Chest Wall And Diaphragm

Front 1

What are the boundaries of the thorax?

Back 1

Thoracic wall and diaphragm

Front 2

What is the thorax composed of?

Back 2

Pleural cavities and the mediastinum

Front 3

What are the two prominent openings of the thorax?

Back 3

Superior thoracic aperture and inferior thoracic aperture

Front 4

What are the osteological definitions of the thorax?

Back 4

Thoracic vertebrae and ribs

Front 5

What is the name of the process, normally associated with lumbar vertebrae, that is seen on the T12 vertebra?

Back 5

Mammillary process

Front 6

How does the spinous process orientation change from T1 to T12?

Back 6

Starts out fairly horizontal at T1, becomes more vertical starting around T4, returns to a more horizontal position around T11.

Front 7

How do the rib heads articulate starting with T2?

Back 7

Rib 2 head articulates with demifacets of T1 & T2.

Front 8

How do the rib tubercles articulate?

Back 8

Rib 2 tubercle articulates with T2 transverse process.

Front 9

What is unique about the 1st rib?

Back 9

It is immobile and robust.

Front 10

Costotransverse ligament

Back 10

Neck of rib to transverse process

Front 11

Superior costotransverse ligament

Back 11

Rib neck to transverse process of next superior vertebra

Front 12

Lateral costotransverse ligament

Back 12

Non-articular part of tubercle to transverse process of same vertebra

Front 13

Radiate ligaments

Back 13

Vertebral body to rib neck

Front 14

Which costovertebral joints have TWO synovial cavities (separated by an intra-articular ligament)?

Back 14

Ribs 2 - 9

Front 15

Costotransverse joint

Back 15

Secondary rib joint;
Not all thoracic vertebra exhibit this joint (T11 and T12 do not)

Front 16

What connects the ribs to the sternum?

Back 16

Costal cartilages

Front 17

What type of joint is between the first costal cartilage and the manubrium?

Back 17

Synchondrosis

Front 18

At which costal cartilage would you find a synovial joint with TWO compartments?

Back 18

2nd costal cartilage (which attaches to sternal body and manubrium at the sternal angle)

Front 19

Describe costal cartilages 3 - 7:

Back 19

Attach along sternal body;
Synovial;
Single compartment

Front 20

Describe costal cartilages 8 - 10:

Back 20

Attach to costal cartilage of next higher rib:
Synovial;
Single compartment (interchondral joints)

Front 21

Where do radiate sternocostal ligaments attach

Back 21

Attach sternum to costal cartilages

Front 22

Costoxiphoid ligaments

Back 22

Attach rib to xiphoid process

Front 23

Which ribs are known as true ribs?

Back 23

1 - 7

Front 24

Which ribs are known as false ribs?

Back 24

8 - 10

Front 25

Which ribs are known as floating ribs?

Back 25

11 - 12

Front 26

External intercostal muscles

Back 26

n: intercostal nerve
a: elevate ribs
*strong laterally
*do not continue all the way to the sternum
*"hands in pockets" analogy

Front 27

Internal intercostal muscles

Back 27

n: intercostal nerve
a: depress ribs

Front 28

Where do the intercostal vessels lie?

Back 28

Between the external/internal intercostal mm. and the innermost intercostal mm.

Front 29

Innermost intercostal muscles

Back 29

n: intercostal nerve
a: depress ribs
*Strongest in lateral rib cage
*Weak anterior and posterior

Front 30

Transversus thoracis muscles

Back 30

n: intercostal nerve
a: depress costal cartilages
*Same "level" as innermost intercostals

Front 31

Subcostal muscles

Back 31

n: intercostal nerve
a: depress ribs
*Same "level" as innermost intercostals
*Span multiple rib levels

Front 32

What are the 3 primary directions of lung expansion?

Back 32

Vertical
Transverse
Anteroposterior

Front 33

Which direction of lung expansion does the diaphragm largely facilitate?

Back 33

Vertical motion

Front 34

Which direction of lung expansion do the ribs facilitate?

Back 34

Lateral and anteroposterior motion

Front 35

Describe the different types of rib motion:

Back 35

Rib 1: elevated/depressed by scalene m.
Ribs 2-5: largely pump handle motion
Ribs 6-10: largely bucket handle motion
Ribs 11 & 12: pincer/caliper-like

Front 36

Describe "pump" motion:

Back 36

Left and right ribs work as pair to raise the sternum;
Increases anteroposterior motion;
Axis closer to coronal plane, joint more concavo-convex;
Less coronal motion, MORE SAGITTAL

Front 37

Describe "bucket" motion:

Back 37

Left and right ribs DO NOT work symmetrically;
Axis closer to sagittal plane, joint more planar;
Less sagittal motion, MORE CORONAL

Front 38

Where does the superior intercostal artery arise from?

Back 38

Costocervical trunk

Front 39

Where do the 9 most inferior intercostal arteries branch directly from?

Back 39

Aorta

Front 40

Where does the superior-most intercostal vein arise from?

Back 40

Subclavian v.

Front 41

Where do the remaining veins arise from?

Back 41

Azygos v. (right side) or Hemiazygos or Accessory Hemiazygos vv. (left side)

Front 42

Where does the first intercostal nerve arise from?

Back 42

Small branch of Brachial Plexus (ventral ramus of T1)

Front 43

Where do the remaining intercostal nerves arise from?

Back 43

Respective ventral rami

Front 44

Name the intercostal nerves from 1 - 12.

Back 44

Thoracic Intercostal nn. (1 - 6)
Thoracoabdominal Intercostal nn. (7 - 11)
Subcostal n. (12)

Front 45

Where does the internal thoracic artery descend from?

Back 45

Subclavian a. (posterior to sternum, anterior to transversus thoracis mm.);
First branches are the pericardiacophrenic aa.

Front 46

Name all of the internal thoracic arteries:

Back 46

Internal thoracic a. (from subclavian)
Pericardiacophrenic a.
Anterior intercostal aa. (from internal thoracic a.
Musculophrenic a.
Superior epigastric a.
Perforating branches

Front 47

What is the structure of the diaphragm?

Back 47

Musculotendinous structure (NOT smooth muscle) separating the abdomen and thorax;
Consists of 2 domes with a central tendon;

Front 48

Where does the diaphragm attach?

Back 48

Attaches peripherally to xiphoid process, costal margin, ribs 11 & 12, ligaments of posterior abdominal wall, and lumbar vertebrae

Front 49

What happens when the diaphragm muscles contract?

Back 49

The diaphragm is pulled RADIALLY and is DEPRESSED during INSPIRATION

Front 50

Where do the R and L domes reach during EXPIRATION?

Back 50

R dome reaches rib 5;
L dome reaches 5th intercostal space

Front 51

What are the innervations of the diaphragm?

Back 51

Motor: phrenic n.
Sensory: innercostal nn.

Front 52

On which side of the diaphragm does a congenital diaphragmatic hernia occur and what happens when this occurs?

Back 52

Generally happens on L side of diaphragm; small intestine moves into thorax

Front 53

What are two consequences of congenital diaphragmatic hernia?

Back 53

Pulmonary hypoplasia - incomplete development of the lungs, resulting in an abnormally low number or size of bronchopulmonary segments or alveoli;
Pulmonary hypertension - an increase in blood pressure in the pulmonary artery, pulmonary vein, or pulmonary capillaries, together known as the lung vasculature, leading to shortness of breath, dizziness, fainting, and other symptoms, all of which are exacerbated by exertion

Front 54

What are the 3 primary openings of the diaphragm?

Back 54

Vena Caval aperture (inferior vena cava)
Esophageal aperture (esophagus, vagus nn.)
Aortic aperture (aorta, thoracic duct, azygos & hemiazygos)