The Thoracic Wall Flashcards
(148 cards)
1
Q
what is the thorax
A
a truncated dome-shaped structure, formed by the sternum, costal cartilages, ribs and thoracic vertebrae
2
Q
where does the thorax extend
A
from the root of the neck to the abdomen
3
Q
what are the basic boundaries of the thorax
A
- superior thoracic aperture
- inferior thoracic aperture
- thoracic wall
4
Q
contents of the thorax
A
- lungs
- heart
- mediastinum
- trachea
- bronchi
- oesophagus
- vagus and phrenic nerves
- major systemic and pulmonary vessels
5
Q
another name for the superior thoracic aperture
A
thoracic inlet
6
Q
margins of superior thoracic aperture
A
- superiorly - upper first rib, costal cartilage, manubrium
- posteriorly - 1st thoracic vertebra
7
Q
what is present between the margins of the superior thoracic aperture
A
apexes of each lung covered by the suprapleural membrane
8
Q
what is another name for the suprapleural membrane
A
sibson’s fascia
9
Q
superior thoracic aperture function
A
allows important structures to pass in and out thorax
10
Q
five important structures that pass through the superior thoracic aperture
A
- trachea
- oesophagus
- subclavian artery and vein
- common carotid artery
- internal jugular vei
11
Q
shape and size of superior thoracic aperture
A
- 5cm in length
- 10cm transversely
- slopes down from posterior aspect to anterior aspect
12
Q
another name for inferior thoracic aperture
A
thoracic outlet
13
Q
what is the inferior thoracic aperture composed of
A
diaphragm
14
Q
margins of the inferior thoracic aperture
A
- T12 posteriorly
- costal margins of ribs 7-12 mediolaterally
- xiphoid process anteriorly
15
Q
name three important structures that pass through the inferior thoracic aperture
A
- oesophagus
- descending aorta
- inferior vena cava
16
Q
name 1
A
lung
17
Q
name 2
A
pleural cavity
18
Q
name 3
A
visceral pleura
19
Q
name 4
A
parietal pleura
20
Q
name 5
A
intercostal vein
21
Q
name 6
A
intercostal artery
22
Q
name 7
A
intercostal nerve
23
Q
name 9
A
collateral branches
24
Q
name 10
A
endothoracic fascia
25
name 11
serratus anterior muscle
26
name 12
external intercostal muscle
27
name 13
internal intercostal muscle
28
name 14
innermost intercostal muscle
29
name 15
skin
30
name 16
superficial fascia
31
four functions of the thorax
- respiration
- protection of vital organs
- conduit
- support for breast tissue
32
explain respiration as a function of the thorax
movements of the thoracic wall increase/decrease intra-thoracic volume. this results in inspiration and expiration
33
what vital organs does the thorax protect
- heart and lungs
- abdominal organs - liver, spleen, kidneys
34
what is the primary function of the thorax
respiration
35
why are thoracic lines important
for the placement of ecg leads
36
name the three anterior thoracic lines
- midsternal line
- midclavicular lines
- lateral sternal lines
37
where does the mid sternal line run
bisects the middle part of the sternum
38
where do the midclavicular lines run
run vertically from the centre of the jugular notch to the tip of the acromiom of scapula
39
where do the lateral sternal lines run
lateral margins of sternum
40
name the two posterior thoracic lines
- midvertebral line
- scapular lines
41
where does the midvertebral line run
straight down the middle of the spine
42
clinical consideration for the midvertebral line
scoliosis will cause it to be crooked
43
where do the scapular lines run
down through the inferior margins of the scapula
44
name the two lateral thoracic lines
- axillary lines (posterior and anterior)
- midaxillary line
45
where do the axillary lines run
vertical lines which correspond to the anterior and posterior axillary folds
46
what are the axillary folds
- frame axilla
- formed anteriorly by lateral border of pec major
- formed posteriorly by the borders of latissimus dorsi and teris major
47
where does the midaxillary line run
bisects the axillary lines
48
what is another name for the suprasternal notch
jugular notch
49
where is the suprasternal notch located
above the manubrium and below the clavicles, at the vertebral disc between T2 and T3
50
clinical consideration of the suprasternal notch
The superior vena cava passes directly behind the manubrium returning blood from the head and neck - notch means we can measure jugular venous pressure to help form a differential diagnosis of congestive heart failur
51
another name for the sternal angle
angle of louis
52
where is the angle of louis located
- at manubriosternal junction - at the vertebral disc between T4 and T5
- It’s the point at which the 2nd rib and costal cartilage attach to the sternum
53
where is the xiphosternal joint located
at the level of the ninth thoracic vertebra
54
what is 1
| cardiac auscultations
aortic area: second right intercostal space
55
what is 2
| cardiac auscultations
pulmonary area: second left intercostal space
56
what is 3
| cardiac auscultations
erb's point: third left intercostal space (left sternal border)
57
what is 4
| cardiac auscultations
tricuspid area: fourth left intercostal space (left lower sternal border)
58
what is 5
| cardiac auscultations
mitral area or apex: fifth left intercostal space (midclavicular line)
59
how many chest leads are there in a 12 lead ECG
6
60
V1/V2
fourth left and right intercostal spaces
61
V4
fifth intercostal space at the midclavicular line
62
V3
midway between V2 and V4
63
V5
fifth intercostal space at the anterior axillary line
64
V6
fifth intercostal space at the midaxillary line
65
what is the sternum made up of
manubrium, body and xiphoid process
66
where are intercostal spaces
spaces in between the ribs
67
what do intercostal spaces contain
three layers of muscle and the neurovascular bundle
68
where specifically is the neurovascular bundle within the intercostal space
the costal groove
69
where does the thoracic wall thicken
at the apex of each lung as the suprapleural membrane (sibson's fascia) atttaches to the internal border of the first rib and the transverse processes of C7
70
what are the components of the thoracic cage
- 12 thoracic vertebrae
- 12 pairs of ribs
- sternum
71
which are the true ribs
1-7
72
what are true ribs
those which have a direct connection to the sternum anteriorly
73
which are the false ribs
8-10
74
what are false ribs
their costal cartilages are connected to the rib above them not the sternum directly
75
which are the floating ribs
11-12
76
what are floating ribs
no cartilaginous connection to the sternum
77
main features of typical thoracic vertebrae
- heart shaped body
- superior and inferior demi-facets on both sides of the body
- costal facets on transverse processes
- long downward slanting spinous processes
78
purpose of demi-facits on thoracic vertebrae
articulation with ribs
79
main feature of atypical thoracic vertebrae
do not contain 2 demi-facets
80
puporse of the expanded head at the end of a rib
- articulates with demi-facets of thoracic vertebrae
- apex of head articulates with intervertebral disc between the two vertebrae
81
shape of rib 1
short and wide
82
features of rib 1
- only has 1 facet
- only articulates with manubrium
- superior surface is marked with two grooves which make way for subclavian vein and artery
83
shape of rib 2
thin and long
84
main feature of rib 2
has a rough edge where the serratus anterior muscle originates from
85
where are the sternocostal joints
between true ribs
86
classification of the sternocostal joint at the first rib
primary cartilaginous
87
classification of sternocostal joints at ribs 2-7
plane synovial
88
is the plane synovial joint at rib 2 single or double
double
89
are the plane synovial joints at ribs 3-7 double or single
single
90
what are sternocostal joints stabilised by
sternocostal ligaments and thin capsules
91
what kind of movement do sternocostal joints allow for
slight, gliding movements
92
where are costochondral joints found
between costal cartilages and ribs
93
classification of costochondral joints
primary cartilaginous
94
another name for primary cartilaginous
synchondrosis
95
what kind of movement do costochondral joints allow for
no movement
96
clinical consideration for costochondral joints
may become inflamed - costochondritis
97
where are interchondal joints
between ribs 8-10
98
classification of interchondral joints
plane synovial
99
what are interchondral joints stabilised by
interchondral ligaments and thin capsules
100
classification of xiphersternal joint
secondary cartilaginous
101
another name for secondary cartilaginous
symphysis
102
classification of manubriosterna joint or angle of louis
secondary cartilaginous
103
measurement of angle of louis
162 degrees
104
what kind of movement does the angle of louis allow for
little movement
105
sternoclavicular joint classification
synovial saddle joint
106
what is the sternoclavicular joint stabilised by
anterior and posterior sternoclavicular, interclavicular and costoclavicular ligaments
107
costovertebral joint location
articulations of the demi-facets in the head of each rib with the bodies of the corresponding vertebra and that of the vertebra above
108
costovertebral joint classification
2 plane synovial
109
what kind of movements do costovertebral joints allow for
gliding movements
110
what are costovertebral joints stabilised by
capsular, radiate, intra-articular ligaments
111
costotransverse joint locations
articulations between rib facets and the transverse process of their corresponding vertebra
112
costotransverse joints classification
2 plane synovial
113
what kind of movement do costotransverse joints allow for
simple, rotational and sliding movements
114
what are costotransverse joints stabilised by
capsular, inferior costotransverse, superior costotransverse and lateral costotransverse ligaments
115
which thoracic joint usually ossifies late in life
xiphosternal joint
116
the movements of which two thoracic joints occur simultaneously
costovertebral and costotransverse joints
117
primary respiratory muscles for inhalation
diaphragm
external intercostal muscles
118
accessory respiratory muscles for inhalation
- sternocleidomastoid muscle
- scalene muscles
- pectoralis minor
- serratus anterior muscle
119
accessory respiratory muscles for expiration
- internal intercostal muscles
- transverse thoracis muscle
- external oblique muscle
- rectus abdominus
- internal oblique muscle
120
why are there no primary respiratory muscles for expiration
because it is usually a passive process
121
where are the intercostal muscles found
intercostal space between ribs
122
name the three intercostal muscles
- external intercostal muscle
- internal intercostal muscle
- innnermost intercostal muscle
123
external intercostal muscle function
- inspiration
- contraction causes teh adjacent rib to rise and seperate - thus increasing thorax volume
124
internal intercostal muscle function
- expiration
- contraction pulls ribs together, compressing the thorax - this reducing thorax volume
125
what is the transverse thoracis group
- innermost part of thoracic wall
- help with articulation of the ribs and sternum
126
three muscles that make up the transverse thoracis group
- subcostalis posteriorly
- transverse thoracic (sternocostalis) anteriorly
- innermost intercostal laterally
127
what artery supplies teh 1st and 2nd intercostal spaces dorsally
the superior intercostal artery from the costocervical trunk
128
what artery supplies all the intercostal spaces bar 1&2 dorsally
the descending aorta
129
what artery supplies the upper six intercostal spaces anteriorly
branches of the internal thoracic artery
130
what artery supplies intercostal spaces 7-9 anteriorly
the musculophrenic branch of the internal thoracic artery
131
how many veins in each intercostal space
- one posterior intercostal
- two anterior intercostal
- one collateral
132
where do anterior veins drain into
the musculophrenic and internal thoracic veins
133
where do posterior veins drain into
into the azygos vein on the right and the hemiazygos and accessory hemiazygos on the left
134
name 7 simple clinical considerations for the thoracic wall
- Costovertebral dislocation (at any level)
- Transverse rib fracture
- Oblique rib fracture
- Overriding rib fracture
- Costochondral separation
- Chostosternal separation
- Sternal fracture
135
name 5 complicated clinical considerations for the thorax
- Traumatisation of pleura and of lung
- Multiple rib fractures
- Tear of blood vessels (hemothorax)
- Compound by missile or by puncture wound
- Injury to heart or to great vessels
136
three examples of traumatisation of pleura and of lung
- Pneumothorax
- Lung contusion
- Subcutaneous emphysema
137
what is 1
costovertebral dislocation
138
what is 2
tranverse rib fracture
139
what is 3
oblique rib fracture
140
what is 4.
overriding rib fracture
141
what is 5.
chondral fracture
142
what is 6
chostochondral seperation
143
what is 7
chondosternal seperation
144
what is 8
sternal fracture
145
what is 9
traumatisation of pleura and of lung
146
what is 10
multiple rib fractures
147
what is 11
tear of blood vessels
148
what is 12
compound by missile or by puncture wound
