MSK 24 - Imaging and Clinical Anatomy of the Thorax

Question 1

Answer 1

Question 2

What does the sternum articulate with?

Answer 2

Clavicle

Costal cartilages 1-7

Question 3

Discuss what the sternal angle is a landmark for.

Answer 3

Question 4

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Question 5

What runs through the costal groove of a rib?

Answer 5

A neurovascular bundle

Question 6

Which ribs are atypical?

Answer 6

1, 2, 10, 11, 12

Question 7

Describe the joints that the ribs take part in.

Answer 7

Question 8

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Question 9

What are the three types of ribs and which ribs are which?

Answer 9

Question 10

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Question 11

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Question 12

What are the inferior thoracic aperture boundaries?

Answer 12

Question 13

What are the boundaries of the superior thoracic aperture? What structures pass through this aperture?

Answer 13

Question 14

Label picture and say what condition it is showing.

Answer 14

Thoracic outlet syndrome. Extra rib attaching to C7

Question 15

What is thoracic outlet syndrome? What typically causes it? What are the symptoms?

Answer 15

Thoracic outlet syndrome is a condition in which there is compression of the nerves, arteries, or veins passing between the thorax and axilla. It is usually caused by an extra rib attaching to C7, muscular abnormalities, or an injury. Symptoms include pain, numbness, weakness, palor, and edema (from vascular compression). The hand is most commonly affected and symptoms may be consistent or intermittent.

Question 16

List the intercostal muscles, the direction of their fibers, their actions, and their associated neurovasculatures.

Answer 16

Question 17

List the deep muscles of the thoracic cage and describe their function and neurovasculature?

Answer 17

Internal and Innermost intercostal muscles -

Transversus thoracis muscles - the radiate out from the posterior surface of the sternum and attach to the posterior surfaces of the ribs close to the costal cartilages. They depress the ribs to aid in forced expiration. They are innervated by the intercostal nerves

Subcostal muscles - found posteriorly near the rib angles and span 1 or more intercostal spaces. Their function is unclear but are thought to aid in forced expiration. They are innervated by the intercostal nerves

Question 18

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Question 19

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Question 20

List and explain the different scapular movements.

Answer 20

Question 21

List the anterolateral thoracic wall muscles, their innervations, and actions.

Answer 21

Pectoralis Major - innervated by the medial and lateral pectoral nerves. Acts to adduct and flex shoulder as well as medially rotate the humerus.

Subclavius - innervated by the subclavian nerve. Acts to depress clavicle

Serratus Anterior - innervated by the long thoracic nerve. Acts to rotate scapula upward (allowing for should abduction >90 degrees) and keep it held against the thoracic cage

Pectoralis Minor - innervated by the medial pectoral nerve. Acts to depress shoulder and proctract (abduct) scapula.

Question 22

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Question 23

Discuss the movement of the ribs during respiration.

Answer 23

Question 24

What are the three regions of thoracic pleura and what innervates each region.

Answer 24

Question 25

What is a Thoracocentesis? What is a Thoracostomy?

Answer 25

Question 26

Discuss the location and purpose of the thoracic pleural recesses.

Answer 26

Question 27

At rest, how does the inferior border of the visceral and parietal thoracic pleuras differ?

Answer 27

The visceral pleura is 2 rib levels higher than the parietal

Question 28

Answer 28

Question 29

What is a pleural reflection?

Answer 29

A pleural reflectionis a line or curvature that occurs when a fold is made so that the pleura can change direction.

Question 30

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Question 31

In what order superiorly to inferiorly do the neurovascular vessels run in the neurovascular bundle of the costal groove?

Answer 31

VAN Intercostal Vein Intercostal Artery Intercostal Nerve

Question 32

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Question 33

What region of the spinal nerves gives rise the nerve supply of the thoracic wall? Which nerves innervate the thoracic wall and what structures do they provide sensory innervation for?

Answer 33

Question 34

How is thoracic pleural pain felt?

Answer 34

On the skin along the corresponding dermatome

Question 35

What are some important dermatome levels to remember?

Answer 35

Question 36

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Question 37

What arteries supply the thoracic parietal pleura?

Answer 37

Question 38

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Question 39

What is unique about the venous drainage of the first two intercostal spaces?

Answer 39

Question 40

Describe the lymphatic drainage of the thoracic wall

Answer 40

Question 41

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Question 42

Facts to know about the thoracic duct.

Answer 42

Question 43

General facts to know about the mammary gland

Answer 43

Question 44

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Question 45

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Question 46

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Question 47

Facts to know about patient positioning during a thoracic x-ray.

Answer 47

* Typically chest x-rays are taken in the PA view; this means the film is "in front" of the patient and the x-rays travel through starting from the back. The x-ray bean is oriented so that _the upper 4 thoracic spinous processes appear half way between the clavicles on the radiograph_ (refer to picture). * Lateral view images are taken with the investigation side towards the film (typically left)

Question 48

How should a thoracic x-ray be evaluated?

Answer 48

Question 49

How can you tell if a thoracic radiograph is of good quality?

Answer 49

Question 50

How can you tell what phase of respiration a patient is in on a radiograph?

Answer 50

Question 51

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Question 52

How do you differentiate between the anterior and posterior aspects of ribs on a radiograph?

Answer 52

Question 53

What is the hilum of the lung and why is it important for thoracic imaging.

Answer 53

The hilum is the large triangular depression where the connection between the parietal pleura and the visceral pleura is made, and this marks the meeting point between the mediastinum and the pleural cavities. This also where the pulmonary vessels enter/exit the lungs. This portion of the lung is less dense and therefore appears as an empty space on a lateral thoracic x-ray

Question 54

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Question 55

Describe how a normal lateral thoracic x-ray should appear?

Answer 55

Question 56

What is the weakest area of the rib and therefore the most likely to fracture?

Answer 56

The angle of the rib

Question 57

What are the common causes, symptoms, and treatments for a single point rib fracture?

Answer 57

Question 58

How do you identify rib fracture on a radiograph?

Answer 58

Question 59

Describe the common causes and results of a multiple point rib ribfracture.

Answer 59

Question 60

What is flail chest?

Answer 60

Question 61

Facts to know about pleurisy/pleuritis.

Answer 61

Question 62

What will pleurisy/pleuritis look like on a radiograph?

Answer 62

Question 63

Describe how a thoracocentesis is performed?

Answer 63

A syringe is inserted into the pleural cavity via the 9th intercostal space to obtain a sample of fluid. The needle is inserted just above the 10th rib (to avoid the neurovascular bundle) at the midaxillary line and is directed slightly upwards.

Question 64

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Question 65

What are common conditions causing thoracic wall pain?

Answer 65

* Inflammation of the costochondral and costovertebral joints * Pleurisy * Skin lesions such as herpes zoster

Question 66

Where is pleurisy of the central diaphragmatic and mediastinal regions felt? Why?

Answer 66

It is felt in the C3-C5 dermatomes because of the phrenic nerve

Question 67

Facts to know about shingles

Answer 67

Question 68

What/where are the milk lines and what is their clinical significance?

Answer 68

Question 69

What is polythelia, polymastia, and gynecomastia?

Answer 69

Question 70

How does a regular mammogram appear?

Answer 70

Question 71

How will "lumps" appear on a mammogram?

Answer 71

Question 72

How do you determine if a breast lump is cancer? What are some signs that it is not cancer? Give examples of lumps that are non-malignant.

Answer 72

Question 73

List the arteries that supply the breast.

Answer 73

Internal thoracic sends small segmental branches Lateral thoracic artery Pectoral artery

Question 74

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Question 75

Facts to know about a breast self examination.

Answer 75

Question 76

What are the visible indicators of breast cancer?

Answer 76

Question 77

Describe the peau d' orange appearance of a cancerous breast.

Answer 77

Question 78

What does a radical mastectomy involve? What remaining structures are usually damaged and why? What are some of the long term symptoms of a mastectomy?

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Question 79

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Question 80

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Question 81

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