Thorax General

What is the floor of the thoracic wall?

the diaphragm

What movement does the thoracic vertebra allow?

roation and some flexion/extension

What movement is limited by thoracic vertebrae and why?

flexion because of rib cage, extension because of spinous processes

What are the specific facets on the thoracic vertebrae?

costal facets for rib attachment

What is the joint that connects the rib to the transverse process?

costotransverse joint

Which thoracic vertebrae does Rib 1 articulate with?

just T1

Which vertebrae do typic ribs attach to?

the one above and below

T2-T9 have what kind of facet?

demi-facet, only half the rib

T10-T12 have what kind of costal facet?

one bilateral (whole) costal facet

Describe a thoracic compression fracture

axial loading injury, thicker posteriorly than anteriorly

What do ribs anteriorly attach to?

sternum via costal cartilages (except ribs 11 and 12)

Which are your true ribs?

ribs 1-7

which are false ribs?

ribs 8-10

why are ribs 8-10 considered false ribs?

they indirectly connect to the sternum through shared cartilage

which ribs are floating ribs?

ribs 11 and 12

Why are ribs 11-12 considered floating ribs?

do not connect to the sternum

What runs through the costal groove?

arteries

Why is rib 1 difficult to palpate?

it is well protected by calvicle

What are the grooves on the superior surface of rib 1?

the subclavian v and a

Which vessel sits more anterior on rib 1?

subclavian v sits more anteriorly than subclavian a

What separates the vessels and grooves on rib1?

scalene tubercle

What is rib 1 a bony landmark for?

the subclavian v&a becoming axillary v&a

ribs 10-12 have only a single facet on head, how many vertebral bodies do they articulate with?

one each

What are not present in ribs 11 and 12

costotransverse joints

What region of the rib are most commonly fractured

middle portion; at or anterior to angle

what are the three parts of the sternum?

manubrium, body, xiphoid process

What is the bony landmark separating the manubrium and the body?

sternal angle

what is the plane at the sternal angle?

transverse thoracic plane

what is the sternal angle a landmark for?

notch for 2nd costal cartilage, level of t4/t5 IVD

the xiphoid process is at what vertebral level?

T10

what are the three sternocostal joints?

costochondral joint, sternochondral joint, interchondral joint

what makes up the costochondral joint

rib to costal cartilage

what makes up the sternochondral joint

costal cartilage to sternum

what makes up the interchondral joint?

costal cartilage to costal cartilage (ribs 8-10)

what is costochondritis?

inflammation of costochondrial joint

What are the three divisions of the thoracic cavity?

2 lateral (pulmonary), 1 central (mediastinum)

What divides the superior and inferior mediastinum?

the transverse thoracic plane

Where does the superior medistinum start?

the superior thoracic aperture

Where does the inferior mediastinum end?

the diaphragm

What are the quadrants of the breast?

superior lateral, inferior lateral, inferior medial, superior medial

what quadrant is the axillary process in?

the superior lateral quadrant

what quadrant is breast cancer most common in?

the superior lateral quadrant in the axillary tail

What causes a winged scapula?

damage to the long thoracic nerve (c5-c6-c7)

if a patient has a winged scapula, what action will they have difficulty with

adduction

What two structures pass in between anterior and middle scalene m?

brachial plexus and subclavian a

what passes immediately anterior to anterior scalene m?

phrenic n and subclavian v

What part of the VAN is least protected in the innermost intercostal muscles?

the intercostal nerve

What does it mean for a structure to terminate?

end its course, changed name, split into other structure

what does it mean for a structure to branch?

a larger structure giving off smaller structures of same kind

what does it mean for a structure to coalesce?

structures merge together and increase in size

What are the branches of the aorta?

brachiocephalic trunk, L common carotid a, L subclavian a

What is the first branch off of the subclavian artery?

vertebral artery

What does the internal thoracic a supply blood to?

intercostal spaces 1-6

what are the two branches of the anterior intercostal arteries?

musculophrenic a and the superiorepigastric a

what does the musculophrenic a supply blood to?

supplies intercostal spaces 7-9

Is the L or R posterior intercostal a longer?

the right posterior intercostal a

why is the right posterior intercostal a longer than the left?

because the descending thoracic aorta sits to the left of the middle

What is the first part of the axillary a?

between lateral border of 1st rib and medial border of pectoralis minor m

What is the second part of the axillary a

covered by pectoralis minor m

What is the third part of the axillary a

between lateral border of pectoralis minor m and inferior border of teres major m

What are the 2 branches of the 2nd part of the axillary a

the thoracoacromial trunk (CAPD), lateral thoracic a

What does the lateral thoracic a supply

serratus anterior m, intercostal m, pectoral m

what nerve parallels the lateral thoracic a

long thoracic n

What are the three branches of the 3rd part of the axillary a

subscapular a, thoracodorsal a, anterior humeral circumflex a, posterior humeral circumflex a

what branches off of the subscapular a

thoracodorsal a, scapular circumflex

What two veins drain into SVC?

left and right brachiocephalic vein

What makes up the left venous angle?

Left internal jugular v and left subclavian vein

what makes up the right venous angle?

the right jugular vein, right subclavian v

what duct drains into the L venous angle?

thoracic duct

what duct drains into the right venous angle?

right lymphatic duct

what fiber types are in the collateral branches?

sensory, motor, post-symp

what type of fibers are in the cutaneous branches?

sensory and post-symp

Fiber types of 2nd intercostal n?

sensory and post-symp

where do you do an intercostal nerve block?

below/above rib, close to nerve

where do you perform a thoracentesis?

intercostal space and avoiding the nerve

why do you perform a thoracentesis?

to remove fluid build up in intercostal space

inferior border of the mediastinum?

diaphragm

superior border of mediastinum

superior thoracic aperture

anterior border of mediastinum

sternum and costal cartilages 1-7

posterior border of mediastinum

thoracic vertebrae 1-12

lateral borders of mediastinum

left and right pulmonary cavities

contents of superior mediastinum

thymus, great vessels, phrenic n, vagus n, trachea, esophagus, thoracic duct and lymphatic vessels

what vein will empty blood into the SVC before it enters the pericardial sac?

azygous vein

what is the aortic arch a continuation of?

ascending aorta

where does the aortic arch begin?

right side at T4/T5 IVD (sternal angle)

What does the aortic arch branch over?

L primary bronchus

What is the structure that moves blood away from lungs in a fetus

ductus arteriosus

what does the ductus arteriosus turn into after a baby’s first breath?

the ligamentum arteriosum

what does the foramen ovale turn into?

the fossa ovalis

what does the umbilical v turn into

round ligament of the liver

where is the vagus nerve located

descends through neck posterolateral to common carotid a

what branches off of the vagus n

the L/R recurrent laryngeal n

Where does the ventral rami derive from?

C3-C4-C5

what are the fiber types of the phrenic n

motor, sensory, post-symp

what does the phrenic n supply

diaphragm m (majority), central portion of diaphragmatic parietal pleura, mediastinal parietal pleura, fibrous pericardium

What does “SAP” stand for?

superior vena cava, ascending aorta, pulmonary trunk

what are the contents of the middle mediastinum

pericardium, heart, roots of great vessels (SAP)

What are the key landmarks of the heart?

apex (inferior) and base (superior)

What are the three layers of the pericardium from superficial to deep?

fibrous pericardium, serous parietal pericardium, serous visceral pericardium

what is the purpose of the pericardial fluid

reduce friction as the heart beats