1
Q
What are the three articular surfaces of ribs?
A
- Costal cartilage (anterior; sternum)
- Head of the rib (posterior; vertebrae)
- Tubercle of the rib (posterior; vertebrae)
2
Q
What are the true ribs?
A
I-VII Direct insertion to sternum via costal cartilage
3
Q
What are the false ribs?
A
VIII-X Indirect insertion on to sternum via costal margin
4
Q
What are the floating ribs?
A
XI-XII No insertion on to sternum
5
Q
Name and explain the atypical ribs.
A
- Rib I: Short, flat and horizontally oriented, No costal groove (anterior and posterior grooves for subclavian vein and artery respectively), articulates with vertebral bone of own level only
- Rib II: smaller like rib I, but 2x as long, flat and horizontally oriented – all other features are typical
- Rib X – Only articulates with vertebral bone at own level, all other features are typical
- Ribs XI, XII: each articulate with vertebral bone at its own level only, no tubercles or necks, short
6
Q
What nerves innervate the diaphragm?
A
Left and right phrenic nerve from C-3-4-5 (keeps the diaphragm alive)
7
Q
External intercostal muscles (fibers and function)
A
- Fibers direction: anterior-inferior (hands in the pockets)
- Elevates ribs (inspiration)
8
Q
Internal intercostal muscles (fibers and function)
A
- Fibers direction: anterior, superior (hands under armpit)
- Depresses the ribs (forceful expiration)
9
Q
Transversus thoracis (fibers and function)
A
- Origin: body of the sternum & xiphoid process
- Insertion: ribs 2-6
- Function: Depresses ribs; forceful expiration
10
Q
What are the the joints of the thoracic cage
A
- Costovertebral Joint = Head of the rib articulates with the body of the vertebrae
- Costotransverse Joint = Tubercle of the rib articulates with costal facet on transverse process of thoracic vertebrae
11
Q
Name where and in what order are the intercostal artery-nerve-vein
A
- UP → Vein → Artery → Nerve → DOWN
- Location: right below the ribs (in the costal groove)
12
Q
What is the course of the vascular supply to the thoracic wall?
A
13
Q
What nerve innervates the nipple?
A
T4
14
Q
What nerve innervated the skin over xiphoid process?
A
T6
15
Q
What nerve innervated the Umbilicus?
A
T10
16
Q
Where do cervical nerves pass compared to the cervical vertebras
A
Above the vertebra
17
Q
Where do thoracic nerves pass compared to the thoracic vertebras
A
Below the vertebra
18
Q
What is the pleura?
A
A serous membrane forming a closed sac on the outer surface of the lung and lining the thoracic cavity that is one continuous layer and has 8-10 ml of fluid in it.
19
Q
What does disruption of intra-pleural pressure leads to?
A
- Dyspnea: mediastinal shift in severe pneumothorax compromises hemodynamic stability.
- the lungs is gonna collaps and shrink because there’s no negative pressure anymore
20
Q
What are the two parts of the pleura and their specificity?
A
- Parietal (innervated by costal nerves, pain referred to the neck)
- Is divided in cervical, costal, diaphragmatic and mediastinal
- Visceral (autonomic innervation, no pain) pleura.
21
Q
What are the different impressions on the right lung ?
A
- Azygos vein impression
- SVC impression
- esophagus
22
Q
What are the different impressions on the left lung look like?
A
- Cardiac impression
- Aorta impression
- Esophagus impression
23
Q
Describe the organization of the tertiary bronchi in both lungs
A
Right
- Superior (3)
- Middle (2)
- Inferior (5)
Left
- Superior (5)
- Inferior (5)
24
Q
Describe the lymphatic drainage of the lungs
A
- Pulmonary Nodes (middle lobe)
- Hilar/Bronchopulmonary Nodes (superior lobe)
- Tracheobronchial Nodes (next to the aorta)
- Paratracheal Nodes (Apex)
- Bronchomediastinal trunks (trachea)
Goes to right lymphatic duct (right) or thoracic duct (left) and then in the SVC.
25
What innervates the thoracic wall?
Intercostal (T1-T11) and Subcostal (T12) Nerves – Anterior Rami of Thoracic Spinal Nerve:
* Intercostal nerve (MOTOR)
* Lateral and anterior cutaneous nerves (SENSORY)
26
what's the difference between tendon and ligaments ?
* **Tendon :** connects muscle to bone
* **Ligament :** connects 2 bones
27
What is Fascia ?
A sheet or band of **fibrous connective tissue** that envelops, separates, or binds together structures such as muscles, organs and other soft tissues.
28
How do you call the two possible type of muscle attachment ? What differentiates them ?
1. **Origin :** most *proximal*, fixed attachment (*least moveable*)
2. **Insertion :** most *distal, moveable* attachment
29
name those structures
1. Superior Thoracis Aperture (thoracic intlet)
2. ribs (I-XII)
3. Inferior Thoracic Aperture (thoracic outlet)
4. Thoracic spine
5. Sternum
30
name those structures
1. head
2. tubercule
3. neck
4. costal angle
5. crest
6. articular facets
7. articular facet
8. costal groove
9. body of the rib
10. costal cartillage
31
name those structures
1. Spinous process (SP)
2. Transverse process (TP)
3. Vertebral Foramen
4. Vertebral body
5. Facets for Ribs articulation
32
name those structures and the associated vertabrea they are parallel to (at the level of)
1. jugular notch **(TII)**
2. manubrium
3. manubrosternal joint (sternal angle) **(TIV/TV)**
4. body of the sternum
5. xiphisternal joint **(TIX)**
6. xiphoid process
33
Innermost intercostal muscle (fibers and function)
* Fibers direction: anterior, superior (hands under armpit)
* Depresses the ribs (forceful expiration)
34
name those structures
1. subclavian artery
2. internal thoracic artery
3. arch of the aorta
4. anterior intercostal aa.
5. musculophrenic artery (à partir de rib 7)
6. subcostal artery
7. superior epigastric artery
8. transversus thoracis
9. internal thoracic (mammary) artery
35
how many anterior intercostal artery there is ?
only 11 pairs because only 11 intercostal spaces (after rib 12, the same «type» of artery is called the subcostal artery)
36
name those structures
1. posterior intercostal aa.
2. posterior
3. intercostal a.
4. anterior
5. internal thoracis a.
37
name those structures
1. branchiocephalic vein
2. internal thoracic vein
3. anterior intercostal vv.
4. musculophrenic vein
5. superior epigastric v.
6. right posterior intercostal vein
7. azygos vein
8. hemiazygos vein
9. left posterior intercostal v.
38
All the blood in the posterior half of the thorax drains into a certain vein. Which each side throught what veins ?
* All the blood in the posterior half of the thorax drains into the **azygos vein** (that leads to the SVC)
* the left inderectly via the **hemiazygos vein**
* the right side directly
39
name those structures
1. lateral cutaneous nerve
2. intercostal nerve
3. anterior cutaneous nerve
4. ventral ramus
40
what is this structure ?
intravertebral foramen
41
what's a dermatome ? What is it useful for ?
* area/region of skin innervated by a single spinal nerve
* it has a clinical significance because you can know in what nerve a virus is travelling through if you see a rash on the skin
42
Define the sensory innervation of the pleura and where does the pain refers to ?
* PARIETAL PLEURA
* **intercostal nerve** : pain refers to *lateral thoracic and abdominal walls*
* **phrenic nerves :** pain refers to *neck and shoulder*
* VISCERAL PLEURA
* **autonomic nerve :** *insensitive* to pain
43
name this structure
1. costomediastinal recess
2. costodiaphragmatic recess
44
name those structures
1. apex
2. horizontal fissure
3. superior lobe
4. inferior lobe
5. middle lobe
6. oblique fissure
7. cardiac notch
8. lingula
9. superior lobe
10. inferior lobe
11. left lung
12. right lung
45
What can you find ar rib VI at midclavicular line ?
* inferior border of both lungs not inflated
* oblique fissure of both lungs
46
What can you find at rib IV when your face to a patient ?
* horizontal fissure of right lung
47
what's at the crossing of rib V and midaxillary line ?
horizontal fissure
48
The oblique fissure is crossing whihch rib in a lateral view ?
ribs IV to VI
49
where is the border of the lungs at midaxillary line ? And where is the parietal pleura ?
* Rib VIII
* parietal pleura : rib X
50
in a posterior view:
* Where is the beginning of the oblique fissure ?
* Where is the diahragmatic/inferior border of the lungs ?
* TIV (it's at the medial scapular border when both arms are up on the head)
* Tx, rib X
51
* What's the trend from front to back for the inferior border ?
* And for the parietal pleura ?
* inferior border : ribs 6, 8, 10
* parietal pleura : ribs 8, 10, 12
52
identify those structures
1. trachialis muscle
2. secondary bronchi
3. primary bronchi
4. carina
5. tertiary bronchi
6. trachea
53
identify those structures
1. tertiary (segmental) bronchus
2. respiratory bronchiole
3. branching of segmental bronchus
4. bronchiole
5. alveolar sacs
6. terminal bronchiole
7. respiratory bronchiole
54
are all veins containing deoxygenated blood ? What about arteries containing only oxygenated blood ?
Yes, but 2 exceptions
* pulmonary artery : deoxygenated blood towards the lungs to be oxygenated
* pulmonary vein : oxygenated blood towards the heart to be delivered to the body
*you should say that an artery always leaves the heart while a vein always comes to the heart*
55
how are the veins, artery and bronchus placed at the hilum of each lungs ?
* Right lung (anterior to posterior) : Vein, Artery, Bronchus
* Left lung (cephalad to caudal) : Artery, Bronchus, Vein
56
Define the innervation of the trachea and lungs ?
2 different contribution, one from the sympathetic and one from the parasympathetic (always *autonomic nervous system*)
* **vagus nerve:** parasympathetic innervation
* **T1-T6 from the spinal cord :** sympathetic innervation
57
what is the venous angle ?
* convergence of the **internal jugular vein** and the **subclavian vein** to become the **brachiocephalic vein**
