Thoracic Wall

Question 1

Characteristics of thoracic vertebrae

Answer 1

• Long, inferiorly pointing spinous processes
• Heart shaped vertebral bodies
• Superior/Inferior articular facets - Oriented in coronal place
• Costal facets on transverse processes of ribs

Question 2

Three parts of the sternum

Answer 2

Manubrium, Body, Xiphoid process

Question 3

Jugular notch (Sternal notch)

Answer 3

• Notch on superior part of manubrium

- Separates R/L Sternoclavicular joints

Question 4

Notches on manubrium where SC joint articulates

Answer 4

Clavicular notches

Question 5

What ribs (costal cartilages) does the manubrium articulate with

Answer 5

Costal cartilages 1 and 2

Question 6

Manubriosternal joint

Answer 6

• Articulation between inferior manubrium and the body of the sternum
• Cartilaginous, symphysis joint

Question 7

What ribs (costal cartilages) does the body of the sternum articulate with?

Answer 7

Costal cartilages 2-7

Question 8

Sternal angle

Answer 8

• Marks fusion of manubrium and body
• Palpable spot
• Horizontal plane through sternal angle marks:
  
  • T4-T5 IV disk, division of mediastinum into superior and inferior regions, bifurcation of trachea, origin and termination of aortic arch

Question 9

Xiphisternal joint

Answer 9

• Articulation between xiphoid process and the body of the sternum
• Cartilaginous, synchondroses

Question 10

What are the two types of cartilaginous joints and what are they made of?

Answer 10

1. Primary cartilaginous - Synchondroses joints - hyaline cartilage (ossify)
2. Secondary cartilaginous - Symphysis joints - fibrocartilage - don’t ossify

Question 11

Ribs 1-7

Answer 11

• True ribs

- individual costal cartilages of ribs 1-7 articulate with sternum

Question 12

Ribs 8-10

Answer 12

• False ribs

- Indirect articulation between costal cartilages connected to superior costal cartilages

Question 13

Ribs 11-12

Answer 13

• Floating ribs

- Don’t articulate with sternum

Question 14

Costochondral joints

Answer 14

• Articulation between costal cartilages of ribs 1-10 and the bony segment of the rib
• Cartilaginous, synchondroses

Question 15

Sternocostal joints

Answer 15

• Articulation between costal cartilages of ribs 1-7 and (costal notches) on sternum
• Rib 1 - Cartilaginous, synchondroses
• Ribs 2-7 - Synovial, plane

Question 16

Costotransverse joints

Answer 16

• Articulation between costal tubercle on rib and costal facets on the transverse processes of the vertebrae
• Synovial, plane

Question 17

Costovertebral joints

Answer 17

• Ribs 2-10: articulation between the head of rib and the costal facet on adjacent vertebrae and on the demifacet of the superior vertebrae
• Ribs 1,11,12: articulation between the head of the rib and the costal facet on adjacent vertebrae
• Synovial, plane joints

Question 18

Name and describe the boundaries for the thoracic apertures

Answer 18

1. Superior Thoracic Aperture
   - bounded by manubrium of sternum, 1st rib, T1 vertebrae
   - open thorax superiorly to neck
2. Inferior Thoracic Aperture
   - bounded by xiphoid process of sternum, 11th and 12th ribs, T12 vertebrae, costal margin

Question 19

Interchondral joint

Answer 19

• Between costal cartilages

- Synovial, plane

Question 20

Sternoclavicular joint

Answer 20

• Articulation between clavicular notches on manubrium and sternal end of clavicle
• Synovial, saddle

Question 21

Intervertebral joint

Answer 21

Ask

Question 22

Right and left crura

Answer 22

• Extensions of the posterior diaphragm
• attach to lumbar vertebral bodies
• Right crus is slightly longer than left crus

Question 23

What happens to the diaphragm during expiration/inspiration

Answer 23

During inspiration, the diaphragm depresses increasing the room in the thoracic cavity.
During expiration, the diaphragm elevates to the 4th or 5th rib level

Question 24

Which side of the diaphragm is slightly higher

Answer 24

Right

Question 25

What are the three apertures (openings) in the diaphragm that allow for passage of structures between the thorax and abdomen

Answer 25

1. Caval aperture (hiatus ) 2. Esophageal aperture (hiatus) 3. Aortic aperture (hiatus_

Question 26

Caval aperture (hiatus)

Answer 26

- Passageway for inferior vena cava | - at T8 level, through central tendon of diaphragm

Question 27

Esophageal aperture (hiatus)

Answer 27

-Passageway for esophagus (R/L gastric artery/vein, ant/post vagal trunks) -T10 vertebral level -Formed by the right (sometimes left) crura -Crura constrict and form a sphincter around the esophagus

Question 28

Aortic aperture (hiatus)

Answer 28

- Behind T12 level - In between right and left crura - Passage for aorta (thoracic duct, azygos/hemiazygos veins)

Question 29

List the neurovasculature of the diaphragm

Answer 29

Arteries - mainly supplied by the inferior phrenic arteries (branch of abdominal aorta) -also supplied by superior phrenic, pericardiophrenic, musculophrenic Veins -venous blood drains into azygos vein (from posterior intercostal and superior phrenic veins)

Question 30

What innervates the diaphragm

Answer 30

Phrenic nerve (C3,4,5)

Question 31

What is the breast composed of

Answer 31

Mammary gland (modified sweat gland +supporting fat/fibrous tissue)

Question 32

Where is the breast located in females

Answer 32

Lateral sternum to midaxillary line (over ribs 1-6, pec major and serratus anterior muscles)

Question 33

Retromammary space

Answer 33

- Loose C.T. that creates a space between the breast and underlying pectoralis major fascia - Allows for movement on thoracic wall

Question 34

Highest prominence of the breast

Answer 34

- Nipple - T4 level - Smooth muscle fibers

Question 35

Areola

Answer 35

- pigmented skin surrounding nipple | - contains sebaceous glands that lubricate the area during nursing

Question 36

What are the two components of the mammary gland

Answer 36

Parenchyma and stroma

Question 37

What are the parts of the parenchyma

Answer 37

- Lobes - Lobes divide into 15-20 lobules - Lobules contain sacs of alveoli (hollow, with secretory cells) - Lactiferous ducts - drain lobules, open at nipple - Lactiferous sinus - small dilation of ducts, stores small amount of milk in lactating women

Question 38

What is the stroma of the breast composed of/function

Answer 38

- Fibrous network of the mammary gland | - Separates lobules/supports lobes

Question 39

What attaches the stroma of the mammary gland to overlying dermis

Answer 39

Suspensory (cooper) ligaments | -especially strong superiorly

Question 40

Neurovasculature of the breast

Answer 40

Arteries - anterior intercostal and medial mammary arteries (branches of internal thoracic) Veins - venous blood drains into axillary vein Lymph - 75% lymph drains into axillary nodes

Question 41

What makes up the thoracic cage

Answer 41

T1-T12 vertebrae, Ribs 1-12, Sternum