Thoracic Wall And Cavities (Ch. 4: p. 291 - 311)

Question 1

What are the three parts of the thoracic cavity

Answer 1

Mediastinum (heart, vessels, trachea etc.)

L pul. Cavity
R. Pul. Cavity

Question 2

Define the true thoracic wall

Answer 2

Thoracic cage, the intercostal muscles, skin, tissue, fascia, etc on the anterior portion, not the posterior portion

Question 3

What are the three types of ribs

Answer 3

True
False
Floating (Free)

Question 4

Define True Ribs

Number?
Aka
Special why?

Answer 4

Number 1 - 7
Aka vertebrocostal ribs

Attach directly to sternum through own costal cartilage

Question 5

Define False Ribs

Number
Aka
Special why

Answer 5

Ribs 8 - 10
Aka vertebrochondral ribs

Connected to sternum through cartilage of rib above them

Question 6

Define Floating ribs

Number
Aka
Special why

Answer 6

11, 12

Aka vertebral ribs

End in posterior abdominal muscles

Question 7

Define typical ribs

Number

Special why?

Answer 7

3 - 9

Has head with 2 facets

Tubercles

Body with costal angle

Question 8

How do typical ribs articulate with the thoracic vertebra

Answer 8

Attache to superior costal facet of same number vertebra, as well as inferior costal facet of vertebra superior to it

Question 9

What are some distinguishing characteristics of rib #1

Answer 9

Broadest and shortest

Has 1 facet for articulation with T1

Has two grooves for subclavian V (ant.) and subclavian A. (Post.)

Has scalene tubercle

Question 10

Define scalene tubercle

Answer 10

Separates grooves on Rib #1

Attachment site for scalene M.

Question 11

What is special about Rib #2

Answer 11

Has tuberosity for serratus Ant. M.

Question 12

What is special about rib 11/12

Answer 12

No neck or tubercle and only 1 facet

Question 13

What N. Is below Rib 12

Answer 13

Ant. Ramus of SN T12

Question 14

What are the three parts of the sternum

Answer 14

Manubrium
Body
Xiphoid process

Question 15

Most superior notch of manubrium

Answer 15

Jugular notch

Question 16

What attaches to the L and R clavicular notches

Answer 16

SC joints and clavicles

Question 17

How many costal notches are there

Answer 17

7 for attachment of costal cartilage

Question 18

What are the 4 transverse ridges of the sternum remnants of

Answer 18

4 sternebrae (primordial segments of sternum) which fuse around age 25

Question 19

Where does the xiphoid process stop

Answer 19

T10

Question 20

When is the xiphoid process ossified by

Answer 20

Age 40

Question 21

What are the borders of the superior thoracic aperture

Answer 21

Posteriorly - T1
Laterally - 1st pair of ribs
Anteriorly - superior border of manubrium

Question 22

What are the borders of the inferior thoracic aperture

Answer 22

Posteriorly - T12
Posteriolaterally - 11/12 ribs
Anteriolaterally - costal cartilage of ribs 7 - 10
Anteriorly by xiphisternal joint

Question 23

All functions of inspiration

Answer 23

Muscles contract
Cavity increases
Pressure decreases
Ribs move up and out

Question 24

All functions of expiration

Answer 24

Muscles relax
Cavity decreases
Pressure increases
Ribs move down and in

Question 25

External intercostal muscles are responsible for what

Answer 25

Inspiration

Question 26

Internal and innermost intercostal muscles are responsible for what

Answer 26

Expiration

Question 27

The NVB bundle runs where in regards to the rib

Answer 27

Under the rib that it corresponds with

Question 28

The NVB runs where in regards to the intercostal muscles

Answer 28

Between the internal and innermost

Question 29

External Intercostal M. ``` O I N A A ```

Answer 29

O: inferior border of ribs (posteriorly) I: Superior border of rib below (points anteriorly) N: Intercostal N. A: Elevate Ribs Art:

Question 30

Which direction do the External Intercostal ribs point

Answer 30

Anteriorly

Question 31

The EIM’s are replaced by what anteriorly

Answer 31

Ant. Intercostal Membrane

Question 32

The EIM and IIM run how in regards to each other

Answer 32

Perpendicular

Question 33

Internal Intercostal M. ``` O I N A A ```

Answer 33

O: inferior border of ribs (anteriorly) I: superior border of ribs (posteriorly) N: Intercostal N. A: Depress Ribs Art:

Question 34

How do the IIM point

Answer 34

Point posteriorly

Question 35

What is the IIm replaced by posteriorly

Answer 35

The posterior intercostal membrane

Question 36

Innermost Intercostal M. ``` O I N A A ```

Answer 36

O: inferior border of ribs I: superior border of rib below N: Intercostal N. A: unknown A:

Question 37

Define manubriosternal joint

Answer 37

Symphysis joint at the sternal notch Brings together manubrium with body of sternum

Question 38

Define xiphisternal joint

Answer 38

Primary cartilaginous (synchondrosis) joint at 7th costal notch Brings together body with xiphoid process

Question 39

Define the sternocostal joint

Answer 39

Planar synovial joint (2 - 7) [rib 1 is a synchondrosis] Bound by ant./post. Radiate Sternocostal L. Brings together sternum and costal cartilages

Question 40

Define costochondral joint

Answer 40

Synchondrosis joint Brings together ribs with costal cartilage

Question 41

What is the Dx of a sternocostal joint vs a costochondral joint

Answer 41

Sternocostal joint = dislocation Costochondral joint = separation

Question 42

# Define costovertebral joint (type) What is it bound by What does it brings together

Answer 42

Planar synovial joint Bound by Radiate L. [head of rib to vertebral body] Intraarticular L. [head of rib to the interverterbal disc] Articular capsule (strongest anteriorly as the radiate L.) Brings together ribs and vertebra

Question 43

# Define costotransverse joint (type) what two L.’s are associated with it and what do they connect What does it bring together

Answer 43

Planar synovial joint Bound by superior costotransverse L.’s - neck of the rib to the transverse process one vertebral segment superiorly and lateral costotransverse L.’s - tubercle of the rib to the transverse process Joins ribs to transverse processes

Question 44

First rib fx is due to what

Answer 44

Severe trauma

Question 45

Which ribs are most commonly fx

Answer 45

Middle ribs

Question 46

Rib fx usually result from what

Answer 46

Blows or crush injuries

Question 47

Where is the weakest part of the rib

Answer 47

Just anterior to its angle

Question 48

Define rib movement with flail chest

Answer 48

Paradoxical (counter movement)

Question 49

Which approach to a thoracotomy is more satisfactory of entry into chest wall

Answer 49

Lateral approach

Question 50

What is more common, cervical ribs or extra lumbar ribs

Answer 50

Cervical

Question 51

Ossified xiphoid process may produce what in the elderly

Answer 51

A feeling of a “pit in their stomach” They think it’s cancer

Question 52

A sternal fx is usually what/ displacement of the bone fragment is not likely due to what

Answer 52

A comminuted fx. Not likely due to deep fascia

Question 53

Most common site for sternal fx. In the elderly

Answer 53

The sternal angle which result sin a dislocation of the manubriosternal joint

Question 54

The sternal body is often used for what procedure

Answer 54

Bone marrow needle biopsy

Question 55

Define complete sternal cleft

Answer 55

Heart protrudes from sternum (ectopia cordis)

Question 56

Define sternal foramen

Answer 56

Hole in sternum due to incomplete fusion

Question 57

Define pectus excavatum

Answer 57

Funnel chest, receding in

Question 58

Define pectus carinatum

Answer 58

Projecting chest

Question 59

Paralysis of the diaphragm involves what N.?

Answer 59

The phrenic N.

Question 60

Chest tube is usually inserted where

Answer 60

5th or 6th intercostal space laterally

Question 61

What does the superior articular facet of a typical rib articulate with

Answer 61

The inferior costal demifacet of the thoracic vertebral body one segment superiorly

Question 62

What does the inferior articular fact of typical ribs articulate with

Answer 62

Articulates with the superior costal demifacet on the thoracic vertebra of the same level