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1

2

Label the boxes from top down

Jugular notch

Clavicle

Sternal angle

Costal margin

3

Describe the anterior associations of the ribs and their costal cartilages

Ribs 1-7:

Connected by costal cartilages directly to sternum

Ribs 8-10:

Connected by costal cartilage to the costal cartilage above

Ribs 11-12:

Free floating, no connection to sternum/cartilage

4

Label this diagram from top down

The typical rib:

Head

Neck

Shaft

2 articular facets separated by crest

Tubercle (Top = articular, Bottom = non-articular)

Costal groove

5

What ribs are considered typical?

Ribs 3 to 9

6

Label each of these ribs with their number and features that make them 'atypical'

Top to bottom:

Rib 1:

shortest, broadest, most curved, only has 1 facet on head

Rib 2:

Poorly marked costal groove

Ribs 11 + 12:

Floating

Single facet on head

No tubercle

Tapering anterior end

7

Label the boxes

First set of boxes

Participants in joint of head of rib:

Body of vertebra superior to rib

Intervertebral disk

Body of vertebrae same number as rib

 

Second set of boxes

Costo-transverse joint:

Transverse process of vertebra of same number as rib

Tubercle of rib

Axis of rib rotation

Movements (the arrows):

Elevation

Depression

 

8

Label the black and red boxes

Black, top left clockwise:

Axis of movement

Axis of movement

Increase in sagittal diameter

Increase in transverse diameter

Neck of rib

Red, left to right:

Lower rib

Upper rib

9

What are the three layers of intercostal muscle

Give a brief description of each

External intercostals:

Fibre direction is posterior to anterior from the inferior border of the superior rib to the superior border of the inferior rib

Outermost

Internal intercostals:

Fibre direction is anterior to posterior from the inferior border of the superior rib to the superior border of the inferior rib

Middle layer

Innermost intercostals:

Run from the inferior border of the superior rib to the superior border of the inferior rib

Innermost layer

10

Label the boxes top to bottom

External intercostal muscles

Internal intercostal muscles

Innermost intercostal muscles

11

Describe the actions of the external intercostal muscles

Elevation of the upper ribs in a 'pump handle' movement to increase A-P diameter of thorax

Elevation of lower ribs in a 'bucket handle' movement increasing the lateral diameter of the thorax

12

Describe the actions of the internal and innermost intercostal muscles

Depress the ribs during forced expiration

Reduces A-P and lateral diameter

13

What muscles are responsible for passive expiration?

No muscles, passive process driven by elastic recoil of lungs and chest wall

14

What structures are labelled here?

Two neurovascular bundles

Main bundle includes intercostal vein, artery and nerve and runs in costal groove of superior rib

Collateral bundle runs along the superior border of the inferior rib

15

Describe the 12 intercostal nerves

Course:

Appear from the anterior rami of thoracic spinal nerves (T1 - T12)

Run between internal and innermost intercostal muscles

Supply:

Intercostal muscles in corresponding space

Parietal pleura

Overlying skin

16

Label the boxes from top left clockwise

Paravertebral chain

Intercostal nerve

Posterior intercostal artery

Anterior intercostal artery

 

17

What is supplied by the intercostal arteries?

Intercostal muscles

Parietal pleura

Overlying skin

18

Label boxes in two rows, Left row then right row, top to bottom

Left:

Superior vena cavae

Azygous vein

Hemiazygous

IVC

Right:

Anterior intercostal vein

Internal thoracic vein

Posterior intercostal veins

19

From where do the posterior and anterior intercostal arteries arise?

Anterior:

Internal thoracic artery (branch of the subclavian)

Posterior:

Thoracic aorta

Superior intercostal artery (From the costo-cervical traunk, a branch of the subclavian)

20

Describe the venous drainage of the chest wall

Primarily into the Azygous system ---> SVC

Some drainage into internal thoracic vein

21

Describe the structure of the diaphragm

Central tendon + Peripheral  uscle

Peripheral muscle areas:

Sternal - Arising from xiphisternum

Costal - Arising from inner aspects of the 7-12 costal cartilages

Vertebral - Arising from arcuate ligaments (thickenings of fascia over the posterior abdominal wall muscles) + crura

22

Label black boxes from top left clockwise

IVC opening

Central tendon

Oesophaseal opening

Aortic hiatus w/median ligament overlying

Left crus

Right crus

Lateral arcuate ligament

Medial arcuate ligament

23

Give the vertebral level of the openings in the diaphragm and attachment sites of the right and left crus

Oesophagus: 

T10

Vena cava:

T8

Aortic Hiatus:

T12

Right crus:

L4

Left crus:

L3

24

What is the function of the diaphragm in relation to breathing?

Main muscle of inspiration

Contraction causes descent of diaphragm, expanding the thoracic cavity

25

Describe the nerve supply of the diaphragm

Include any additional innervation of that nerve

Phrenic nerve

Roots:

C3 - 5 (3-4-5 keep you alive)

Motor innervation:

Diaphragm

Sensory innervation:

Pericardium

Mediastinal and diaphragmatic portions of parietal pleura

Both surfaces of diaphragm

26

What muscles/actions are involved in inspiration?

What are the results of these muscle actions?

External intercostals:

Elevation of ribs

Contraction of diaphragm:

Descent

Sternocleidomastoids:

Elevates sternum

Scalenes:

Elevate and fix upper ribs

Results:

Increased transverse and A-P diameter

Increase in vertical dimension

27

Describe the process of expiration in regards to actions/muscles involed

Quiet expiration:

No muscles, just elastic recoil

Forced expiration:

Internal and innermost intercostals

Rectus abdominus

External and internal obliques

Transversus abdominus

Results of either passive or forced:

Decrease in AP and transverse diameter

Decrease in the vertical dimension

28

What is the involvement of the pleura in respiration?

Briefly describe how this works

As muscle action expands the thorax and the parietal pleura the pleural seal ensures that the visceral pleura and hence the lung also expand

The pleural seal is formed from surface tension between fluid molecules of the serous secretions in the pleural cavity

29

What is the clinical relevance of the pleural seal?

Puncture of the parietal pleur breaks the pleural seal, allowing the visceral and parietal pleura to separate, this is a pneumothorax (lung collapse)

30

Decribe the nerve supply of the pleura

Parietal:

Somatic innervation (including pain) and autonomic

Visceral:

Only autonomic