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SF3 > Thoracic Wall > Flashcards

Thoracic Wall Flashcards

1
Q

What are the component of the thoracic wall?

A

Skin

Bone

Fascia

Muscles

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2
Q

What are the boundaries of the thoracic wall?

A

Superior:

  • vertebra T1, rib 1, manubrium

Inferior

  • vertebra T12, rib 12, costal margin, xiphoid process

Transversely

  • thoracic cage
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3
Q

What are the borders of the thoracic cavity?

A

Superior border of the liver

Inferior borders of the lungs

Inferior border of pleura

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4
Q

A stab wound below rib _ can pierce the abdominal cavity.

A

5

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5
Q

Stab wound in the ______ can pierce the lungs.

A

neck

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6
Q

Label

A
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7
Q

What are the functions of the thoracic wall?

A
  • Protects internal air and fluid-filled organs
  • Provide rigid exterior wall to prevent collapse of elastic lungs
  • Provides for lung expansion
  • Privides attachment and support to upper limbs
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8
Q

What are the reference lines of the thoracic wall?

A
  • Jugular (suprasternal) notch
  • Sternal angle
  • Anterior median (midsternal) line
  • Midclavicular lines
  • Axillary fossa
  • Anterior axillary line
  • Midaxillary line
  • Posterior axillary line
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9
Q

What are the surface landmarks of the thoracic wall?

A

Jugular notch

Clavicle

Anterior axillary fold

Manubrium

Sternal angle and manubriosternal joint

Body of sternum

Xiphisternal joint

Infrasternal (subcostal) angle

Costal margin

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10
Q

What is the significance of the sternal angle?

A
  • used to ascertain the position of rib 2
  • Marks plane through T4-5 intervertebral disc
  • Marks the superior edge of the heart
  • Marks the bifurcation of the trachea
  • Marks the level of azygos arch
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11
Q

What is the signiicance of the orientation of the ribs?

A

Downward slope of ribs is critical to function

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12
Q

Label

A
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13
Q

Label

A
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14
Q

Which part of the rib articulates with the vetebrae above?

A

Articular facet

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15
Q

Which part of the rib articulates with the numerically corresponding vertebrae?

A

Tubercle

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16
Q

Which part of the rib is for the intercostal vein, artery, and nerve?

A

Costal groove

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17
Q

Which ribs are considered “atypical”?

A

1,2, 11, and 12

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18
Q

Which muscles articulates with the first rib?

A

Levator costae

Scalenus medius

Serratus anterior

Scalenus anterior

Subclavius

*NOTE: The costaclavicular ligament also articulates with the 1st rib

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19
Q

Label

A

1st rib

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20
Q

Which ribs are considered true ribs?

A

Ribs 1-7

*True ribs are ribs that are attached directly to the sternum by costal cartilage

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21
Q

Which ribs are considered false ribs?

A

Ribs 7-12

*False ribs do not attach to the sternum directly but are attached to the 7th rib by cartilage

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22
Q

Which ribs are considered floating ribs?

A

Ribs 11-12

*Floating ribs are important or anchoring of rib cage by abdominal muscles.

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23
Q

Vertebrae, sternum and ribs contain ____________ marrow; a source of blood cells.

A

red

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24
Q

The thoracic vertebrae have two different articulations: intervertebral and costal. What does each articulation allow for?

A

Intervertebral: slight rotation of the trunk

Costal (costal facts of transverse processes): Elevation of ribs

*The discs found in between each vertebrae allows for weight bearing

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25
Q

Demi facets are found on __________ of the thoracic vertebrae.

A

Body

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26
Q

Rib has same number as the _________ (superior/inferior) vertebra and its transverse process.

A

Inferior

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27
Q

As ribs rotate and elevate along ___________ joint, thorax expands both laterally and anteriorly.

A

costovertebral

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28
Q

Label

A

Sternum

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29
Q

Label

A
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30
Q

List the 4 sternal joints

A

•Sternocostal:

  • rib 1 (fibrocartilaginous)
  • ribs 2-7 (synovial)
  • Interchondral: synovial
  • Manubriosternal: symphysis
  • Xiphisternal: symphysis

NOTE: Symphsis and costal cartilage ossify with age

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31
Q

If multiple rib fractures produce an isolated segment, get _____________: paradoxical movement produces pain and impairs breathing.

A

flail chest

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32
Q

Rib dislocation

A

an injury where one or more of the ribs are moved from their normal location in the chest cavity

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33
Q

Where do rib separations occur?

A

At the costochondral joint

34
Q

Where do rib fractures usually occur?

A

Just anterior to the angle

35
Q

Label

A
36
Q

Label

A
37
Q

Label

A
38
Q

The internacostal vein, artery and nerve run between which two muscles?

A

Internal intercostal

Innermost intercostal

NOTE: These muscles are numbered by the superior rib

39
Q

Label

A
40
Q

Label

A
41
Q

What are the attachment point for transversus thoracis?

A

The inferior attachment of the transversus thoracis muscle is on the sternum and its superior attachments are on costal cartilages 2 to 6.

42
Q

What is the function of transversus thoracis?

A

The transversus thoracis muscle depresses the ribs.

43
Q

Label

A

Proprioceptive muscles

44
Q

What are the major muscles of inspiration and expiration respectively?

A

Inspiration: Diaphragm

Expiration: Abdominal wall muscle

45
Q

What is the major function of intercostal muscles?

A

Stiffen wall to resist elastic forces

46
Q

What actions are involved in quiet inspiration?

A
  1. Diaphragm contracts
  2. External intercostal muscles pull rib up and out
47
Q

What actions are involved in forced inspiration?

A
  1. Sternocleiodomastoid elevates sternum
  2. Pectoralis minor elevates rib
  3. Diaphragm contracts more (than in quiet inspiration)
48
Q

What actions are involved in quiet expiration?

A

Abdominal organs recoil and press diaphragm upward

49
Q

What actions are involved in forced expiration?

A
  1. Posterior internal intercostal muscles pull ribs down and inward
  2. Abdominal organs force diaphragm higher
  3. Abdominal wall muscles contract and compress abdominal organs
50
Q

What are the accessory respiratory muscles?

A

Trapezius

Scalenus

Sternocleidomastoid

*People with dyspnea (asthma, emphysema, heart failure, etc.) fix the pectoral girdle and use accessory respiratory muscles

51
Q

Where does the intercostal nerve arise from?

A

Anterior rami of the spinal nerves of T1 to T11

52
Q

Intercostal nerves arise from the ___ nervous system.

A

Somatic

53
Q

Posterior ramus of the intercostal nerve supplies what?

A

Skin of back

54
Q

The intercostal enrves primarily supply which structures?

A

Motor to intercostal muscles

Sensory to overlying skin and parietal pleura

55
Q

Which intercostal nerves are considered atypical? Which are considered typical?

A

Atypical: 1,2, and 7-11

Typical: 3-6

56
Q

Which branch of the first intercostal nerve joins the brachial plexus?

A

The superior part

57
Q

What are the branches of the second intercostal nerve? What are it’s functions?

A

Intercostobrachial nerve (lateral cutaneous branch)

Functions: Supplies skin of axilla and communicates with medial cutaneous nerve

58
Q

The seventh to eleventh intercostal nerve cross costal margin and become the ______________ nerves of the anterior abdominal wall.

A

Thoracoabdominal

59
Q

What is the course of the intercostobrachial nerve?

A
  1. T2 exits anterior armpit
  2. Courses over to humerus as it goes thru axilla under pectoralis muscles
  3. Splits into intercostobrachial nerve branches near bottom-most crease of axilla.
60
Q

Label

A
61
Q

Thoracentesis

A

an invasive procedure to remove fluid or air from the pleural space for diagnostic or therapeutic purposes

62
Q

Where should a thoracocentesis be performed?

A

midaxillary line, in the eighth, ninth, or tenth intercostal space

63
Q

What arteries supply the thoracic wall?

A
  1. Costocervical trunk
  • ​Superior intercostal aa.
    • ​Posterior intercostal aa. (1st and 2nd)
  1. internal thoracic aa.
    * Anterior intercostal aa.

​3. Aorta

  • Posterior intercostal aa. (3-11)
64
Q

Why does shingles affect a single dermatome?

A

Shingles is a herpes zoster infection of a spinal ganlion that is transported along axons, so it affects a single dermatome.

65
Q

Why are the right posterior intercostal arterieslonger than the left ones?

A

Becuase they cross over the vertebral bodies

66
Q

Thoracic aorta runs along the _______ (left/right) side of the vertebral bodies.

A

Left

67
Q

________________ arteries run along the posterior and anterior roots of the spinal nerves and supply them with blood.

A

Radicular

*Radicular arteries are branches of posterior intercostal arteries. A blood clot here could result in infarction of the spinal cord

68
Q

The ___________ artery supplies the first and second intercostal spaces.

A

Superior intercostal

69
Q

Label

A
70
Q

What is the clinical signifance of the internal thoracic artery?

A
  • used for by-pass
  • Important to avoid during pericardiocentesis
71
Q

The internal thoracic artery birfurcates into which two arteries?

A

Superior epigastric artery

Musculophrenic artery

72
Q

Label

A
73
Q

There are 9 anterior intercostal arteries. From where does each artery arise?

A

Internal thoracic artery: 1-6

Musculophrenic artery: 7-9

NOTE: The anterior intercostal artteries are absent from the 10th and 11th intercostal spaces

74
Q

Label

A
75
Q

The medial mammary branches are branches of the ___________ artery, while the lateral mammary branches are branches of the ___________ artery.

A

Internal thoracic; lateral thoracic

76
Q

Where do intercostal veins drain?

A

Internal thoracic veins

  • Then drain in to brachiocephalic vein

​Azygos veins

  • Then drain into the superior vena cava
77
Q

What is the clinical significance of the azygos vein?

A

It is an alternate route back to the heart when IVC or SVC are blocked

78
Q

The _________ vein provides alternate circulation when there is liver disease.

A

Thoracoepigastric vein

79
Q

The ventromedial portion of somites develop into __________ and _____.

A

Vertebrae and ribs

*This is the sclerotome

80
Q

The dorsolateral portion of somites develop into _________- and ___________.

A

Dermatome (skin and subcutanenous)

Myotome (muscles)

81
Q

How is the sternum formed?

A
  1. Sternal bars form from somatic mesoderm in the ventral body wall
  2. Sternebrae fuse at puberty
82
Q

Sternebrae are supposed to fuse at puberty. What happens if this does not occur?

A

Failure to fuse results in bifid or perforated sternum

SF3 (15 decks)

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