Lab Guide- Thoracic Wall through Superior Mediastinum

Question 1

What is the only bony articulation between the upper limb and the trunk?

Answer 1

sternoclavicular joint

Question 2

Where does the sternoclavicular joint run?

Answer 2

The sternoclavicular joint occurs between the proximal end of the clavicle and the clavicular notch of the manubrium of the sternum together with a small part of the first costal cartilage

Question 3

Name the structure where the manubrium articulates with the body of the sternum

Answer 3

sternal angle (located ~5cm inferior to the suprasternal notch)

Question 4

The sternal angle demarcates the level of articulation of which rib with the sternum?

Answer 4

2nd rib

Question 5

In males, the nipples are usually located in which intercostal space?

Answer 5

4th. In females, the nipples are frequently not reliable landmarks due to the variable amount of fatty tissue of the breast (aka how big dem titties is)

Question 6

What muscles form the most superficial muscle layer of the intercostal spaces?

Answer 6

external intercostal muscles. Note the vertical direction of the fibers of these muscles

Question 7

The anterior intercostal arteries (usually two in each space) branch from which artery in the upper 5 spaces?

Answer 7

the internal thoracic artery

Question 8

The anterior intercostal arteries (usually two in each space) branch from which artery in the lower 5 or 6 spaces?

Answer 8

musculophrenic arteries

Question 9

The anterior intercostal arteries course laterally through the intercostal spaces where they anastomose with what?

Answer 9

posterior intercostal arteries which arise from the thoracic aorta

Question 10

Which intercostal nerves continue beyond the intercostal spaces and also provide somatic and motor innervation for the abdominal wall?

Answer 10

intercostal nerves 7-11

Question 11

The internal thoracic arteries (one on each side) are bound to the inner aspect of the chest wall by which muscles?

Answer 11

transversus thoracis muscle

Question 12

The transverses thoracic muscle arises from the inner surface of the sternum and attaches to which costal cartilages?

Answer 12

2nd through the 6th

Question 13

The internal thoracic arteries originate where?

Answer 13

from the right and left subclavian arteries in the root of the neck (they enter the thorax just posterior to the sternoclavicular joints)

Question 14

The internal thoracic arteries give rise to which arteries?

Answer 14

the anterior intercostal arteries in the upper 5 intercostal spaces and

at the inferior end of the sternum, it divides into the superior epigastric and musculophrenic arteries (on both sides)

Question 15

the sternal angle is formed between which two structures?

Answer 15

manubrium of the sternum and the body of the sternum

Question 16

The sternal angle provides a marker for estimating the level of which structures?

Answer 16

RATPLANT (mnenomic)

1) 2nd rib
2) arch of aorta
3) Trachea bifurcation
4) Pulmonary trunk bifurcation
5) left recurrent laryngeal and ligamentum arteriosum
6) azygos drain to SVC
7) nerves of the cardiac plexus
8) thoracic duct entering the left subclavian vein

Question 17

What structure connects the pulmonary trunk to the arch of aorta?

Answer 17

ligamentum arteriosum

Question 18

T or F. the pericardium covers portions of both the heart and the lungs

Answer 18

T. centrally it covers the heart and laterally it cover the lungs and pleurae

Question 19

What is the most anterior structure in the superior mediastinum?

Answer 19

the thymus gland. In the adult, most thyme tissue has been replaces by fat and connective tissue

Question 20

The brachiocephalic veins branch into which two structures?

Answer 20

the internal jugular and subclavian veins (on each side)

Question 21

Right brachiocephalic vein route

Answer 21

descends vertically deep to the clavicle and along the right border of the sternum

Question 22

Left brachiocephalic vein route

Answer 22

passes obliquely and inferiorly across the superior mediastinum deep to the manubrium and ventral to the arterial branches of the aortic arch

Question 23

What is formed by the convergence of the left and right brachiocephalic veins?

Answer 23

the superior vena cava

Question 24

What does the internal thoracic branch into?

Answer 24

musculophrenic and superior epigastric

Question 25

Where does the internal thoracic branch into the musculophrenic and superior epigastric arteries?

Answer 25

deep to the 6th cartilage

Question 26

What runs just anterior to the transverse thoracic muscles?

Answer 26

the internal thoracic arteries

Question 27

What ribs do the transverse thoracic muscles attach to?

Answer 27

2-6

Question 28

What intercostal spaces does the internal thoracic arteries supply?

Answer 28

upper five

Question 29

What separates the superior mediastinum from the inferior mediastinum?

Answer 29

sternal angle

Question 30

What vertebrae are in the superior mediastinum?

Answer 30

T1-T4

Question 31

What is the most anterior structure in the superior mediastinum?

Answer 31

thymus gland (lies right behind the manubrium)

Question 32

Where does the left brachicephalic vein meet the right brachiocephalic vein?

Answer 32

deep to the first right costal cartilage

Question 33

What separates the left vagus and phrenic nerves?

Answer 33

the left superior intercostal vein

Question 34

Where does the brachiocephalic trunk run in relation to the manubrium?

Answer 34

directly posterior to it

Question 35

How many veins is the internal thoracic artery accompanied by?

Answer 35

Two internal thoracic veins

Question 36

What do the internal thoracic veins empty into?

Answer 36

brachiocephalic veins

Question 37

Are the lungs in the mediastinum?

Answer 37

No, they are lateral to it

Question 38

Where does the ligamentum arteriosum attach on the aortic arch?

Answer 38

inferior aspect directly under the left subclavian artery

Question 39

Is the heart in the anterior mediastinum?

Answer 39

no, middle

Question 40

Describe the route of the right vagus nerve

Answer 40

enters the superior mediastinum between the subclavian arteries, descends down between the right brachiocephalic vein and the brachiocephalic trunk and passes into the posterior mediastinum by passing deep to the root of the lung

Question 41

T or F. The left recurrent laryngeal nerve passes anterior to the ligament arteriosum

Answer 41

F. It passes deep and posterior to it

Question 42

How many pair of external and internal intercostal muscles are there?`

Answer 42

11