Thorax

Question 1

Angle of Louie

Answer 1

Very important landmark esp if we need to count the rib or to find interspaces; corresponds to the second rib

Tells us where the bifurcation of trachea is

Question 2

Where to insert chest tube?

Answer 2

Fourth intercostal space

Question 3

Behind manubrium

Answer 3

arteries of aorta

Question 4

Ribs

Answer 4

May be typical or atypical

Question 5

Typical rib

Answer 5

round body

Question 6

Atypical rib

Answer 6

flat

Question 7

True ribs

Answer 7

Attached to the sternum; first to the 7th rib

Question 8

False ribs

Answer 8

Below the 7th rib; not attached to the sternum; only attached to the ribs above

Question 9

Inferior angle of rib

Answer 9

Costal Groove; where you find inTercostal VAN - vein arteries nerves

Insert needle just above the superior part of rib

Question 10

First rib

Answer 10

There’s an elevation for tubercle where a muscle is attached.

There is a groove behind tubercle - for subclavian and brachial plexus: a network of nerves

Question 11

Clavicle

Answer 11

Round end - attaches to sternum
Flat end - scapular; forms a joint with the acromion of scapula

How to know the inferior surface? Look for conoid tubercle.

Question 12

Scapula

Answer 12

Not part of thoracic bony cage;

Spine of scapula on posterior; glen lid cavity: forms a joint with humerus; acromion (where clavicle is attached)

Question 13

Boundaries of breast

Answer 13

Superior - once you reach clavicle
Along sternum
Inferior - six to the 7thrib; midaxillary line/latissimus Doris

Question 14

Breast

Answer 14

15 to 20 lobules; divided into compartments by fibrous septa which are actually attached to the dermis of skin (suspensions ligament)

Question 15

Breast

Answer 15

extension of breast - axillary tail of spens
Lobes will produce milk and
Suspenseful ligaments are attached to lobules. Tumor within the duct will pull down suspensory ligament - dimpling of skin; lymph vessels of breast will be obstructed by the tumor cells - orange fruit appearance of breast

Question 16

3 major arterial supply for breast

Answer 16

• Axillary artery - continuation of subclavian artery
  Branches coming from internal mammary artery
  Arteries between interspaces/intercostal arteries

Question 17

Axillary fat

Answer 17

Where lymph nodes are found

Question 18

Attachments of pectoral is muscle

Answer 18

Medial clavicle, sternum

Attached to clavicle is the muscle that moves arm -deltoid muscle which forms a groove with pectoralis major — along the groove is the cephalic

Attachments should be separated to be able to see structure behind it

Question 19

Sublca

Answer 19

Small muscle ends on first rib

Question 20

Lift pectoral is minor

Answer 20

Intercostal muscles will be seen

First layer of intercostal muscles - extend from rib above to rib below

Outermost later - external intercostal muscle

Question 21

Costafonrral

Answer 21

Joint formed by cartilaginous

Question 22

External intercostal membrane/ anterior ICM

Answer 22

Starts from posterior thoracic wall continues forward to sternum

Downward and backward

Question 23

Internal intercostal membrane/posterior intercostal membrane

Answer 23

Layer of muscles between the ribs after the internal intercostal

Fibers are oriented downward forward

EndS up along angle of rib and continues as membrnae

Question 24

Internal intercostal muscles

Answer 24

3rd later - inner most intercostal muscles - can span more than one interspace; can occupy two or more interspaces

Question 25

Thoracic wall muscles

Answer 25

Serratus anterior - lateral thoracic artery; long thoracic nerve; exposed during removal of breast - cut - paralysis Posterolateral - latissimus dorsi; thoracodoral artery/nerve - cut - paralysis of lats

Question 26

Layers of thoracic wall that will be traversed in tube insertion

Answer 26

Skin, fasciae, serrated I Innermost intercostal

Question 27

2 terminal branches

Answer 27

One branch would follow costal margin - usculoclinic artery Other would go towards central portion of abdominal wall to become superior episgastric artery These will be accompanied by veins with the same name . Wins drain into azygous system before they drain to the vena cava.

Question 28

2 terminal branches

Answer 28

One branch would follow costal margin - usculoclinic artery Other would go towards central portion of abdominal wall to become superior epigastric artery These will be accompanied by veins with the same name . Wins drain into azygous system before they drain to the vena cava.

Question 29

Jugular or Suprasternal notch

Answer 29

Superior most margin of the manubrium sternae

Question 30

Below skin

Answer 30

Subcutaneous connective tissue, which may be infiltrated by fat especially among females. Fatty tissue of breast is part of SUBQ fat

Question 31

Sternal Angle or angle of Louie

Answer 31

Bump along the sternum Joint formed between the manubrium of the sternum and body of sternum allows us to count the rib levels and intercostal spaces At the same level with second costal Cartilage and second rib IMPORTANCE: Important for invasive procedures - thoracentesis, thoracostomy tube insertion Auscultation of heart sounds - there are areas of chest where we can hear heart sounds coming from four main valves of the heart

Question 32

Aortic valve

Answer 32

Sound is heard best at the level of second intercostal space (Right parasternal)

Question 33

Left parasternal (second intercostal space)

Answer 33

Auscultation area for pulmonic valve

Question 34

Right side - 5th intercostal space parastenal

Answer 34

Auscultation area for tricuspid valve (between right atrium and right ventricle)

Question 35

5th intercostal space - left midclavicular line

Answer 35

Auscultation area for the mitral valve; it produces the loudest heart sound.

Question 36

Large and wide muscles that cover anterior chest wall

Answer 36

- pectoralis major (mainly move upper extremities) Pectoralis muscles are responsible for adduction and flexion fo shoulder joint.

Question 37

Groove between deltoid and pectoralis major

Answer 37

Cephalic vein passes through her. It’s a large superficial vein that starts from dorsal palmar arch of the hand (radial side) and courses up, passing through forearm and brachium. Also courses on lateral aspect for forearm (antebrachium). Drain into the AXILLARY VEIN Aka DELTOPECTORAL GROOVE

Question 38

Another important triangle found in the area of deltoid and pectoralis major - what are its boundaries?

Answer 38

Base of triangle as the clavicle Lateral margin of triangle - medial border of deltoid muscle Medial margin of triangle - margin of pectoralis major