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Questions and Answers

What distinguishes the 11th and 12th ribs from other ribs?

They are attached directly to the sternum.

They are larger than the first ten ribs.

They have a long neck.

They are short and have no neck or tubercle. (correct)

Which type of cervical rib is attached by a fibrous cord to the first rib?

A cartilaginous rib.

A thick fibrous cord rib.

A floating rib.

A bonney rib. (correct)

How many intercostal spaces are there in the human body?

11 (correct)

What muscle is primarily responsible for quiet inspiration?

Diaphragm. Signup and view all the answers

What purpose do the interosseous portions of the internal intercostals serve?

Depress the ribs. Signup and view all the answers

What is the subcostal space?

The space below the 12th rib. Signup and view all the answers

At what age do the ribs begin moving to assist in respiration?

7 years. Signup and view all the answers

What separates the intercostal spaces?

Costal cartilages. Signup and view all the answers

Which arteries supply the first to sixth intercostal spaces?

Anterior intercostal arteries Signup and view all the answers

What is the source of the posterior intercostal arteries for the 3rd to 11th intercostal spaces?

Descending thoracic aorta Signup and view all the answers

Which artery accompanies the phrenic nerve and supplies the pericardium?

Pericardiacophrenic artery Signup and view all the answers

Where do the upper six anterior intercostal veins drain?

Internal thoracic vein Signup and view all the answers

What is the terminal drainage point for the anterior intercostal veins?

Brachiocephalic vein Signup and view all the answers

Which vein does the right superior intercostal vein join?

Arch of azygos vein Signup and view all the answers

Which arteries supply the lower intercostal spaces?

Branches of the musculophrenic artery Signup and view all the answers

Which structure is NOT a tributary of the azygos vein?

Pericardiacophrenic vein Signup and view all the answers

What does each respiratory cycle consist of?

Inspiratory and expiratory phases Signup and view all the answers

Which intercostal nerves are considered typical?

3, 4, 5, 6 Signup and view all the answers

What is the function of the intercostobrachial nerve?

Supplies the axilla Signup and view all the answers

What happens to the lower 5 intercostal nerves?

They supply the anterior abdominal wall Signup and view all the answers

Which structure connects the intercostal nerve to a sympathetic trunk ganglion?

Rami communicantes Signup and view all the answers

How do the 10th and 11th intercostal nerves travel since their corresponding ribs are floating?

They pass directly into the abdominal wall Signup and view all the answers

What is the role of the collateral branch of the intercostal nerve?

Runs forward inferiorly to the main nerve Signup and view all the answers

Which branch of an intercostal nerve reaches the skin near the midline?

Anterior cutaneous branch Signup and view all the answers

What role does the pericardium serve with respect to the heart?

It restricts excessive movements of the heart. Signup and view all the answers

Which part of the heart is formed by the left ventricle?

Apex Signup and view all the answers

What structure is continuous with the fibrous pericardium?

Central tendon of the diaphragm Signup and view all the answers

Where is the apex of the heart located?

Fifth left intercostal space Signup and view all the answers

Which segments are indicated as having a segmental vein located between them?

Bronchopulmonary segments Signup and view all the answers

What correctly describes the fibrous pericardium?

A strong fibrous part attached to several structures. Signup and view all the answers

Which structure contributes to the formation of the superior border of the heart?

Roots of the great blood vessels Signup and view all the answers

Which border of the heart is formed by the right atrium?

Right border Signup and view all the answers

What supplies the upper two thirds of the trachea?

Inferior thyroid arteries Signup and view all the answers

Which nerve provides the sensory supply to the trachea?

Vagus nerve Signup and view all the answers

How do the right and left principal bronchi differ?

The right is wider, shorter, and more vertical than the left. Signup and view all the answers

What is a characteristic of a bronchopulmonary segment?

It has a segmental artery. Signup and view all the answers

How many segments does the left lung typically have?

8-9 Signup and view all the answers

What anatomical structure separates the lungs from the mediastinum?

Visceral pleura Signup and view all the answers

What does the right principal bronchus divide into upon entering the hilum?

Middle and inferior lobar bronchi Signup and view all the answers

Where does the lymph from the trachea primarily drain?

Pretracheal and paratracheal lymph nodes Signup and view all the answers

What structures are involved in the formation of the diaphragm?

Septum transversum, pleuroperitoneal membranes, dorsal mesentery Signup and view all the answers

Which type of hernia occurs due to incomplete fusion during developmental formation?

Congenital diaphragmatic hernia Signup and view all the answers

What physiological change occurs in the rib cage with aging?

Calcification and ossification of costal cartilages Signup and view all the answers

How does aging affect respiratory movements?

Disuse atrophy of thoracic and abdominal muscles Signup and view all the answers

Which cavity is involved in the lubricating mechanism for the lungs?

Pleural cavity Signup and view all the answers

What term describes the space between the lungs where the heart is located?

Mediastinum Signup and view all the answers

What impact does kyphosis have on lung function in the elderly?

Reduces chest capacity Signup and view all the answers

Which condition is characterized by weakness around the esophageal opening in the diaphragm?

Sliding hernia Signup and view all the answers

Study Notes

Thorax

The thorax (or chest) is the region of the body between the neck and the abdomen.
The bony framework of the thorax consists of the vertebral column, ribs, and their cartilages and the sternum.
It communicates superiorly with the neck and inferiorly with the abdomen, separated by the diaphragm.
The bony structure protects the lungs and heart and provides attachments for muscles.

Structure of the Thoracic Cage

The thoracic cage is composed of the sternum, ribs, and thoracic vertebrae.
The sternum is a flat bone in the middle of the anterior chest wall. It is made up of the manubrium, body, and xiphoid process.
The ribs are curved, flat bones. Ribs 1-7 are true ribs, while ribs 8-10 are false ribs and ribs 11-12 are floating ribs. Costal cartilages attach the ribs to the sternum.
The thoracic wall is formed by the thoracic part of the vertebral column posteriorly, the sternum and costal cartilages anteriorly, and the ribs and intercostal spaces laterally.

Thoracic Openings

The thoracic cavity has two main openings, superior and inferior.
The superior thoracic aperture (thoracic inlet) is bounded by the first thoracic vertebra, the first pair of ribs, and the superior border of the manubrium.
The inferior thoracic aperture (thoracic outlet) is bounded by the 12th thoracic vertebra posteriorly and the xiphisternal joint anteriorly.

The Ribs

Ribs are curved, flat bones that form the anterolateral part of the thoracic cage.
Each rib has a spongy interior containing bone marrow that produces blood cells.
There are three types of ribs: true, false, and floating ribs.
True ribs (1-7) attach directly to the sternum.
False ribs (8-10) attach indirectly to the sternum through the cartilage of the rib above.
Floating ribs (11-12) do not attach to the sternum.

Structure of a Rib

Typical ribs (3rd-9th) have a head, neck, tubercle, and body (shaft).
The head has two facets, separated by the crest of the head for articulation with the vertebrae.
The neck connects the head to the tubercle.
The tubercle has an articular part for the transverse process of the vertebra and a rough non-articular part for the costotransverse ligament attachment.
The body (shaft) is thin, flat, and curved. The inner surface has a costal groove. This protects intercostal nerve and vessels

Atypical Ribs

Atypical ribs (1st, 2nd, 10th, and 12th) have variations in their structure and articulations.
The first rib has two transverse grooves for the subclavian vessels and lacks a tubercle.
The second rib has the rough area for the origin of serratus anterior muscle.
The 10th and 12th ribs have a single facet on the head and do not have a neck or tubercle.

Intercostal Spaces

Intercostal spaces are the spaces between the ribs.
There are 11 intercostal spaces.
The spaces contain intercostal muscles, membranes and two sets of blood vessels and nerves.
The space below the 12th rib is called the subcostal space.

Intercostal Muscles

Intercostal muscles help in respiratory movements.
External intercostals elevate the ribs during inspiration.
Internal intercostals depress the ribs during expiration.

Intercostal Nerves

The intercostal nerves are branches of the thoracic spinal nerves.
They run in the intercostal spaces between the parietal pleura and the posterior intercostal membrane.
The first six intercostal nerves are mainly within the intercostal spaces though they supply the abdominal wall.
The 7th to 9th intercostal nerves pass deep to the costal cartilages before entering the abdominal wall.
The 10th and 11th nerves pass directly into the abdominal wall as the corresponding ribs are floating.

Respiratory Movements

Quiet inspiration is primarily driven by the diaphragm.
External intercostals are also involved in inspiration.
Interosseous portions of the internal intercostals perform the action of expiration.

Thoracic Cavity

It is the cavity bordered by the thoracic wall and diaphragm.
It is divided into two primary compartments—the mediastinum and the lungs.

The Sternum

The sternum is a flat bone located in the midline of the anterior chest wall, consisting of three parts: manubrium, body, and xiphoid process.
It articulates with the first seven pairs of ribs (the true ribs) via costal cartilages.
Landmarks include the jugular notch, sternal angle, and xiphisternal joint.

Mediastinum

The mediastinum is a broad central compartment separating the two pleural cavities, extending from the superior thoracic aperture to the diaphragm.
It is divided into the superior and inferior mediastinum.
The inferior mediastinum is subdivided into the anterior, middle, and posterior mediastinum, which contains various structures including the heart, esophagus, trachea, major vessels, and lymphatic tissues.

The Lungs

Lungs are paired organs, situated laterally to the mediastinum within the pleural cavities.
Each lung is conical, covered with visceral pleura, and suspended freely.
The right lung has three lobes (superior, middle, and inferior), while the left lung has two (superior and inferior). The left lung has a cardiac notch.

Bronchopulmonary Segments

Functional, and surgical units of the lungs.
The right lung has 10 segments, and the left has 8 to 9.
Each segment is supplied by a segmental bronchus and associated blood vessels, lymph vessels and nerves.

Pericardium

A fibroserous sac that encloses the heart and the roots of the great vessels.
It restricts excessive heart movements and acts as a lubricated container for the heart's different parts during contraction.
Lies within the middle mediastinum posterior to the body of the sternum and anterior to the 5th-8th thoracic vertebrae.
Fibrous pericardium is the outer, tough layer attached to the diaphragm and great vessels and sternopericardial ligaments.
Serous pericardium is the inner, thin layer with visceral (covering the heart) and parietal (covering the inner surface of the fibrous pericardium) parts.

The Trachea

The trachea is a cartilaginous tube connecting the larynx to the bronchi.
It is situated in the superior mediastinum.
The trachea bifurcates into the right and left primary bronchi at the level of the sternal angle.

Blood Supply to Thoracic Wall

The anterior intercostal arteries supply the upper parts (1-6). Musculophrenic artery supplies lower 7-11 intercostal spaces.
Posterior intercostal arteries (from descending thoracic aorta) are the supply for intercostal spaces 3 to 11. Supreme thoracic artery from the costal cervical trunk supplies the thoracic wall.

Venous Drainage

The anterior veins accompany their corresponding arteries.
The lower 3 drain into the musculophrenic vein, and the upper 6 drain into the internal thoracic vein.
The posterior veins (11 pairs) drain into the superior vena cava, azygos vein or hemi-azygos veins.

The Diaphragm

The diaphragm is the primary muscle of inspiration.
It is a dome-shaped muscle that separates the thoracic and abdominal cavities.
It has crura, and muscular portions.
It has openings for the esophagus and vena cava.

Diaphragmatic Hernia

Congenital or acquired herniation results from incomplete diaphragm development or weak musculature around the esophageal opening.
Sliding herniae involve the stomach sliding into the thoracic cavity. Paraesophageal hernia involves the stomach pushing into the mediastinum adjacent to the esophagus.

Surface Marking for Parietal Pleura

Parietal pleura covers the inner surface of the thorax, diaphragm, and mediastinum, and is divided into costal, diaphragmatic, and mediastinal pleura.
Surface markings define the boundaries of the pleura relative to the ribs, sternum, and vertebral column.

Thoracic Outlet

The thoracic inlet (superior thoracic aperture) is where major structures enter and leave the thoracic cavity from the neck.
The thoracic outlet (inferior thoracic aperture) is where structures enter and leave the thoracic cavity from the abdomen.

Clinical notes

Air in the pleural cavity associated with serous fluid is called hydropneumothorax; with pus is called pyopneumothorax;. With blood, hemopneumothorax. Pus (without air) in the pleural cavity is called an empyema.

Clinical Notes

Pleural effusion is the abnormal collection of fluid in the pleural space.
This leads to diminished cough and breath sounds.
This can be caused by many medical conditions

Heart

The heart is a muscular pump located in the mediastinum, posterior to the body of the sternum and between the 2nd and 6th rib cartilages and anterior to 5th to 8th thoracic vertebrae.
It has 4 chambers - left and right atria, and left and right ventricles.
The heart is supplied by coronary arteries and drained by coronary veins.

Coronary Arteries

Coronary arteries arise from the aorta and supply blood to the heart muscle.
Important coronary arteries include: right coronary artery, left coronary artery, circumflex branch and anterior interventricular branch.

Surface Marking of Heart Valves

Valves of the heart are in close proximity to the chest wall. Correct marking is essential for auscultation (listening to the heart) and other diagnostic procedures.

Auscultation

Auscultation involves listening to the heart sounds with a stethoscope.
The heart sounds (lub-dub) are generated by valve closure and contraction/relaxation of the heart muscles.
Locations of different valves for auscultation are carefully laid out for improved diagnosis.

Lymphatic Drainage of Trachea

Lymph from the trachea drains into pretracheal, paratracheal lymph nodes, and deep cervical nodes.

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