1- Organization of the thorax

Question 1

All structures in the bony landmarks are easily palpable except ___ and ____.

Answer 1

1st and 12th rib

Question 2

The __________ is a readily palpable indentation at the superior border of the manubrium.

Answer 2

Jugular notch

Question 3

Running a finger inferiorly from the jugular notch, the first palpable projection is the _______, which is connected to the ________ of the ____ribs.

Answer 3

Sternal angle;

costal cartilage, 2nd

Question 4

The sternal angle is at the transverse level of _______; forming the _______ plane.

Answer 4

T4-T5 (specifically, the
intervertebral disc between T4 and T5);

transverse thoracic

Question 5

The ________ is a is the triangular shaped bone
at the back of the shoulders.

It has 2 easily palpable
projections _______ and _______ that surround
the head of humerus.

Answer 5

Scapula;
Acromion
Coracoid process

Question 6

For acromion and the coracoid process, which is more anterior?

Answer 6

Coracoid process.

Mnemonic: While spelling S ca pula, the C is in front of the A .
The Coracoid process is anterior to the Acromion.
Acromion arises from the spine (at posterior)

Question 7

Which 4 surface lines you should remember?

Answer 7

1. Anterior midline
2. Posterior midline
3. Mid-clavicular line
4. Scapular line (middle of the scapular at the posterior)

Question 8

A. Sternal line is equivalent anterior midline

B. Parasternal line is equivalent to mid-clavicular line.

Answer 8

Both wrong.

A. Sternal line is at the head of the clavicular; Anterior midline is really the midline

B. Parasternal line is the middle of sternal line and mid-clavicular line.

Question 9

The _______th intercostal space of the _________ line is the apex of the heart where the heartbeat can be felt.

Answer 9

5th;

Mid-clavicular line

Question 10

The ________ line passes through the inferior angle of

scapula. (Lowest part of the scapula, covered by latissimus dorsi.

Answer 10

Scapular

Question 11

What is in between the manubrium and the sternum?

Answer 11

Manubriosternal joint

Question 12

What is the part of the sternum and is at the level of T9?

Answer 12

Xiphoid process

Question 13

What are the 3 lines in the axillary region?

Answer 13

Anterior axillary line,
Midaxillary line,
Posterior axillary line

Question 14

The anterior axillary line is formed by the border of the __________.

Answer 14

Pectoralis major.

Question 15

The posterior axillary line is formed by the _____ and ______ muscles.

Answer 15

Latissimus dorsi;

Teres major

Question 16

When we ask the patient to put their hands on their waist, it will contract the _________ and make the _________ line more prominent.

Answer 16

Latissimus dorsi;

Posterior axillary line

Question 17

What are the boundaries of the safety triangle?

Answer 17

○ Anteriorly: lateral border of pectoralis major
○ Posteriorly: lateral border of latissimus dorsi
○ Inferiorly: horizontal line from nipple (commonly the
5th intercostal space)

defines the safe site for
thoracocentesis,

Question 18

In thoracocentesis, the needle run in the ___________ to prevent the VAN from being damaged .
It it also done in the safety triangle to prevent the ________, _____ and ____ from being damaged.

Answer 18

intercostal groove;

diaphragm, liver (right) or spleen (left)

Question 19

What are the differences between true ribs and false ribs? What is the remaining ribs called?

Answer 19

● True ribs (1-7): connect directly to the sternum

● False ribs (8-10): costal cartilage connect to the cartilage of
the rib superior to them

● Floating ribs (11-12): Do not connect to the sternum at all

Question 20

Typical ribs are ribs _____to _____. Which 6 structures to they have?

Answer 20

3-9

1. Head: site of 2 facets for articulation
2. Neck
3. Tubercle
4. Shaft (body)
5. Angle: where fractures are most likely to occur.
6. Costal groove: where intercostal veins, arteries and nerves run. (VAN)

Mnemonic: Typical structures in Thorax comes in multiples
of 3, typical ribs are 3-9, typical intercostal nerves are 3-6

Question 21

Which 2 structures are behind the sternum?

Answer 21

1. Arch of aorta
2. Bifurcation of the trachea

(T4-T5)

Question 22

What are the 5 structures of a thoracic vertebra?

Answer 22

1. Vertebral body
2. Superior articular facet
3. Inferior articular facet
4. Transverse process
5. Spinous process

Question 23

What are the key characteristics of a thoracic vertebra?

Answer 23

1. Heart-shaped body (heart is located in the thorax);

Kidney-shaped body of lumbar vertebrae (kidneys in abdomen)

2. Presence of transverse process
3. Spinous process slants inferiorly (lumbar and cervical vertebrae have horizontal spinous processes)

Question 24

For ribs 2-10, the transverse process, superior costal facet and the inferior costal facet of the vertebra above are connected to which structure of the rib respectively?

Answer 24

Transverse process: Tubercle

Superior costal facet: Inferior surface of head

Inferior costal facet of the vertebra above:
Superior surface of the head

Question 25

Describe the movements of the thoracic cage in inspiration.

Answer 25

Inspiration: Upward and outward movement of the rib cage and sternum, diaphragm and intercostal muscles contract, flattening of the diaphragm from 5th to 6th ribs. Intrathoracic volume increases, pressure is lower than atm pressure and draws air into lungs.

Question 26

About dermatomes: A. There is some overlap of adjacent dermatomes, so there would not be total loss of sensation upon damage of one spinal nerve B. Shingles (生蛇) go along dermatome area of a spinal nerve C. Nipples are in T4 dermatome D. Umbilicus is on T10

Answer 26

All

Question 27

Which 3 major kinds of muscles are on the thoracic wall? List all the muscles involved.

Answer 27

1. Chest muscles - Pectoralis major - Pectoralis minor - Serratus muscles (Boxer's muscle) 2. Rib to rib muscles - External intercostal muscle becomes External intercostal membrane at the anterior side - Internal intercostal muscle becomes Internal intercostal membrane at posterior side - The transversus thoracis and the innermost intercostal muscles are a continuous layer 3. Sternum to ribs muscles - Transversus thoracis

Question 28

What nerves innervate the pectoralis minor?

Answer 28

Medial and Lateral pectoral nerves (Brachial plexus)

Question 29

The Serratus Anterior muscle inserts onto the external surface of ______ parts of ribs 1-8 individually. The muscle originates from the anterior surface of medial border of scapula. It is innervated by the ____________ and acts to protect the scapula. Damage of the nerve will cause ___________.

Answer 29

lateral; Long Thoracic nerve; Winged scapula Mnemonic: SALT ○ Serratus Anterior muscle is innervated by Long Thoracic nerve

Question 30

What is the fibre direction of intercostal muscles?

Answer 30

Mnemonic: Fibre direction of intercostal muscles ○ Fibre direction of e xternal intercostal muscles = direction of forearm when hands are in pock e ts (run inferomedially) ○ Fibre direction of i nternal intercostal muscles and i nnermost intercostal muscles = direction of forearm when hands are on t i ts (run superomedially)

Question 31

Blood supply of the thoracic wall can be divided into 2 parts: 1. Posterior intercostal arteries which arise from the _________; 2. Anterior intercostal arteries which arise from the ___________and then _________.

Answer 31

Thoracic aorta; | Subclavian artery > internal thoracic artery

Question 32

The internal thoracic artery (branches from subclavian | artery ) run lateral to the _______________.

Answer 32

internal thoracic vein (drains into | subclavian vein )

Question 33

Each intercostal space is supplied by?

Answer 33

a large posterior intercostal artery and a pair of anterior intercostal arteries

Question 34

Each intercostal space is drained by?

Answer 34

posterior intercostal veins (tributaries of azygos/hemiazygos venous system) and anterior intercostal veins (tributaries of internal thoracic veins )

Question 35

The internal thoracic artery ends at ____th intercostal space and branches into _________ and __________.

Answer 35

6; | musculophrenic and superior epigastric artery

Question 36

The _________ containing ___________ (superior to inferior) runs along the costal groove.

Answer 36

Neurovascular bundle; - Intercostal veins (goes to azygous and hemiazygous veins) - Intercostal arteries (anterior and posterior) - Intercostal nerves

Question 37

The ________ is the circular pigmented area of skin surrounding the nipple.

Answer 37

Areola

Question 38

Mammary glands are modified _____ glands. Glands consist | of ____________ and _________ that open onto the nipple.

Answer 38

Sweat; Secretory lobules; Lactiferous ducts

Question 39

Breast cancer pulls on the _________ , resulting in | pitting of the skin, appearance like skin of an orange

Answer 39

suspensory ligaments (Cooper's ligament)

Question 40

What are the 3 major arterial supply to the breasts?

Answer 40

1. Intercostal arteries 2. Internal thoracic arteries 3. Branches from axillary artery (lateral thoracic artery)

Question 41

In breasts, most lymph drains to the ___________ (includes the pectoral , central axillary , subscapular and supraclavicular nodes).

Answer 41

Axillary lymph nodes *Breast cancer: spread of metastasis via lymphatic drainage

Question 42

Venous drainage of the breast is mainly to the ________ vein , but there is some drainage to the _____ vein.

Answer 42

Axillary; | Internal thoracic

Question 43

The transverse thoracic plane at the sternal angle (T4-T5) separates the _____ mediastinum and the _______ mediastinum.

Answer 43

Superior and inferior.

Question 44

The inferior mediastinum is separated into _____, _______ and ______mediastinum.

Answer 44

Anterior, middle and posterior | 前中後

Question 45

When cut in coronal plane, which mediastinum can be seen?

Answer 45

Superior and inferior.

Question 46

When cut in transverse plane, which mediastinum can be seen?

Answer 46

Anterior, middle and posterior

Question 47

When cut in mid-sagittal plane, which mediastinum can be seen?

Answer 47

All 4

Question 48

Thoracic duct and esophagus are in the ______ mediastinum.

Answer 48

Posterior

Question 49

Which muscle causes a winged scapula?

Answer 49

- Weakness of serratus anterior. - It is due to the damage of long thoracic nerve which innervates serratus anterior muscles. - Normally when the arm is extended and pressing against the wall, serratus anterior contracts to pull the originally flipped out scapula towards the body. But without contraction of serratus anterior, the scapula appears to be winged.

Question 50

In anesthesia during thoracentesis, the intercostal nerves superior and inferior to the insertion site of needle have to be blocked. Explain the reason.

Answer 50

- Intercostal nerves have collateral branches, which travel above and along the rib. - The cutaneous branches of one intercostal nerve and the collateral branch of the superior one intercostal nerve together innervate the same area of skin. (overlapping in sensory field) - Both of the nerves have to be blocked to eliminate all sensation of the insertion site during thoracentesis.