Thoracic Wall and Pectoral Region

Question 1

Inferior thoracic aperture

boundaries:

Answer 1

– 12th thoracic vertebra
– 11th and 12th pair of ribs
– Costal cartilages of ribs
7
th – 10th (costal margin)
– Xiphisternal joint
– Closed by the diaphragm

Question 2

Superior thoracic aperture-Boundaries:

Answer 2

Body of 1st thoracic vertebra
– 1st ribs and their costal cartilages
– Jugular notch

Question 3

Superior thoracic aperture-Structures passing through

Answer 3

Left Subclavian artery
– Subclavian (or SCV) vein
– Brachiocephalic trunk

Question 4

Thoracic wall-Bones

Answer 4

Vertebrae, ribs, sternum

Question 5

Thoracic wall-Muscles

Answer 5

Diaphragm, intercostal, pectoral, serratus

anterior, latissimus dorsi

Question 6

Thoracic wall-Nerves and blood vessels

Answer 6

– Intercostal neurovascular bundle

Question 7

Sternum-three portions:

Answer 7

– Manubrium
– Body
– Xiphoid process

Question 8

Sternum-Articulates with:

Answer 8

– Clavicle

– Costal cartilages I-VII

Question 9

Jugular notch

Answer 9

Small indentation on the superior

border of the manubrium

Question 10

Manubriosternal joint

Answer 10

Anterior boundary of the
transthoracic plane
– Corresponds to:
• T4/5 intervertebral disc
• 2nd costal cartilage

Question 11

Atypical ribs

Answer 11

(1, 2, 10, 11, 12)

Question 12

Thoracic vertebrae

Answer 12

-Small heart shaped body
• Round vertebral foramen
• Downward slanting spinous process
• Two demifacets on body for articulation with the head of the rib
• A facet on the transverse process for articulation with the tubercle of the rib

Question 13

COSTOVERTEBRAL Joints

Answer 13

Synovial joints between rib and

vertebrae

Question 14

STERNOCOSTAL Joints

Answer 14

Synovial joints between costal
cartilage and sternum
(1st is fibrocartilaginous)

Question 15

True ribs (1-7)

Answer 15

attach to sternum via

own costal cartilage

Question 16

False ribs (8-10) -

Answer 16

attach to costal cartilage of

rib above

Question 17

Floating ribs

Answer 17

• no attachment anteriorly

Question 18

Intercostal muscles-Neurovascular bundle

Answer 18

– intercostal artery, vein, nerve
– between internal and innermost
-Innervation is segmental from intercostal nerves**

Question 19

Intercostal muscles-Action:

Answer 19

Elevation and depression of ribs
and maintaining the intercostal space
during respiration

Question 20

Intercostal muscles

Answer 20

• External intercostal-Fibers – down and medial
• Internal intercostal-Fibers – down and lateral
• Innermost intercostal-same as internal

Question 21

Transversus thoracis muscle- loction

Answer 21

Radiates out from the

sternum”

Question 22

Subcostal muscles

Answer 22

Found posteriorly near the
angles of the ribs and
span 1 or more
intercostal spaces

Question 23

Pectoralis major

Answer 23

medial & lateral
pectoral n.
Shoulder adduction, flexion
& medial rotation of humerus

Question 24

Subclavius

Answer 24

nerve to
subclavius
depresses clavicle

Question 25

Pectoralis minor (in clavipectoral fascia)

Answer 25

medial pectoral n. depresses shoulder, protracts scapula

Question 26

Serratus anterior

Answer 26

long thoracic n. | upward rotates scapula

Question 27

Rib movement during respiration-pump handle

Answer 27

``` increases AnteriorPosterior (AP) dimensions ```

Question 28

Rib movement during respiration-“bucket handle”

Answer 28

increases lateral dimension

Question 29

Viscera Pleura

Answer 29

– lines/adhered to the lungs

Question 30

Parietal Pleura

Answer 30

lines/adhered to the thoracic cage

Question 31

Pleura-innervation

Answer 31

-Costal; intercostal nerves – Mediastinal; phrenic nerve – Diaphragmatic; phrenic and intercostal – Cervical

Question 32

Surface landmarks for pleura-*At rest (relaxed) Inferior border of lung (visceral pleura)

Answer 32

Midclavicular-Rib 6 Midaxillary-Rib 8 Paravertebral-TV10

Question 33

Surface landmarks for pleura-*At rest (relaxed)-Inferior edge of parietal pleura

Answer 33

Midclavicular-Rib 8 Midaxillary-Rib 10 Paravertebral-TV12

Question 34

Thoracocentesis

Answer 34

pleural tap” to sample fluid from pleural space

Question 35

Thoracostomy

Answer 35

Chest tube inserted to drain fluid or air from | pleural cavity

Question 36

Ventral rami of spinal nerves (intercostal | nerves):

Answer 36

Motor innervation to muscles – Sensory innervation to ribs, costal cartilages, skin, costal pleura and peritoneum (T7-12)

Question 37

Dermatomes-T4 –

Answer 37

Nipple

Question 38

Dermatomes-T7

Answer 38

Tip of xiphoid

Question 39

Dermatomes-T10

Answer 39

Umbilicus

Question 40

Dermatomes-T12

Answer 40

Suprapubic region

Question 41

Dermatomes-L1

Answer 41

– Inguinal region

Question 42

Internal thoracic A

Answer 42

Gives anterior intercostal arteries and terminates into musculophrenic and superior epigastric

Question 43

Anterior intercostal a.

Answer 43

Follows the inferior border of the rib and anastomoses with the posterior intercostal arteries

Question 44

Musculophrenic a

Answer 44

continues along the costal margin supplies diaphragm, anterior and lateral walls

Question 45

Superior epigastric a

Answer 45

continues onto the anterior abdominal wall and anastomoses with inferior epigastric a

Question 46

Posterior intercostal | artery

Answer 46

Runs in costal groove

Question 47

Descending | Thoracic Aorta

Answer 47

Supplies posterior | intercostal arteries

Question 48

Subclavian A

Answer 48

Gives internal thoracic a. Vertebral a. Costocervical trunk

Question 49

Costocervical trunk

Answer 49

Supplies the first 2 | posterior intercostal spaces

Question 50

Diaphragmatic Parietal pleura -nerve innervation

Answer 50

supplied by superior phrenic arteries

Question 51

Mediastinal Parietal pleura -nerve innervation

Answer 51

supplied by pericardiacophrenic artery

Question 52

Venous drainage of thoracic wall

Answer 52

``` The veins from the upper 2 intercostal spaces posteriorly join together and may drain into the azygos and accessory hemiazygos or directly into the brachiocephalic vein ```

Question 53

Lymphatic drainage of the thoracic | wall

Answer 53

Anteriorly to parasternal nodes – Posteriorly to intercostal nodes – Inferiorly to diaphragmatic nodes -Most lymph nodes from thorax eventually drain into thoracic duct -Upper part of right thorax into right bronchomediastinal trunk