vertebra with head of rib and thoracic vertebra with tubercle of rib

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46
Q

what is the joint between the thoracic vertebra and the tubercle of the rib

A

costotransverse joint

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47
Q

what does the superior rib facet articulate with

A

the inferior facet of the superior vertebra

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48
Q

what does the inferior rib facet articulate with

A

the superior articular facet of the vertebra at the same level

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49
Q

what does the tubercle rib facet articulate with

A

transverse articular facet of the vertebra at the same level

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50
Q

which ribs only have 1 articular facet

A

1, 10-12

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51
Q

what is the function of the thoracic wall and diaphragm

A

change the volume of the thorax to move air in and out

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52
Q

what changes the vertical height of the thorax

A

contraction/relaxation of the diaphragm (contract = increase volume)

53
Q

what changes the lateral width of the thorax

A

elevation/depression of rib angle

54
Q

what changes the anterioposterior width of the thorax

A

anterior rib and sternum moving out/up

55
Q

what is the bucket handle movement

A

lateral ribs moving up while they are attached in the front and back

56
Q

what is the pump handle movement

A

front of chest moving up

57
Q

what is the most important inspiration muscle

58
Q

what muscles are used in inspiration

A

diaphragm

intercostal muscles

59
Q

what do the intercostal muscles do

A

inspiration- raise the sternum and anterior ribs

expiration- nothing, only used during forced expiration

60
Q

what is the infrasternal angle

A

angle formed by costal margins

61
Q

what is the costal margin

A

bilateral lines formed by ending of rib cage

62
Q

what is the anterior median line

A

midline of sternum

63
Q

what parts of the scapula are used to count ribs?

A

superior angle- rib 2
spine- rib 4
inferior angle- rib 8

64
Q

what is the scapular line?

A

line down midline of scapula

65
Q

what is the posterior median line

A

line down back of spine

66
Q

what passes through the superior thoracic aperture

A

trachea
esophagus
subclavian artery
brachial plexus

67
Q

what are the boundaries of the superior thoracic aperture

A

T1
rib pair 1 and the associated cartilage
manibrium

68
Q

what are the two types of thoracic outlet syndrome?

A

costoclavicular syndrome

cervical rib syndrome

69
Q

what are the symptoms of costoclavicular syndrome?

A

compression of the subclavian artery between rib 1 and clavicle
pallor
cold upper limb skin
decreased radial pulse

70
Q

what are the symptoms of cervical rib syndrome?

A

compression oc C8-T1 nerve roots and inferior trunk of brachial plexus

71
Q

what structures are in the inferior thoracic aperture

A

esophagus
inferior vena cava
aorta

72
Q

what covers the inferior thoracic aperture

73
Q

how do the inferior thoracic aperture structures get through the diaphragm?

A

esophagus and inferior vena cava go through it

aorta is behind it

74
Q

what are the boundaries of the inferior thoracic apeture

A

T12
ribs 11 and 12
costal cartilage 7-10
xiphisternal joint

75
Q

what is the joint between the xiphoid and sternum

A

xiphisternal joint

76
Q

accessory muscles of inspiration

A

pectoralis major/minor
seratus anterior
serratus posterior inferior/superior

77
Q

what might be the function of the serratus posterior inferior/superior?

A

proprioception

78
Q

what are the intercostal muscles?

A 
external intercostals
internal intercostals
innermost intercostals
subcostals
transverse thoracic
79
Q

what direction do the external intercostal fibers run

A

“hands in the pocket”

inferiorly, lateral to medial

80
Q

where is the external intercostal membrane

A

anterior- begins at midclavicular line

81
Q

when are external intercostals most active

A

inspiration- elevate ribs

82
Q

what direction do internal intercostal fibers run

A

superiorly, medial to lateral (perpindicular to external obliques)

83
Q

where is the internal intercostal membrane?

A

posteiror- begins at mid scapular line

84
Q

when are the internal intercostals most active?

A

expiration- depress ribs (middle layer)

85
Q

what are the 2 parts of the internal intercostals and what do they do

A

interosseous- depress ribs with expiration

interchondral- elevate ribs during inspiration with the external intercostals

86
Q

where are the innermost intercostal muscles located

A

lateral rib cage- approx mid clavicular to mid scapular

87
Q

where are the subcostal muscles

A

posterior internal thoracic wal, spans 1 or 2 intercostal spaces

88
Q

where are the transverse thoracic muscles

A

anterior internal thoracic wall connecting posterior sternum to costal cartilage 1 or 2 ribs superior

89
Q

what is the function of the subcostal muscles

A

elevate ribs

90
Q

what is the function of transverse thoracic muscle

A

unimportant respiratory function

91
Q

where does the neuromuscular bundle travel

A

intercostal groove

92
Q

what order are the structures of the neuromuscular bundle

A

superior- vein
artery
inferior- nerve
*all intercostal

93
Q

what layer of the intercostal space is the van located in

A

between the internal intercostal and the innermost intercostal

94
Q

where do the anterior intercostal arteries come from?

A

1-6 internal thoracic artery

7-9- musculophrenic artery

95
Q

what and where does the internal thoracic artery split?

A

at ICS 6, it splits into the musculophrenic and superior epigastric arteries

96
Q

what is the path of the musculophrenic arter

A

follows the subcostal angle down and gives off branches to ribs 7-9

97
Q

what anterior intercostal artery supplies ICS 10 and 11?

98
Q

where does the superior epigastric artery go?

A

runs inferiorly into the anterior abdominal wall

99
Q

what supplies blood to each ICS?

A

two anterior intercostal arteries and 1 posterior intercostal artery (except 10 and 11- only posterior)

100
Q

what do posterior intercostal arteries come from?

A

1-2- supreme intercostal artery

3-12- thoracic aorta

101
Q

where does the supreme intercostal artery come from?

A

the costocervical trunk off of the subclavian artery

102
Q

which side of the 3-12 intercostals is longer and why?

A

right side longer because the thoracic aorta travels to the left of the vertebra

103
Q

what supplies the collateral branches that run superior to the rib?

A

posterior intercostal arteries

104
Q

how do anterior and posterior intercostal arteries end

A

anastamose together

105
Q

describe venous drainage of thorax

A

veins follow the arteries
anterior- intercostal veins drain into internal thoracic
- internal thoracic splits into musculophrenic and superior epigastric veins too
posterior- posterior- drain into azygous (right) or hemiazygous (lower left) or accessory hemiazygous (upper left) which all drain into azygous whig goes back to superior vena cava

106
Q

where does the intercostal nerve come from

A

ventral rami T1-T11

107
Q

where does the subcostal nerve come from

A

ventral rami T12

108
Q

what are atypical thoracic nerves

A

T1- brachial plexus
T2- brachial plexus and intercostobrachial cutaneous branch
T7-T12- supply anterolateral abdominal wall

109
Q

what are T7-T12 nerves called

A

thoracoabdominal nerves

110
Q

significant thoracic dermatomes

A

T4- nipple

T10- umbilicus

111
Q

what are the 3 types of mesoderm and what do they differentiate into

A

paraxial- somites and body wall (muscle, bone, skin)
intermediate- urogenital system
lateral- body cavities (visceral and parietal pleura)

112
Q

what are the 2 layers of lateral mesoderm and what do they become

A

somatic mesoderm- parietal layer lining body cavities
splanchnic mesoderm- visceral layer adherant to organs
intraembryonic cavity- space between the layers that forms the cavities

113
Q

what is splanchopleurae

A

organ wall- splanchnic mesoderm + endoderm

114
Q

what is somatopleurae

A

body wall- somatic mesoderm + ectoderm

115
Q

what causes cleft sternum

A

incomplete lateral folding of the embryo

116
Q

what is ectopic cordis

A

heart on outside of body due to incomplete lateral folding resulting in complete sternal cleft

117
Q

how are somites formed

A

segmentally arranged groupings of paraxial mesoderm that run cranial to caudal

118
Q

what are somitomeres

A

somites in head region that form pharyngeal arches

119
Q

what is from sclerotome

A

ribs, vertebra, cartilage

120
Q

myotome

A

segmented skeletal muscle
epimere- dorsal
hypomere- ventral

121
Q

what does the ventral group of the hypomere of the myotome differentiate into

A

cervical- infrahyoid muscles
thorax- disappears
abdominal- rectus abdominins

122
Q

what does dermatome segment of somites do

123
Q

what innervates the diaphragm

A

phrenic nerve- C3, C4, C5

124
Q

what does the lateral group of the hypomere of the myotome differentiate into

A

thorax- intercostal muscles and transversus thoracis

abdominal- abdominal oblique and transversus abdomins

125
Q

what are the 4 components of the diaphragm

A

septum transversum
pleuroparietal membranes
lateral body musculature
esophageal mesentary

126
Q

what is a parasternal hernia of the diaphragm

A

part of muscular fibers do not develop

127
Q

what is an esophageal hernia of the diaphragm

A

congenital shortness of the esophagus

128
Q

what is congenital diaphragmatic hernia?

A

failure of the pleuroperiotoneal membrane to close off the periocardio-peritoneal canals
results in intestines and stomach moving into the thorax and pushing the heart and mediastinum right and compression of the left lung

HS Exam 2 (24 decks)

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