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Flashcards in The Thoracic Wall Deck (66)
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1
Q

An axial slice at the level of the xiphoid process anteriorly and the body of T9 posteriorly indicates the level of:

A

1- superior border of the liver

2- inferior border of the heart

3- the central diaphragmic tendon

2
Q

marks the superior level of the pericardium and the superior limit of the pulmonary trunk

A

Sternal angle

3
Q

Shows the level of the beginning and end of the arch of aorta

A

Sternal angle

4
Q

is the level at which the trachea bifurcates into R and L main bronchi

A

Sternal angle

5
Q

Sternal angle

A

An axial slice through the sternal angle:

ant: sternal angle
pst: T4-T5 intervertebral discs

6
Q

List 4 of the structures marked/shown by an axial slice through the sternal angle anteriorly and the T4/T5 intervertebral disc posteriorly:

A

1- sup level of pericardium

2- sup limit of the pul. trunk

3- arch of aorta begins and ends

4- trachea divides into R/L main bronchi

5- rib II articl8 w/ sternum

7
Q

Protection of intercostal vasculatures

A

The intercostal vein and artery lie in costal groove and are protected by bone. The intercostal nerve is not typically protected by bone.

8
Q

Costal groove

A

The ribs shaft has a groove on the inf. margin of its internal surface. Intercostal aa and vv lie in this groove.

9
Q

Crest of the head

A

the head of a typical rib is wedge-shaped and is divided into two facets by the crest of the head.

10
Q

The tubercle for serratus anterior is located on its superior surface.

A

Rib II

11
Q

It has a singular articular facet on its head for articulation with T1

A

Rib 1

12
Q

Ant. scalene muscle inserts into this rib

A

Rib I (Scalene tubercle)

13
Q

Short ribs without a neck or tubercle

A

11 and 12

14
Q

Ribs with one facets on their heads ( articulation with single vertebrae)

A

1 and 10-12

15
Q

Demifacets on each side of the vertebral body articulate with —— while transverse costal facets articulate with the —– of the ribs.

A

head, tubercles

16
Q

Has a complete superior costal facet instead of a demifacet.

A

T1

Vertebra T1 has a complete superior costal facet instead of a demifacet. The head of rib 1 does not articulate with vertebra C7.

17
Q

a single complete costal facet for articulation with the same-numbered rib.

A

vertebrae T10-12

18
Q

lack transverse costal facets on their transverse processes.

A

Vertebrae T11 & T12

Vertebrae T11 and T12 lack transverse costal facets on their transverse processes. Ribs 11 and 12 do not articulate with the transverse processes.

19
Q

Joints of costal articulation

A

1- Costochondral joints
2- Sternocostal joints
3- Costotransverse joints
4- Costovertebral joints (joint of head of rib)

20
Q

Costovertebral and costotransverse joints are

A

synovial joint

21
Q

Costovertebral joint

A

The head of a typical rib articulates with the superior demifacet of the same-numbered vertebra and the inferior demifacet of the vertebra above it to form a joint of head of rib (synovial joint).

22
Q

Costotransverse joint

A

The tubercle of the rib articulates with the transverse process of the same-numbered vertebra to form a costotransverse joint (synovial joint).

23
Q

The types of the sternocostal joints

A

Rib I- Synchondrosis (fibrocartilaginous)

Ribs II- VII- Synovial

24
Q

Costochondral joints

A

The bodies of ribs articulate with their costal cartilages at fibrocartilaginous joints known as costochondral joints.

25
Q

Sternocostal joints

A

The costal cartilages of the 7 true ribs articulate with the sternum at sternocostal joints.

26
Q

Interchondral joints

A

The costal cartilages of ribs 7-10 articulate with the cartilage above at synovial joints known as interchondral joints.

27
Q

The contents of intercostal space (general)

A
intercostal muscles (3 layers)
intercostal nn and bv
28
Q

From the costochondral junctions to the sternum, the muscles are replaced by

A

external intercostal membrane

29
Q

External intercostal membrane

A

orientation: forward and down

replaced by external intercostal membrane starting from costochondral junctions

30
Q

Internal intercostal membrane

A

“backward & down”

Posterior and medial to the angles of the ribs, the muscles are replaced by the internal intercostal membrane

31
Q

innermost intercostal muscle

A

similar to the internal intercostal muscle

32
Q

innervation of the intercostal muscles

A

intercostal nn.

T12 n is subcostal n

33
Q

subcostal n.

A

T12 n. is subcostal

34
Q

Transversus thoracis m.
Subcostal m.
Also innervated by

A

intercostal nn.

35
Q

Contents of intercostal space (specific)

A

Posterior intercostal Vein

Posterior intercostal Artery
From thoracic aorta

Intercostal Nerve

Anterior intercostal artery
From internal thoracic artery

Form the VAN

36
Q

Orientation of intercostal a and v

A

intercostal v is sup to a.

Both V and A are protected by the costal groove.

37
Q

Orientation of the intercostal n

A

Inf. to the intercostal a.

38
Q

The location of intercostal VAN

A

lies b/w the internal and innermost intercostal muscles.

39
Q

Intercostal nn

A

Ant ramus of a thoracic spinal nerve.

Gives off lateral and anterior cutaneous branches

40
Q

The arterial supply to the thoracic wall comes from the:

A

Thoracic aorta
Subclavian a
Axillary a

41
Q

Thoracic aorta supplies the thoracic wall via

A

the pst. intercostal and subcostal aa.

42
Q

Subclavian a. supply the thoracic wall via

A

internal thoracic and supreme intercostal aa.

43
Q

Axillary a. supply the thoracic wall via

A

sup. and lat. thoracic aa.

44
Q

The posterior intercostal arteries give rise to —–.

A

The posterior intercostal arteries give rise to branches that accompany the posterior rami of the spinal nerves and the lateral cutaneous branches of the intercostal nerves.

45
Q

The posterior intercostal arteries of intercostal spaces 3-11 (and the subcostal arteries) arise —–.

A

The posterior intercostal arteries of intercostal spaces 3-11 (and the subcostal arteries) arise posteriorly from the thoracic aorta.

46
Q

The posterior intercostal arteries of intercostal spaces 1 and 2 arise from —–.

A

The posterior intercostal arteries of intercostal spaces 1 and 2 arise from the supreme (superior) intercostal artery, a branch of the costocervical trunk.

47
Q

The internal thoracic arteries terminate in the sixth intercostal space by dividing into the —– and —–arteries.

A

Superior epigastric and musculophrenic arteries.

48
Q

The internal thoracic arteries arise in the root of the neck from the —–surfaces of the —– arteries.

A

From the inferior surfaces of the subclavian arteries.

49
Q

The internal thoracic arteries descend on the —– surface of the thorax —– to the sternum and —– to the clavicle and upper six costal cartilages.

A

internal surface
lateral to the sternum
posterior to the clavicle

50
Q

Spaces without anterior intercostal aa.

A

Intercostal spaces 10-11

51
Q

The anterior intercostal arteries of intercostal spaces 1-6 arise from the —–.

A

internal thoracic aa.

52
Q

The anterior intercostal arteries of spaces 7-9 arise from —–.

A

musculophrenic aa.

53
Q

The anterior and posterior intercostal arteries have —–and —– branches that anastomose with each other.

A

terminal and collateral

54
Q

The intercostal veins accompany the intercostal arteries and nerves and lie most superior in the —–.

A

costal grooves

55
Q

The posterior intercostal veins anastomose with the —– veins.

A

anterior intercostal

56
Q

Most posterior intercostal veins drain into the —– , while the anterior intercostal veins drain into the —–.

A

pst- azygos system of veins

ant- internal thoracic veins

57
Q

The internal thoracic veins accompany the —–.

A

internal thoracic arteries

58
Q

The breast

A

Breast tissue is typically found overlying the pectoralis major m.

Overlies ribs 2-6 from sternum to midaxillary line

location of the nipple will vary according to the size and shape of the breast

The nipple contains the openings of the 15-20 lactiferous ducts

59
Q

The mammary glands are enclosed in

A

superficial fascia/ subcutaneous connective tissue.

60
Q

suspensory ligament

A

variable amt of fat and bands of fibrous CT

61
Q

retromammary space

A

separates the breast from deep fascia over pectoralis major by loose CT.
It also allows some movement over the chest wall.

62
Q

Allows minor movement of the breast over chest wall

A

retromammary space

63
Q

The axillary tail

A

breast tissue extend into axilla.

Significant during breast examination

64
Q

Blood supply of the breast

A

Mainly from mammary branches of:

internal thoracic artery
lateral thoracic artery
posterior intercostal arteries

65
Q

Venous drainage of the breast

A

Has a venous drainage roughly mirroring its arterial supply:

tributaries of the posterior intercostal veins may carry cancer cells to the vertebral venous plexus.

66
Q

lymphatic drainage of the breast

A

60-75% of lymph from the breast drains into the axillary nodes

Very important in understanding the mechanisms of metastasis of breast cancer