Thoracic Cage Anatomy Quiz

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Questions and Answers

What is the endpoint of the right superior intercostal vein?

  • Left brachiocephalic vein
  • SVC (correct)
  • Inferior vena cava
  • Brachiocephalic vein

The inferior vena cava (IVC) drains which posterior intercostal veins?

  • 1st to 5th
  • 5th to 10th
  • 4th to 11th (correct)
  • 1st to 3rd

Which vein receives the anterior intercostal veins?

  • Superior vena cava
  • Hemiazygos vein
  • Azygos vein
  • Internal thoracic vein (correct)

What does the left superior intercostal vein drain?

<p>2nd and 3rd left posterior intercostal veins (A)</p> Signup and view all the answers

Which of the following veins receives blood from the left side?

<p>Hemiazygos vein (B)</p> Signup and view all the answers

What is the origin of the azygos vein?

<p>Inferior vena cava in the abdomen (C)</p> Signup and view all the answers

The superficial lymphatics of the thoracic wall primarily drain into which nodes?

<p>Axillary lymph nodes (C)</p> Signup and view all the answers

The deep lymphatics from the posterior wall drain primarily into which lymph nodes?

<p>Intercostal lymph nodes (C)</p> Signup and view all the answers

Which joint allows the rib to articulate with the corresponding vertebra and the vertebra above?

<p>Costovertebral joint (B)</p> Signup and view all the answers

What is the site of the weakest point of the rib?

<p>Costochondral junction (C)</p> Signup and view all the answers

Which layer does the external intercostal muscle originate from?

<p>Lower border of the rib above (B)</p> Signup and view all the answers

Where are the intercostal vessels and nerve located within the intercostal space?

<p>Between the external intercostal and internal intercostal muscles (D)</p> Signup and view all the answers

What is the direction of the fibers of the internal intercostal muscle?

<p>Downward and backward (A)</p> Signup and view all the answers

Which muscle is located only in the lateral part of the thoracic wall?

<p>Innermost intercostal muscle (A)</p> Signup and view all the answers

What is the insertion of the transversus thoracis muscle?

<p>Costal cartilages from 2nd to 6th (D)</p> Signup and view all the answers

At which point does the external intercostal muscle get replaced by a membrane?

<p>Costochondral junction (A)</p> Signup and view all the answers

Which structure runs along the inferior border of the rib?

<p>Intercostal VAN (B)</p> Signup and view all the answers

What type of joint are the costo-vertebral joints?

<p>Synovial joints (B)</p> Signup and view all the answers

Which artery is a branch of the subclavian artery?

<p>Internal thoracic artery (C)</p> Signup and view all the answers

What are the anterior intercostal arteries sourced from?

<p>Internal thoracic artery (D)</p> Signup and view all the answers

What is the main function of the internal thoracic vein?

<p>To drain blood from the anterior intercostal veins (D)</p> Signup and view all the answers

Which artery supplies the upper six intercostal spaces?

<p>Internal thoracic artery (A)</p> Signup and view all the answers

Where do the 1st right and left posterior intercostal veins terminate?

<p>Brachiocephalic vein (D)</p> Signup and view all the answers

What branches supply the lower five intercostal spaces?

<p>Musculophrenic artery (B)</p> Signup and view all the answers

Which artery provides branches to the thymus gland?

<p>Internal thoracic artery (C)</p> Signup and view all the answers

What is the origin of the posterior intercostal arteries?

<p>Descending thoracic aorta (C)</p> Signup and view all the answers

What is the primary function of the intercostal muscles during inspiration?

<p>To raise the other ribs towards the first rib (D)</p> Signup and view all the answers

Which muscles assist in fixing the first rib during inspiration?

<p>Scalene muscles (C)</p> Signup and view all the answers

What action do internal intercostal muscles perform during forced expiration?

<p>Lower the ribs towards the last rib (C)</p> Signup and view all the answers

How does the contraction of the diaphragm affect the thoracic cavity?

<p>It increases the vertical diameter (B)</p> Signup and view all the answers

Which type of movement does the elevation of the ribs resemble?

<p>Pump handle movement (D)</p> Signup and view all the answers

What is a key characteristic of the subcostal muscles?

<p>They blend with the innermost intercostal muscles (D)</p> Signup and view all the answers

Which diameter of the thoracic cavity is increased by the movement of the sternum during inspiration?

<p>Anteroposterior diameter (C)</p> Signup and view all the answers

What is the role of the quadratus lumborum muscle during forced expiration?

<p>To fix the last rib in position (B)</p> Signup and view all the answers

What is the primary action of the transversus thoracis muscle?

<p>Depress ribs (A)</p> Signup and view all the answers

Which intercostal nerve is referred to as the subcostal nerve?

<p>T12 ventral ramus (A)</p> Signup and view all the answers

Which branch is NOT typically found in a typical intercostal nerve?

<p>Medial cutaneous branch (A)</p> Signup and view all the answers

What characterizes the atypical 1st intercostal nerve?

<p>It has no lateral or anterior cutaneous branches. (A)</p> Signup and view all the answers

Where do the typical intercostal nerves mostly originate from?

<p>Thoracic spinal nerves (D)</p> Signup and view all the answers

What is the function of the 7th to 11th intercostal nerves?

<p>Enter the anterior abdominal wall (B)</p> Signup and view all the answers

Which artery does NOT supply the thoracic wall?

<p>Superior epigastric artery (C)</p> Signup and view all the answers

What is a branch of the typical intercostal nerves responsible for supplying intercostal muscles?

<p>Collateral branch (D)</p> Signup and view all the answers

What distinguishes the 2nd intercostal nerve from the typical intercostal nerves?

<p>It forms the intercostobrachial nerve. (A)</p> Signup and view all the answers

What is the course of typical intercostal nerves?

<p>They run anteriorly between internal and innermost intercostal muscles. (B)</p> Signup and view all the answers

Which of the following ribs are considered true ribs?

<p>1st to 7th ribs (B)</p> Signup and view all the answers

What structure closes the thoracic outlet?

<p>Diaphragm (B)</p> Signup and view all the answers

Which of the following statements about typical ribs is correct?

<p>Typical ribs have two facets on their head (D)</p> Signup and view all the answers

What type of joint is formed at the costochondral junction?

<p>Primary cartilaginous joint (D)</p> Signup and view all the answers

Which rib is classified as atypical due to its specific structural characteristics?

<p>1st rib (D)</p> Signup and view all the answers

Which vertebral level corresponds to the upper border of the manubrium sterni?

<p>T2-T3 disc (B)</p> Signup and view all the answers

What constitutes the anterior boundary of the thoracic inlet?

<p>Upper border of the manubrium sterni (B)</p> Signup and view all the answers

Which of the following best describes the location of the xiphisternal joint?

<p>At the body of T9 vertebra (C)</p> Signup and view all the answers

Which vessels and nerves are contained within the thoracic inlet?

<p>Great vessels, trachea, and nerves (D)</p> Signup and view all the answers

Which of the following distinguishes the 11th and 12th ribs from typical ribs?

<p>No neck or tubercle (D)</p> Signup and view all the answers

What is the main function of intercostal muscles?

<p>Facilitate rib movement for breathing (D)</p> Signup and view all the answers

Which structure serves as the posterior boundary of the thoracic outlet?

<p>12th thoracic vertebra (C)</p> Signup and view all the answers

What role do intercostal arteries play?

<p>Supply blood to the intercostal muscles and skin (B)</p> Signup and view all the answers

Which type of joint connects the vertebral bodies in the thoracic spine?

<p>Secondary cartilaginous joint (A)</p> Signup and view all the answers

Flashcards

Costo-Vertebral Joint

The joint where a typical rib articulates with the corresponding vertebra (same number) and the vertebra above it.

Costovertebral Joint

The articulation between the rib and its corresponding vertebra. This is a synovial joint.

Costochondral Junction

The weakest point of the rib, located just in front of the angle, where the rib twists. This is the most common site for rib fractures.

Costal Groove

The groove on the inferior border of the rib where the intercostal vessels and nerve (VAN) run.

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Intercostal Space

The space between two ribs, containing intercostal muscles and vessels, as well as the intercostal nerve.

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External Intercostal Muscle

The outermost layer of intercostal muscles. The fibers run downward and forward, helping to elevate the ribs during inhalation.

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Internal Intercostal Muscle

The middle layer of intercostal muscles. The fibers run downward and backward, helping to depress the ribs during exhalation.

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Innermost Intercostal Muscle

The innermost layer of intercostal muscles. The fibers run downward and backward (same direction as internal intercostal muscle), and contribute to rib depression.

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Transversus Thoracis Muscle

The muscle connecting the sternum to the costal cartilages. It is a flat muscle located on the inner surface of the thoracic cage, aiding in rib depression.

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Intercostal VAN

A bundle of vessels (vein, artery, and nerve) running through the intercostal space, essential for supplying blood and innervating the intercostal muscles and thoracic wall.

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Chondrosternal junction

A secondary cartilaginous joint where the costal cartilage of the true ribs (1st-7th) articulates with the sternum.

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Thoracic cage

The bony cage that protects the heart and lungs. It consists of 12 thoracic vertebrae, 12 ribs, and the sternum.

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Thoracic inlet

The upper opening of the thoracic cavity. It's bounded by the 1st thoracic vertebra, 1st ribs and costal cartilages, and the superior border of the manubrium.

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Thoracic outlet

The lower opening of the thoracic cavity. It's bounded by the 12th thoracic vertebra, last two ribs, costal margin, and the xiphisternal joint.

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True ribs

The 1st-7th ribs directly connect to the sternum through their costal cartilage.

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False ribs

The 8th-10th ribs indirectly connect to the sternum through their costal cartilage, which is attached to the cartilage of the rib above.

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Floating ribs

The 11th and 12th ribs do not attach to the sternum at all.

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Sternal angle

The location where the manubrium and the body of the sternum meet. It is located at the level of the lower border of the T4 vertebra.

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Xiphisternal junction

The location where the body and xiphoid process of the sternum meet. It is located at the level of the body of the T9 vertebra.

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1st rib

The 1st rib assists in breathing and helps protect the brachial plexus and subclavian vessels.

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Twist in rib shaft

The shaft of the rib is twisted, contributing to the shape and function of the thoracic cage.

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Superior demifacet

A rounded surface on the head of a typical rib that articulates with the superior demifacet of a vertebral body.

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Subcostal Muscles

Muscles located in the lower part of the thoracic wall, bridging two intercostal spaces. These muscles help with breathing by pulling the ribs down.

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Bucket Handle Movement

The rib cage's movement that increases the chest cavity's side-to-side width.

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Pump Handle Movement

The rib cage's movement that increases the chest cavity's front-to-back depth.

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Diaphragm

The primary muscle involved in inspiration. It contracts and flattens, increasing the vertical diameter of the chest cavity.

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Inspiration

Action of increasing the chest cavity's volume, allowing air to flow into the lungs.

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Expiration

Action of decreasing the chest cavity's volume, forcing air out of the lungs.

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Origin of Upper Anterior Intercostal Arteries

The internal thoracic artery gives rise to the anterior intercostal arteries for the upper 6 intercostal spaces.

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Origin of Lower Anterior Intercostal Arteries

The musculophrenic artery, a branch of the internal thoracic artery, supplies the anterior intercostal arteries for the lower 5 intercostal spaces.

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Origin of Upper Posterior Intercostal Arteries

The superior intercostal artery, a branch of the subclavian artery, supplies the first two posterior intercostal arteries.

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Origin of Lower Posterior Intercostal Arteries

The descending thoracic aorta, a major vessel in the chest, supplies the posterior intercostal arteries from the 3rd to the 11th intercostal spaces.

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Drainage of Anterior Intercostal Veins

The anterior intercostal veins drain into the internal thoracic vein.

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Formation and Drainage of Internal Thoracic Vein

The internal thoracic vein is formed by the union of vena commitantes at the 3rd intercostal space, and it ultimately drains into the brachiocephalic vein.

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Drainage of First Right Posterior Intercostal Vein

The first right posterior intercostal vein drains into the right brachiocephalic vein.

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Drainage of First Left Posterior Intercostal Vein

The first left posterior intercostal vein drains into the left brachiocephalic vein.

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What is unique about the 1st intercostal nerve?

The 1st intercostal nerve is significantly smaller than other intercostal nerves. Most of its fibers are diverted to the brachial plexus, leaving it with minimal sensory and motor output.

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What are intercostal nerves?

They are branches from the ventral rami of the thoracic spinal nerves (T1 to T11). They are responsible for providing sensory and motor innervation to the intercostal spaces, muscles, and skin.

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What is the subcostal nerve?

This nerve is the ventral ramus of the 12th thoracic spinal nerve. It extends inferiorly along the inferior margin of the 12th rib, innervating the abdominal wall.

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What makes the 2nd intercostal nerve atypical?

The 2nd intercostal nerve's lateral branch, unlike other intercostal nerves, doesn't split into anterior and posterior branches. Instead, it merges with a branch of the brachial plexus to form the intercostobrachial nerve, which supplies skin in the axilla and medial side of the arm.

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Where are intercostal nerves located?

They are located in the rib groove, positioned between the internal and innermost intercostal muscles. They run along the rib, above the internal intercostal muscles, and are responsible for sensory and motor innervation.

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What is the anterior cutaneous branch of the intercostal nerve?

This branch of the intercostal nerve continues anterior to the sternum, supplying skin of the chest and abdominal wall.

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What are typical intercostal nerves?

They are the ventral rami of T3 – T6 nerves, and typically run along the inferior border of the ribs above, reaching the anterior chest wall. They provide motor innervation to the intercostal muscles and sensory innervation to the parietal pleura.

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What is the function of the muscular branch of the intercostal nerve?

This branch of the intercostal nerve supplies the intercostal muscles, enabling them to play a role in breathing.

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What is the collateral branch of the intercostal nerve?

This branch of the intercostal nerve runs along the superior border of the rib below, providing sensory innervation to the area.

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What is the function of the lateral cutaneous branch of the intercostal nerve?

This branch of the intercostal nerve splits into anterior and posterior branches, supplying skin of the lateral chest wall.

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Right Superior Intercostal Vein

The right superior intercostal vein collects blood from the 2nd and 3rd right posterior intercostal veins and empties into the azygos vein.

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Left Superior Intercostal Vein

The left superior intercostal vein collects blood from the 2nd and 3rd left posterior intercostal veins and empties into the left brachiocephalic vein.

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Azygos Vein

The azygos vein is a major venous trunk that runs along the right side of the vertebral column. It collects blood from the posterior intercostal veins (from the 4th to 11th on the right), hemiazygos veins from the left, and other tributaries.

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Hemiazygos Veins

The hemiazygos veins are a pair of veins located on the left side of the vertebral column. They collect blood from the left posterior intercostal veins (from the 4th to 8th) and empty into the azygos.

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Internal Thoracic Vein

The internal thoracic vein is located along the inner side of the rib cage. It starts at the 3rd intercostal space and ends in the brachiocephalic vein. It receives blood from the anterior intercostal veins, which collect blood from the front of the rib cage.

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Superficial Lymphatic Drainage of Thoracic Wall

The superficial lymphatics of the thoracic wall drain into the axillary lymph nodes. The anterior wall lymphatics drain into the pectoral group, and the posterior wall lymphatics drain into the subscapular group.

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Deep Lymphatic Drainage of Thoracic Wall

The deep lymphatics of the thoracic wall drain into various nodes. The anterior wall lymphatics drain into the internal thoracic (parasternal) lymph nodes, which sit along the internal thoracic vessels. The posterior wall lymphatics drain into the intercostal lymph nodes, which lie along the posterior intercostal vessels.

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Superior Vena Cava (SVC)

The superior vena cava (SVC) is the major vein that collects blood from the upper body and returns it to the heart. It receives blood from the azygos vein, which is important for draining the thoracic cavity.

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Study Notes

Thoracic Cage

  • Composed of the vertebral column posteriorly, ribs laterally, and the sternum anteriorly
  • Encloses the 11 intercostal spaces
  • Contains the trachea, esophagus, blood vessels, nerves, and the apices of the lungs.
  • The thoracic inlet is a narrow opening bounded by the first thoracic vertebra, the first rib, and the superior border of the manubrium sterni.
  • The thoracic outlet is a lower, wider opening closed by the diaphragm.
  • The costal margin is formed by the fusion of the 7th, 8th, 9th, and 10th costal cartilages.
  • Ribs are classified into true ribs (1-7), false ribs (8-10), and floating ribs (11-12) based on their attachment to the sternum.
  • The thoracic cage has synovial and cartilaginous joints.

Types of Joints in the Thoracic Cage

  • Costochondral joints are primary cartilaginous joints connecting the ribs to their costal cartilages.
  • Chondrosternal joints are synovial joints linking costal cartilages to the sternum.
  • Intervertebral joints connect vertebral bodies, classified as secondary cartilaginous joints.

Intercostal Muscles

  • External intercostal muscles have fibers running downward and forward, originating from the lower border of a rib and inserting into the upper border of the rib below.
  • Internal intercostal muscles run downward and backward, originating from the lower border of a rib and inserting into the upper border of the rib below.
  • Innermost intercostal muscles run downward and backward, found only in the lateral parts of the thoracic wall.
  • Subcostal muscles are fiber bundles located on the inner surface of the thoracic wall posterior rib angles.
  • Transversus thoracis muscles (sternocostalis) originate on the lower sternum, and insert into the costal cartilages from the 2nd to the 6th rib.

Nerves

  • Intercostal nerves are ventral rami of thoracic spinal nerves (T1 through T11 or T12).
  • They run in the groove between ribs and layers of intercostal muscles.
  • They have both anterior and lateral cutaneous branches that innervate cutaneous areas.
  • The nerve to the innermost intercostal muscle and the vessels are superficial to it.
  • The first intercostal nerve is small; its fibers share in the brachial plexus.
  • The second intercostal nerve has a lateral branch that forms the intercostobrachial nerve, supplying skin along the medial side of the arm.

Arteries

  • Intercostal arteries are branches of the aorta and internal thoracic artery.
  • Anterior intercostal arteries supply the upper six spaces, while posterior intercostal arteries supply the lower nine spaces.
  • Anastomosis occurs between anterior and posterior intercostal arteries.
  • The internal thoracic artery divides into anterior intercostal arteries.
  • The branches of the internal thoracic artery are anterior intercostal arteries, perforating branches to breast tissue, branches to the thymus gland, mediastinal branches to the mediastinum, and the superior epigastric artery.
  • Musculophrenic artery in the lower six spaces supplies the diaphragm.

Veins

  • Anterior intercostal veins drain into the internal thoracic veins that empty into the brachiocephalic or superior vena cava.
  • Posterior intercostal veins drain into the azygos, hemiazygos and accessory hemiazygos veins.
  • The first posterior intercostal vein drains into the brachiocephaic vein.

Lymphatic Drainage

  • Superficial lymphatics drain into the axillary lymph nodes.
  • Anterior thoracic wall drains into the pectoral nodes.
  • Posterior thoracic wall drains into the subscapular nodes.
  • Deep lymphatics drain into the internal thoracic (parasternal) nodes and intercostal nodes

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