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Clinical Anatomy > Thorax 1 - Thoracic Wall > Flashcards

Thorax 1 - Thoracic Wall Flashcards

1
Q

what are the two main parts of the thorax?

A

thoracic wall
thoracic cavity

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2
Q

what are the primary functions of the thoracic wall?

A
  1. protects internal organs
  2. facilitates breathing & coughing
  3. attachment site for muscles of the upper limb, neck & back
  4. contains tissues responsible for forming the breast
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3
Q

what are the primary functions of the thoracic cavity?

A
  1. houses vital organs - heart, lungs
  2. contains blood vessels and nerves that control breathing (sympathetic and parasympathetic chains)
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4
Q

which ribs are classified as ‘true’ ribs? why?

A

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

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5
Q

which ribs are classified as ‘false’ ribs? why?

A

ribs 8-10 - join the costal cartilage of the 7th rib & attach indirectly to the sternum via shared cartilage

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6
Q

which ribs are classified as ‘floating’ ribs? why?

A

ribs 11-12 - don’t connect to the sternum, only posteriorly to thoracic vertebrae

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7
Q

what rib level (anteriorly) does the angle of Louis correspond to?

A

level of the 2nd rib

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8
Q

what thoracic vertebrae (posteriorly) does the angle of Louis correspond to?

A

T4

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9
Q

clinical significance of the sternal angle?

A

as it’s anteriorly at the level of rib-2, it’s an important landmark for rib counting

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10
Q

what are the intercostal spaces?

A

spaces that lie beneath each rib - i.e. the 1st intercostal space is beneath the 1st rib

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11
Q

how do typical ribs articulate with the vertebrae? (3)

A

head of the rib has 2 facets:
1. inferior articular facet articulates with the vertebrae of the same number (e.g. 4th rib IAF = T4 vertebral body)
2. superior articular facet articulates with the vertebrae above (e.g. 4th rib SAF = T3 vertebral body)

  1. tubercle on neck of ribs - articulates with transverse process of the sane number vertebrae (e.g. 4th rib tubercle = T4 transverse process)
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12
Q

what does the inferior articular facet on the head of the rib articulate with?

A

vertebral body of the sane number vertebrae - e.g. 4th rib IAF with T4 vertebral body

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13
Q

what would the superior articular facet of rib 6 articulate with?

A

the vertebral body of T5

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14
Q

what would the tubercle of rib 3 articulate with?

A

T3 transverse process

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15
Q

what structures form the boundaries of the thoracic inlet - anterior, posterior, lateral?

A

anterior - superior border of the manubrium
posterior - T1 vertebral body
lateral - first pair of ribs

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16
Q

what is the angle of Louis?

A

junction between the manubrium & body of the sternum

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17
Q

what structures form the triangle-shaped costal margin? (3)

A

lower borders of the ribs
sternum
xiphoid process

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18
Q

what are the boundaries of the thoracic outlet - anterior, posterior, lateral, floor?

A

anterior - costal cartilages of ribs 7-10 & xiphosternal joint
posterior - T12 vertebral body
lateral - 11th and 12th ribs
floor - diaphragm

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19
Q

how does the alignment of the ribs affect their relationship with the thoracic vertebrae - especially with the sternal angle?

A

ribs slope downward & forward - orientation causes the sternal angle to align with the 2nd rib anteriorly & T4 posteriorly

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20
Q

why are the clavicle and scapula not considered part of the thoracic cage, despite their connections?

A

not directly involved in the structure of the thoracic cage - provide attachment points for muscles & connect the upper limb and thoracic cage

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21
Q

which structure is NOT part of the thoracic inlet boundaries?

A. Body of T1 vertebra.
B. Superior border of the manubrium.
C. First pair of ribs.
D. Costal cartilage of the 7th rib.

A

D. costal cartilage of the 7th rib

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22
Q

which of the following statements about floating ribs (ribs 11 and 12) is FALSE?

A. They do not attach to the sternum.
B. They articulate with the transverse processes of T11 and T12.
C. They provide some protection for the kidneys.
D. They have no anterior articulation.

A

B - don’t articulate with transverse processes as they lack a tubercle; only articulate posteriorly with vertebrae

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23
Q

what is the jugular notch?

A

palpable area at the top of the manubrium between the two clavicles

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24
Q

what features make the 1st rib atypical?

A
  1. only one articular facet on head of rib - articulates with T1 vertebral body
  2. tubercle articulates with T1 transverse process
  3. superior surface has a groove for the subclavian artery & vein
  4. scalene tubercle for insertion of the scalene muscle
  5. wide & broader than typical ribs
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25
Q

which rib has a roughened area on its superior surface for the attachment of the serratus anterior?

A

2nd rib

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26
Q

what are the three parts of the sternum?

A

manubrium
body of sternum
xiphoid process

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27
Q

which joints and ribs does the manubrium articulate with?

A

sternoclavicular joints - with the clavicles
1st rib via an articular facet

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28
Q

what landmark is formed by the junction of the manubrium and the body of the sternum?

A

sternal angle/ angle of Louis

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29
Q

which ribs directly articulate with the body of the sternum?

A

ribs 3-7 via the costal notches

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30
Q

what is the relationship between ribs 8-10 (false ribs) and the body of the sternum?

A

ribs 8-10 join the costal cartilage of the 7th rib which then articulates with the body of the sternum via the 7th costal notch (indirect articulation)

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31
Q

what is the function of the thoracic vertebrae in relation to the ribcage and thoracic cavity? (3)

A
  1. maintains spinal alignment through its natural curvature
  2. provides structural support for the ribcage
  3. protects vital organs in the thoracic cavity
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32
Q

which part of the sternum is the insertion point for the pectoralis major?

A

body of the sternum

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33
Q

how are ribs classified based on their connection to the sternum?

A

true ribs (1-7) - directly connected to the sternum via their own costal cartilage

false ribs (8-10) - indirectly connected via the costal cartilage of the 7th rib

floating ribs (11-12) - no connection to the sternum, only posteriorly to the thoracic vertebrae

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34
Q

what are the three main components of a typical rib?

A

head - inferior & superior articular facets
neck - tubercle
body/ shaft - includes the costal angle & costal groove

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35
Q

what are the typical ribs?

A

ribs 3-9

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36
Q

what are the atypical ribs?

A

ribs 1, 2, 10, 11, 12

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37
Q

what is the function of the costal groove on typical rib?

A

located on the internal surface along the inferior border - protects intercostal nerves & vessels travelling to toe thoracic cage

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38
Q

which rib contains a groove for the subclavian artery and vein?

A

1st rib - groove on its superior surface

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39
Q

why is the 1st rib clinically important?

A

has a close relationship to the lower nerves of the brachial plexus and
subclavian vessels - fractures will risk these structures

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40
Q

TRUE/FALSE: rib 1 has smooth superior and sharp inferior borders

A

FALSE - has a smooth inferior border and a sharp superior border

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41
Q

TRUE/FALSE: the 1st rib doesn’t have a costal groove, but does have grooves for the subclavian artery & vein

A

TRUE

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42
Q

which part of the rib is most susceptible to fractures in case of trauma?
A) shaft of the rib
B) angle of the rib
C) neck of the rib
D) head of the rib

A

B: angle of the rib

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43
Q

what distinguishes the 10th, 11th, and 12th ribs from other ribs?

A

10th rib - single articular facet on its head
11th & 12th ribs - single articular facet on its head, no neck or tubercle, shorter & more slender

44
Q

what ribs don’t have a neck or tubercle?

A

11th and 12th ribs

45
Q

what joint is formed when ribs articulate with their associated costal cartilage?

A

costochondral cartilage

46
Q

what type of joint is the costovertebral joint? what does this mean in terms of movement?

A

synovial plane-type movement - very limited movement

47
Q

what articulations form the costotransverse joint?

A

tubercle of rib with the transverse process of the same number vertebrae (e.g. 3rd rib with T3)

48
Q

at what vertebral level does the jugular notch lie?

A

T2/T3

49
Q

at what vertebral level does the sternal angle lie?

A

T4/T5

50
Q

at what vertebral level does the xiphoid process lie?

A

T9

51
Q

at what vertebral level does the costal margin lie?

A

T9-L3

52
Q

what structures lie at the sternal angle? (think RAT PLANT)

A

Rib 2
Aortic arch
Tracheal bifurcation into bronchi
Pulmonary trunk
Ligamentum arteriosum
Azygous vein
Nerves - cardiac plexus & recurrent laryngeal nerve (branch of the vagus nerve)
Thoracic duct

+ oesophagus & pre-vertebral and pre-tracheal fascia

53
Q

what does the aortic arch do at the level of the sternal angle?

A

aortic arch curves at the level of the sternal angle

54
Q

what does the trachea do at the level of rib 2?

A

bifurcates into left & right bronchi

55
Q

what is the ligamentum arteriosum?

A

fibrous structure connecting the aorta & pulmonary trunk

56
Q

what vein drains into the superior vena cava at the level of the sternal angle?

A

azygos vein

57
Q

where does the thoracic duct collect lymphatic fluid from? what does it to at the level of T4/5?

A

collects fluid form the lower limbs & abdomen

shifts from the right to left side at the level of T4/5 (sternal angle) before exiting the thoracic inlet

58
Q

what do the pre-vertebral & pre-tracheal fascia do at the sternal angle?

A

they’re boundaries of the neck compartment - end at the sternal angle

59
Q

what is the role of the thoracic wall in respiration?

A

facilitates respiratory movements - works with diaphragm & intercostal muscles to increase/decrease intrathoracic volume and pressure to allow airflow in/out of the lungs

60
Q

what is the primary muscle for inspiration?

A

diaphragm

61
Q

what happens to intrathoracic volume and pressure during inspiration?

A

increase in intrathoracic volume
decrease in intrathoracic pressure
allows air from outside into lungs

62
Q

describe the pump-handle movement and its role in respiration - what dimension does it affect?

A

occurs when superior ribs 1-6 pull the sternum up & outward - increase the anteroposterior dimension of the thoracic cavity

63
Q

which ribs are involved in the bucket-handle movement? what dimension does it increase?

A

lower ribs 7-12 involved in bucket-handle movement during relaxed inspiration - increases transverse dimension as the lower ribs go laterally and outward

64
Q

how does the diaphragm contribute to changes in the vertical dimension of the thoracic cavity during breathing?

A

during inspiration - diaphragm contracts & flattens, compresses near abdominal viscera and increases the vertical dimension of the thoracic cavity = increases intrathoracic volume

during expiration - diaphragm relaxes & moves upwards, decreases the vertical dimension & intrathoracic volume

65
Q

describe what happens in relaxed inspiration & how the 3 dimensions of the thoracic cavity are affected

A
  • diaphragm contracts and flattens = increases vertical dimension volume
  • external intercostal muscles contract & elevate ribs = increases transverse & anteroposterior dimensions
  • increase thoracic cavity volume, decreases pressure = air flows into lungs
66
Q

describe what happens in relaxed expiration & how the 3 dimensions of the thoracic cavity are affected

A
  • diaphragm relaxes and moves upward = decreases vertical dimension volume
  • external intercostals relax = decrease in AP & transverse dimensions
  • increase in intrathoracic volume = air can leave the lungs
67
Q

what are the primary and accessory muscles involved in forced inhalation?

A

primary - diaphragm & external intercostal muscles

accessory - sternocleidomastoid, pectoralis minor, scalene muscles

68
Q

TRUE/FALSE: the innermost muscle of the thoracic cage is responsible for assisting in forced exhalation

A

TRUE (along with the internal intercostal muscle)

69
Q

what do the accessory muscles do during forced inspiration?

A

elevate the ribs and sternum - increase thoracic volume

70
Q

which two of these are NOT an accessory muscle involved in forced inspiration?
A. pectoralis minor
B. scalene muscle
C. pectoralis major
D. sternocleidomastoid
E. serratus anterior

A

C. pectoralis major
E. serratus anterior

71
Q

what muscles are involved in forced expiration?

A

primary muscles - diaphragm & external intercostal muscles

internal & innermost intercostal muscles

accessory abdominal muscles - internal & external obliques, rectus abdominis & transversus abdominis

72
Q

what do the internal & innermost intercostal muscles & the accessory abdominal muscles do during forced expiration?

A

internal & innermost intercostals: depress the ribs - reduce the transverse dimension

accessory abdominal muscles: compress the abdominal cavity, increase intra-abdominal pressure and forcefully expel air

73
Q

describe what happens during forced inspiration

A

diaphragm contracts & flattens - increases vertical dimension
external intercostals contract & elevate ribs - increase AP + transverse dimensions

accessory muscles (sternocleidomastoid, pec minor & scalene muscles) elevate ribs & increase thoracic volume

forces air into lungs

74
Q

describe what happens during forced expiration

A

diaphragm & external intercostals relax

internal & innermost intercostals contract - depress ribs, reduce transverse dimension

accessory abdominal muscles compress abdominal cavity, increase intra-abdominal pressure

forces air out of lungs

75
Q

the diaphragm is shaped as two domes. which dome is higher, and why?

A

right dome is higher due to the presence of the liver inferiorly

76
Q

what cavity does the diaphragm form the roof of? the floor of?

A

roof of the abdominal cavity
floor of the thoracic cavity

77
Q

what nerve innervates the diaphragm? its nerve roots?

A

phrenic nerve - from anterior rami of C3,4,5

78
Q

finish the saying - … keep the diaphragm alive!

A

C3, 4, 5

79
Q

what are the three major openings of the diaphragm & their vertebral levels? what passes through these openings?

A

inferior vena cava opening (T8) - IVC passes form abdomen to thorax to drain into the heart

oesophageal hiatus (T10) = oesophagus from thorax to abdomen & stomach fundus
aortic hiatus (T12) - abdominal aortal, thoracic duct (with lymphatic fluid) & nervous plexuses

80
Q

what three structures pass through the aortic hiatus at T12?

A

abdominal aorta into thorax
thoracic duct with lymphatic fluid from lower limbs & abdomen
nervous plexuses

81
Q

what is the nerve root of the phrenic nerve?

A

combined anterior rami of C3,4,5

82
Q

describe the course of the phrenic nerve - how does it lie relative to the scalene muscle lungs & heart

A

from the combined anterior rami of C3,4,5 - runs across anterior surface of the scalene muscles

enters thoracic cavity and runs anterior to the hilum of the lungs

descends on either side of the lateral aspects of the heart & lies on the pericardium

83
Q

what two areas/structures does the phrenic nerve provide somatosensory & sympathetic innervation to?

A

diaphragm & fibrous pericardium of the heart

84
Q

what three muscles do the intercostal spaces contain - from superficial to deep?

A

external intercostal muscle
internal intercostal muscle
innermost intercostal muscle

85
Q

where is the neurovascular bundle located in the intercostal space, and what is its order?

A

between the internal & innermost intercostal muscles - in order of vein, artery, nerve (VAN)

86
Q

what is the collateral neurovascular bundle? where is it found?

A

smaller collateral bundle off the main neurovascular bundle - runs along the superior border of the inferior rib

87
Q

why is it important to aim ABOVE the rib during procedures involving the intercostal space?

A

avoids damaging the main neurovascular bundle

88
Q

in which intercostal space and anatomical line is the needle inserted for tension pneumothorax decompression?

A

into the 2nd intercostal space at the midclavicular line (just above the 3rd rib - avoids damaging the main neurovascular bundle)

89
Q

differentiate the positions of the main intercostal neurovascular bundle & its smaller collateral bundle

A

main neurovascular bundle - runs along the costal groove of the inferior border of the superior rib in the intercostal space (strict vein-artery-nerve order)

small collateral bundle - along the superior border of the inferior rib in the intercostal space

90
Q

what is the external intercostal muscle responsible for?

A

elevating the ribs - increases AP thoracic dimension for inhalation

91
Q

what is the most superficial layer of intercostal muscle called?

A

external intercostal muscle

92
Q

how do the fibres of the external intercostal muscle run?

A

from the inferior border of one rib to the superior border of the rib below - ‘hands in pockets’ fibre direction

93
Q

what structure do the external intercostal muscles transition into as they approach the anterior thoracic wall?

A

external intercostal membrane (covers front of thoracic cavity)

94
Q

what is the middle layer of intercostal muscle called?

A

Internal intercostal muscle

95
Q

how do the fibres of the internal intercostal muscle run?

A

from the superior border of one rib to the inferior border of the rib above - ‘hands on opposite-side chest’ direction

96
Q

what is the primary function of the internal intercostal muscles during contraction? during what type of respiratory phase?

A

draw adjacent ribs closer together & depresses ribs - decreases thoracic dimensions during forced expiration

97
Q

during which respiratory phase do the internal intercostal muscles primarily function? how?

A

forced expiration - help depress the ribs & brings adjacent ribs closer together

98
Q

how is the innermost intercostal muscle separated from the internal intercostals?

A

via the main (intercostal) neurovascular bundle

99
Q

how is the innermost intercostal muscle structured?

A

two subdivisions: transversus thoracis and subcostalis

100
Q

what is the origin & insertion of the transversus thoracis muscle?

A

origin: xiphoid process & lower sternum
insertion: costal cartilages of ribs 3-6
- located on the deep surface of the anterior thoracic wall.

101
Q

what is a key characteristic of the innermost intercostal muscles compared to internal intercostals?

A

consists of entirely muscle fibers without transitioning into a membrane

102
Q

what is the neurovascular supply to intercostal spaces?

A

each intercostal space has a separate blood and nervous supply (neurovascular bundle)

103
Q

describe the arrangement of the intercostal neurovascular bundle

A

Intercostal vein → artery → nerve (superior to inferior order ALWAYS)

104
Q

Where does the neurovascular bundle run in relation to the rib?

A

along the inferior aspect of the rib in the costal groove

105
Q

TRUE/FALSE: the innermost intercostal muscles are easy to differentiate from internal intercostals during dissection

A

FALSE- difficult to differentiate due to their deep position

106
Q

what structure separates the upper & lower respiratory tract? clinical significance?

A

vocal cords - certain conditions typically affect one or the other resp tract & division helps with diagnosis and management of condition

(upper resp tract = nasal cavity, paranasal sinuses, larynx & pharynx; lower resp tract = trachea, bronchi, bronchioles)

Clinical Anatomy (27 decks)

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