Thorax

Question 1

Angle of Louis

Answer 1

T4/5

Question 2

T4/5

Answer 2

Lower boundary of superior mediastinum
Upper margin of the heart
Beginning and end of aortic arch
Bifurcation of trachea

Question 3

Sup angle of scapula

Answer 3

T2

Question 4

Spine of scap

Answer 4

T3

Question 5

Suprasternal notch

Answer 5

T2/3

Question 6

Inf angle of scapula

Answer 6

T8 and 7th rib

Question 7

Xiphisternal joint

Answer 7

T9

Question 8

Lowest part of Costal margin

Answer 8

10th rib
L3 level

Question 9

Nipple level in man

Answer 9

4th intercostal space

Question 10

Where is apex beat

Answer 10

5th IC space mcl

Question 11

How far do the lungs reach down

Answer 11

Mcl - T6
Mal - T8
Post - T10

Question 12

How far do the pleura reach

Answer 12

2.5cm above clavicle
Mcl - T8
Mal - T10
Post - T12

Question 13

Where does the internal mammary/ internal thoracic artery run

Answer 13

Behind costal cartilages - 1.25cm from lateral border of sternum

Question 14

Where do the intercostal bundles run

Answer 14

Immediately under the corresponding rib
Vein most inferior then artery then nerve

Question 15

What is the safety triangle for chest drain insertion

Answer 15

Lower border of axilla
Lateral border of pec major
Lateral border of lat Dorsi
5th intercostal space

Question 16

Where are chest drains placed

Answer 16

Above 6th rib, in fifth intercostal space
In mid axillary line

Question 17

Where do the ribs connect

Answer 17

1-7;via costal cartilages to the sternum
8-10 communicate with the rib below
11 and 12 free floating

Question 18

What crosses over the neck of the first rib

Answer 18

From med to lateral - sympathetic trunk, superior intercostal artery (from Costco cervical trunk), large branch of first thoracic nerve to the brachial plexus

Question 19

Where does the body of the sternum lie

Answer 19

T5-T8
2nd to 7th ribs connect

Question 20

What are the accessory muscles of respiration

Answer 20

Scm, lat dorsi, serratus anterior and pec major

Question 21

Blood supply to the intercostal muscles

Answer 21

Paired anterior intercostal artery and posterior - lower 2 only have posterior

Post arteries
- first two are from superior intercostal branch of costocervical trunk from subclavian artery
- remainder are directly from descending thoracic aorta

Ant arteries
- 1-6 = branches of internal thoracic artery
- 7-9 = musculophrenic branch of internal thoracic artery

Veins = azygous or hemiazygous veins

Question 22

Nerve supply to intercostals

Answer 22

Anterior primary rami of thoracic nerves

Question 23

Diaphragm openings

Answer 23

T8 - IVC via caval opening - also right phrenic and lymph - on right of aorta via central tendon
T10 - oesophagus and vagus and left gastric - on left of aorta via right crus
T12 - aorta and thoracic duct and azygous veins

Question 24

Diaphragm attachments

Answer 24

Central and peripheral attachments
Central
- right crus - L1-L3 and iv discs
- left crus - L1 -L2

Peripheral
- lumbar vertebrae and arcuate ligaments
- costal cartilages 7-10
- xiphoid process

Question 25

What fuses to form the diaphragm

Answer 25

1 septum transversum - forms the central tendon (mesoderm - moves from head end - hence phrenic nerve orgins 345)
2 foregut/ dorsal oesophageal mesentry
3 peripheral rim from body wall
4 pluripotent membranes - close fetal connection between pleural and peritoneal cavities

Question 26

Relations of the Hila

Answer 26

Right main bronchus
- post = azygous goes on to join scv at t4/5 level

Left main bronchus
- post oesophagus and aorta