Thoracic wall

Question 1

Which are true ribs

Answer 1

1-7

Question 2

Which are false ribs

Answer 2

8-10

Question 3

which are floating ribs

Answer 3

11+12

Question 4

What are typical ribs and what do they have

Answer 4

3-9

• Head of rib which has two facets separated by crest of the head
• Neck of rib
• Tubercle of rib
• Body of rib

Question 5

What does the tubercle of the rib have

Answer 5

Smooth articular facet that connects with corresponding transverse process of vertebra (via synovial joint)

Rough non articular facet to the process via the costotransverse ligament

Question 6

What does the costotransverse ligament connect

Answer 6

Non articular part of rib to the spinous process

Question 7

What is the scalene tubercle

Answer 7

Separates the grooves on the 1st rib which is for the subclavian vessels

Question 8

What mm attach to the second rib

Answer 8

Serratus anterior and posterior scalene muscles

Question 9

which ribs have no necks or ribs

Answer 9

11+12

Question 10

What are joints between costal cartilages called

Answer 10

Interchondral joints

Question 11

What are joints between ribs and costal cartilages called

Answer 11

Costochondral

Question 12

What is a thoracotomy

Answer 12

Creating an opening through the thoracic wall to enter the pleural cavity

Question 13

What is involved in an anterior thoracotomy

Answer 13

H shaped cuts through the perichondrium of one or more costal cartilages and then shelling out segments of the costal cartilage to gain access to thoracic cavity

Question 14

Where are important sites for a posterior thoracotomy

Answer 14

postolateral aspects of the 5th to 7th intercostal spaces

Question 15

How is a posterior thoracotomy performed

Answer 15

Patient lying on side and the upper limb is fully abducted, placing the forearm beside the patient’s head (allows higher access by moving scapula)

Question 16

What are sternal biopsies used to obtain

Answer 16

Specimens of bone marrow for transplantation and for detection of metastatic cancer

Question 17

What is median sternotomy

Answer 17

Sternum split in middle and retracted (e.g. for coronary artery bypass grafting)

Question 18

What is lateral thoracotomy used for

Answer 18

Provides wide access to the pulmonary cavity (and is done through intercostal spaces)

Question 19

What is is minimally invasive thoracic surgery fir

Answer 19

Allows access to the thorax through small intercostal incisions for many intrathoracic procedures

Question 20

What are the symptoms of costoclavicular syndrome

Answer 20

Pallor and coldness of skin of upper limb and diminished radial pulse as a result of compression of subclavian artery between clavicle and 1st rib

Question 21

What is a rib dislocation the dissociation of

Answer 21

Dislocation of costal cartilage from sternum

Question 22

What is a rib separation?

Answer 22

Dislocation of costochondral junction between the rib and its costal cartilage

Question 23

What usually happens in the separation of the 3rd-10th ribs and what is the result of this

Answer 23

Tearing of the perichondrium and periosteum (rib may move superiorly, overriding the rib above and causing pain)

Question 24

What muscles act as accessory muscles of respiration

Answer 24

Pec muscles
Inferior part of serratus anterior
Scalene muscles

Question 25

What is the origin of the internal thoracic artery

Answer 25

Subclavian artery

Question 26

What is the course of the internal thoracic artery

Answer 26

Passes inferiorly, lateral to sternum, between the costal cartilages and internal intercostal muscles to divide into the epigastric and muscolpphrenic arteries

Question 27

What does the internal thoracic artery divide into

Answer 27

Musculophrenic | Epigastric

Question 28

What does the internal thoracic artery supply

Answer 28

Anterior intercostals to ics1-6 Musculophrenic arteries ics 7-9

Question 29

Where does the lateral thoracic artery originate from

Answer 29

Axillary artery

Question 30

What is the course of the lateral thoracic artery

Answer 30

Inferiomedially along the inferior border of pectorals minor to the anterior surface of the serratus anterior

Question 31

What does the lateral thoracic artery supply

Answer 31

Lateral structures of the breast and thorax

Question 32

Where does the acromiothoracic artery originate from

Answer 32

Axillary artery

Question 33

What does the acromiothoracic artery supply

Answer 33

Pec minor + major | Anterior part of deltoid

Question 34

What are the origins of the posterior intercostal arteries

Answer 34

``` Supreme intercostal arteries (ics 1+2) Thoracic aorta (remaining ics) ```

Question 35

What are the courses of the anterior and posterior intercostal arteries

Answer 35

Between internal and innermost intercostal muscles

Question 36

What are the origins of the anterior intercostals

Answer 36

internal thoracic arteries (ics1-6) and Musculophrenic arteries (ics 7-9)

Question 37

How many intercostal veins are there on each side of the thoracic wall

Answer 37

11 posterior intercostals | 1 subcostal vein

Question 38

Where do most posterior intercostal veins end in

Answer 38

Azygos/hemiazygos venous system (which goes to superior vena cava)

Question 39

What does the medial pectoral nerve innervate

Answer 39

Pec minor and sternocostal portions of the pec major

Question 40

What does the lateral pectoral nerve innervate

Answer 40

Pec major

Question 41

What do the intercostal nerves supply

Answer 41

Thoracic wall, pleura and peritoneum

Question 42

What is the root value for the intercostal nerves

Answer 42

T1-11

Question 43

Origin of the internal thoracic artery

Answer 43

Subclavian artery

Question 44

Origin of the internal thoracic vein

Answer 44

Arises from superior epigastric and terminates as brachiocephalic vein

Question 45

What is the arterial supply of the breast

Answer 45

- Medial mammary branches of anterior intercostals from internal thoracic arteries - Lateral thoracic from axillary arteries - Thoraco-acromial from axillary arteries - Posterior intercostals from thoracic aorta

Question 46

Where does all lymph from breast go into

Answer 46

Sub-areolar plexus

Question 47

Where does all the breast lymph from the sub-areolar plexus drain into

Answer 47

Axillary (75%) [drain into infra/supra clavicular nodes then into subclavian lymph trunk] Parasternal (opposite breast) Abdominal

Question 48

Where do the parasternal lymph nodes drain into

Answer 48

Bronchomediastinal trunks

Question 49

What are the different axillary lymph nodes

Answer 49

``` Pectoral Humeral Subscapular Central Apical ```

Question 50

What is the pec major innervated by (and root values)

Answer 50

C6-8 Lateral and medial pectoral nerves

Question 51

Innervation of the pectoralis minor and root value

Answer 51

Medial pectoral nerve (C8-T1)

Question 52

Innervation of the serratus anterior and root value

Answer 52

C5-7

Question 53

Where are anterior intercostal arteries from

Answer 53

Internal thoracic aorta

Question 54

Where does the anterior intercostal vein drain into

Answer 54

Internal thoracic vein