BOARDS week #3

Which ribs directly connect to the sternum via costal cartilage?

1-7

The upper seven ribs are called?

True ribs

The five lover ribs 8-12 do NOT connect to the?

Sternum

The lower five ribs are called?

False ribs

Ribs 11 and 12 don not connect to the?

Sternum or costal margin

Rib 11 and 12 are called?

Floating ribs

Rib 11 and 12 also do NOT form what kind of joint with their respective vertebrae?

Costotransverse

The costal margin is formed by the?

Costal cartilage of ribs 7-10

The costal Margin roughly separates the abdominal from the?

Thoracic cavity

The costal margin is at the level of the?

Diaphragm

The rib cage mainly protects the?

Esophagus, heart, and lungs

The rib cage connect posteriorly to the spine via the?

-costotransverse joint

-costovertebral joint

The rib cage connect anteriorly to the sternum via?

-costal cartilage

-rib 1 is a non-movable, synchondrosis, non-synovial, non-diarthrodial joint

-ribs 2-7 are synovial joint

Osseous ribs join their respective costal cartilage at the?

Costochondral joint

Costochondral joints are classified as a ____________ in childhood?

Synchondrosis

Costochondral joints are cartilaginous joint united by?

Hyaline cartilage

By adulthood Costochondral joints, most of these joints ossify and become?

Synostosis

Ribs 3-9 are typical ribs always have the following posterior rib structures?

Head, neck, and tubercle

The posterior end of ribs 3 through 9, the posterior end articulates with the?

Vertebral column

The head of the rib contains two _____ for articulation with the superior and inferior costal _______?

Facets, Demifacets

The crest of the rib is what?

Facets are separated by a crest

Neck of the rib is between the?

Head and tubercle

The tubercle of the rib is located at the meeting of the?

Shaft and the neck

The tubercle of the rib contains a facet for articulation with the?

Transverse process

The shaft of the rib progressively flattens out as it moves toward the anterior end and ends posteriorly at the rib tubercle? T/F

True

The shaft of the rib contains an?

Angle and a costal groove

The costal groove is always located?

Inferiorly

The angle of the rib is lateral to the tubercle and is the part of the rib shaft which dramatically _______?

Curves

The angle of the rib has a high risk area for?

Fracture

Rib head attachments found at the _________ end of the rib?

Posterior

Ribs 2-9 articulate with?

2 adjacent vertebral bodies

The rib head attachments of ribs 2-9 attach to 2 adjacent vertebral bodies via?

Superior and inferior costal Demi-facets

All ribs except for which ones connect to the same numbered costotransverse facet?

11 and 12

The rib head vs crest have facets between the rib and TP and are separated by the?

Bony crest

The crest actually attaches to the lateral part of the intervertebral disc via what ligament?

Intra-articular

The neck of the rib is located between the?

Head and tubercle of the rib

The neck of the rib is an attachment point for?

-costotransverse ligament

-superior costotransverse ligament

The costal groove is located?

Along the inferior aspect of each rib

The costal groove contains what 3 important structures in order from superior to inferior?

Intercostal VAN

Medical students are taught to never put in a chest tube against the?

Inferior border of the rib

There are three sets of muscles that run between each pair of ribs, what are they?

-external intercostal

-internal intercostal

-innermost intercostal

Which pair of muscles sandwich's the VAN together?

Innermost intercostal and internal intercostal

A pathological right to left shunt can immediately lead to serious medical problems like?

Hypoxia and cyanosis

What is central cyanosis?

Problem with deoxygenated blood mixes with oxygenated blood, usually from a congenital heart problem

What is peripheral cyanosis?

A problem with slow blood flow through the arteries which causes the tissues to steal too much oxygen from the blood

What is an atrial septal defect?

A person is born with a real congenital hole somewhere in the interatrial septum

An ASD typically occurs in the valve of the?

Fossa ovalis

An ASD causes blood to shunt from?

Left atrium to the right atrium

Extra blood flow caused by an ASD from the left atria into the right atria causes more blood to pour into the lungs and will lead to?

Small pulmonary artery and pulmonary arteriole fibroblast-heavy, fibrosis and remodeling which thickens the tunica media and tunica intima causing lumina stenosis

What is luminal stenosis cause?

Beaver dam induced pulmonary hypertension

The luminal stenosis blocks the flow of blood through the lungs and decreases?

Left atrial filling

Luminal stenosis for an ASD also backs blood up in the pulmonary arteries, pulmonary trunk, and right heart which dramatically raises?

Pressure

When pulmonary hypertension occurs from and ASD blood will now flow from?

Right atria to left atria

When pulmonary hypertension causes right to left shunt of blood with someone with an ASD what syndrome has begun?

Eisenmenger syndrome

The pathological right to left shunt results in?

-total body hypoxia

-cyanosis

What is the most common congenital defect of adults?

ASD

Why does hypoxia happen in adults with ASD?

Because atrial pressures are low compared to ventricular pressures, therefore the right heart and lungs receive only modest amount of extra arterial blood from ASD

What is. By far the most common type of ASD?

Ostium secundum defect

An ostium secundum defect is a true defect in the interatrial septum which typically involves both the?

Limbus but more of the valve

The limbus comes from?

Ostium secundum

The valve came from?

Ostium primum

Ostium decundum defect is typically not dangerous?

True

Unlike PFO and OSD always shunts blood from?

Left to right

Eventually when having an OSD in adulthood this could potentially lead to?

Right to left shunt via eisenmenger syndrome

A sinus venosus defect involve abnormal communication between?

Left and right atria

Superior sinus venosus defect =

Superior part of interatrial septum

Inferior sinus venosus defect =

Inferior part of interatrial septum

A superior sinus venosus defect is a problem with the embryological development of the?

Superior part of the sinus venosus

With someone with a superior sinus venosus defect, 85% of the time there is an abnormal communication between superior pulmonary vein and either the?

Right atria or right superior vena cava

For a superior sinus venosus defect this allows oxygenated arterial blood to spill into the deoxygenated blood of the?

Right atrium or superior vena cava

A person with inferior sinus venosus defect will initially get a left to right shunting of oxygenated blood into deoxygenated blood but years down the road what can occur?

Eisenmenger syndrome

What is an ostium primum defect?

Hole in inferior most interatrial septum which is near the tricuspid valve

What is the cause of an ostium primum defect?

Endocardial cushions fail to seal this hole during development

Ostium primum defect is associated with what?

Down syndrome

What is the treatment for an ASD if small or large?

-small = scar will shut the passage

-large = surgical closure of the defect may be necessary

In the fetus the DA is an open tube typically between the distal what structures?

Pulmonary trunk and the isthmus of the aorta

During development most of the pulmonary trunk blood that passes through the DA into the?

Isthmus of the aorta

Normally the ductus arteriosus closes before birth and forms into the?

Ligamentum arteriosum

If the DA remain open after birth and does not close this is called?

Patent ductus arteriosus

With a patent DA large amounts of blood from the high pressure aorta dump into the?

Lower pressured pulmonary trunk and pulmonary artery

Because large amount of blood passing through the patent DA what will occur very quickly?

Eisenmenger syndrome