Thorax Anatomy

Front 1

What are the thoracic inlet boundaries?

Back 1

manubrium, 1st thoracic vertebrae, R/L 1st rib

Front 2

what are the 6 components? What is NOT part of the thorax

Back 2

skin, subcutaneous tissue, fascia, muscles (EXCEPT pecs), bones (ribs, sternum, manubrium), cartilage (costal)

Front 3

What does the thoracic wall skeleton consist of? (7)

Back 3

12 ribs, 12 thoracic vertebrae, IV discs, costal cartilages, manubrium, sternum, and xiphoid process

Front 4

Pectus excavatum
3 causes:

Back 4

Anterior concave chest wall deformity
causes: intrauterine pressure during development, abnormal diaphragm position causing posterior retraction, abnormal CT production

Front 5

Pectus carinatum:
3 causes:

Back 5

"pigeon chest" ; abnormal protrusion of sternum and costal cartilage
-abnormal ant cartilage/sternal growth, CT disorders, assoc conditions may include scoliosis and congenital heart dz

Front 6

Flail chest
-subjected to what?

Back 6

unstable chest wall due to multiple double rib fractures.
-uncouples chest wall from rib cage- subjected to intra-pleural pressure=paradoxical motion

Front 7

thoracic outlet syndrome

Back 7

related to thoracic inlet because of structures coming out:
upper limb, ulnar and median nerve, subclavian blood vessels
(could all get compressed)

Front 8

what are the 3 types of ribs?

Back 8

-True 1-7
-False 8-10
-Floating 11-12

Front 9

typical vs atypical ribs

Back 9

typical: 3-9 (head, neck, tubercle, body)
atypical: 1 (broadest, shortest, most curved), 2 (more typical), 10-12 (no neck or tubercle)
*only one facet on their head

Front 10

Rib fractures:
1st=
middle=
lower=

Back 10

- rarely fractured (behind clavicle) brachial plexus and subclavian vessels may get injured
-most common, ant to rib angle
-diaphragm can be injured and cause diaphragm hernia

Front 11

Rib dislocation vs Rib separation

Back 11

-costal cartilage is displaced from sternum
-rib is displaced from costal cartilage

Front 12

supernumerary ribs

Back 12

increase # through cervical or lumbar ribs or missing 12th
-may interfere with neurovascular structures exiting superior thoracic aperture and confuse in diagnostics

Front 13

Sternum
What does the xiphoid sternal joint indicate?

Back 13

1. manubrium (clavicle); "angle of Louis"-2nd costal cartilage
2. sternum T5-T9
3. xiphoid process
=inf limit of thoracic cavity, sup limit of liver, central tendon of diaphragm, inf heart border

Front 14

Sternal fractures
-where is the most common site?

Back 14

not common, comminuted (pieces not displaced due to fascia), most common site is sternal angle

Front 15

median sternotomy

Back 15

-gain access to thoracic cavity
-coronary artery grafting
-removal of superior lobe lung tumor

Front 16

sternal biopsy
what is bone marrow used for?

Back 16

-bone marrow needle biopsy
-BM used for transplantation, detection of metastatic cancer, and blood abnomalities

Front 17

ankylosing spondylitis

Back 17

-chronic inflammatory dz of axial joints
-limits range of spine movement
-extra-articular manifestations
-exercise intolerance maybe

Front 18

muscles of respiration?
inspiration

Back 18

Diaphragm
external intercostals
serratus post superior
levator costorum

Front 19

muscles of respiration?
forced inspiration

Back 19

external inercostals
scalen ant, midd, post
sternocleidomastoid

Front 20

muscles of respiration?
expiration
forced expiration

Back 20

-passive (no muscle involvement)
-internal intercostals
abdominal wall muscles (external/internal obliques, transversus/rectus abdominis)
serratus post inferior

Front 21

Paralysis of the diaphragm
how does the affected side move?

Back 21

Hemi diaphragms NN by the L/R phrenic nerve.
-affected side moves superiorly during inspiration

Front 22

lymph drainage:
above clavicle?
below clavicle?

Back 22

-lymph drains into inferior jugular nodes
-parietal lymph drains into axillary lymph nodes

Front 23

Surface anatomy
jugular notch?
manubrium?
What is used in CPR for proper hand location?

Back 23

-T2
-T3-4
-infrasternal angle

Front 24

Intercostal approach?

Back 24

skin> superficial fascia> external, internal, innermost muscles> endothoracic fascia> parietal pleura

Front 25

Arteris:
from aorta?
subclavian?
Ant intercostal?
axillary?

Back 25

-post 3-11 intercostal, and subcostal 12
-sup from costocervical trunk 1-2
-internal thoracic arteries
-lateral thoracic artery

Front 26

What is the vein drainage?
ant vs post?

Back 26

11 pairs of posterior and 1 subcostal
-ant tributaries from internal thoracic
-superior vena cava receives from: R azygos vein <L hemiazygos + L accessory hemiazygos

Front 27

Atypical intercostal nerve
1st:
2nd:
7-11th:

Back 27

-a large superior (brachial plex) and a small inferior
-large intercostal brachial N. (communicates with?)
-crosses costal margin to become thoracoabdominal N.

Front 28

2 layers of pleura:

Back 28

1. visceral-covers lung surface
2. lines pulmonary cavities + the root of the lung!!

Front 29

What attaches parietal pleura to inside thoracic wall?

Back 29

endothoracic fascia

Front 30

what are the 4 parts of parietal pleura?

Back 30

cervical
costal
mediastinal
diaphragmatic

Front 31

what is endothoracic fascia covering cervical?
what is it attaching diaphragm to parietal pleura?

Back 31

-supra pleura membrane (Sibson fascia)
-Phrenico pleura fascia

Front 32

What is the R line of pleural reflection?

Back 32

1. sternoclavicular joint to 6th costal cartilage
2. 8th rib at mid clavicular line
3. 10th rib at mid axillary line
4. 12th rib at its neck

Front 33

What is the left line of pleural reflections?

Back 33

1.sternoclavicular joint to 4th costal cartliage
2. it deviates to the left and creates a notch "Bare area"
<here perichardium is in direct contact with thoracic wall>

Front 34

Recesses:
R & L costodiaphragmatic:
costomediastinal:

Back 34

-potential pleural spaces into which lungs slide in/out during respiration
-potential pleural space where perichondrium is in direct contact w/ post surface of wall
"area of cardia dullness"

Front 35

pericardiocentesis

Back 35

"bare area"-needle is inserted 5-6th intercostal space
-infrasternal angle
-avoid puncturing internal thoracic a. and branches

Front 36

pleuritis

Back 36

lung surfaces become rough b/w visceral and parietal pleura making a sharp rubbing noise
-acute-sharp stabbing pain

Front 37

injury to cervical pleura

Back 37

projects into neck w/out bony protection except for Sibson fascia
-1st ribs expose cervical pleura

Front 38

pleurodesis

Back 38

obliteration of pleural cavity by disease like pleuritis
<spontaneous atelectasis (lung collapse) might be necessary to fuse parietal and visceral with an irritating agent to prevent