Thorax Anatomy Practical 1

Practical Activity Tasks
1. Bones & Joints
1.1. Identify the bones that make up the thoracic cage/ walls:[ADELENE]
1.1.1. Ribs & costal cartilages
1.1.2. Sternum
1.1.3. Thoracic vertebrae
1.1.4. Why do the ribs of infants and children not fracture as often in crushing injuries of the chest when compared to elders? [CAROLINE]

1.2. Broadly classify & identify ribs as follows
1.2.1. True ribs
1.2.2. False ribs
1.2.3. Free/floating ribs
1.2.4. Why are the upper two and lower two ribs least commonly injured in a crushing injury of the chest?

1.3. Identify a typical rib
1.3.1. Which ribs are typical?
1.3.2. What are the characteristic features of a typical rib?
1.3.3. Where do fractures of ribs commonly occur?[CAROLINE]
1.3.4. What is a ‘flail chest’? [ADELENE]
1.3.5. What is paradoxical respiration?

1.4. Identify the 1st rib (an atypical rib).
1.4.1. Locate the important structures related to the 1st rib
1.4.2. What is a ‘cervical rib”? Give its incidence and its significance.
1.4.3. What are the boundaries of the ‘thoracic inlet’ (superior thoracic aperture)?[ADELENE]

1.5. Identify the typical thoracic vertebrae. [JENG HWAN]
1.5.1. What are the characteristic features of a typical thoracic vertebra?

1.6. Identify the parts of the sternum (manubrium, body, xiphisternum).
1.6.1. What is the role played by the sternum in cardiopulmonary resuscitation (CPR)?
1.6.2. Why is the sternum the preferred site for bone marrow aspiration?

1.7. Identify the major joints of the thoracic walls including the following:
1.7.1. Thoracovertebral joints:
1.7.1.1. Costovertebral joints
1.7.1.2. Costotransverse joints
1.7.1.3. What types of joints are these and what movements are possible? [JENG HWAN]

1.7.2. Sternum-related joints: [TOMMY]
1.7.2.1. Sternocostal joints (1st, 2-7th)
1.7.2.2. Sternoclavicular joint
1.7.2.3. Manubriosternal joint
1.7.2.4. Other joints of the thoracic cage – costochondral,interchondral joints
1.7.2.5. What types of joints are these and what movements are possible?

2. Muscles
2.1. Identify the 3 layers of intercostal muscles and their features: External Internal Innermost (including subcostal, transverse thoracis)
2.1.1. How are the muscle fibres arranged?
2.1.2. What are the actions of these muscles?
2.1.3. What is their nerve supply? [TOMMY]

2.2. Identify the boundaries of a typical intercostal space. [MAJID]
2.2.1. In what plane are its contents located?
2.2.2. What is the relationship of its contents?

2.3. Identify the diaphragm.
2.3.1. Briefly describe the (sternal, costal and vertebral) attachments of the diaphragm.
2.3.2. Identify major openings of the diaphragm and associated vertebral levels.
2.3.3. What structures pass through the major openings?
2.3.4. Briefly list minor openings of the diaphragm and the structures passing through.
2.3.5. What are the actions of the diaphragm? [MAJID]
2.3.6. Briefly list the embryological origin of the diaphragm and its clinical significance? [DIVVYA]

2.4. Briefly explain the dynamic interaction between bones, joints and muscles of the thoracic cage involved in the mechanics of respiration.[CHANG THAI]
2.4.1. Why is the respiration in the first two years of life almost entirely abdominal?

2.5. Identify the accessory muscles of respiration attached to the thoracic cage:
2.5.1. Pectoralis major
2.5.2. Pectoralis minor
2.5.3. Serratus anterior
2.5.4. Why does a dyspnoeic patient feels comfortable in a sitting position and by leaning forward and fixing the arms?[CHANG THAI]

3. Vessels
3.1. Identify the internal thoracic artery.[DIN]
3.1.1. Locate its origin 3.1.2. What are its main branches and area of supply?

3.2. Identify the anterior & posterior intercostal arteries.
3.2.1. What is the origin of these arteries?
3.2.2. What do they supply?

3.3. Identify the intercostal veins.
3.3.1. Which major veins do these drain into? [DIN]

4. Nerves
4.1. The thoracic spinal nerves are typical spinal nerves. [GAYA]
4.1.1. Draw a labelled schematic diagram showing a typical thoracic spinal nerve with all its communications ( including the intercostal nerves). [GAYA]

4.2. Identify and trace the origin of the intercostal nerves. [JOANNA]
4.2.1. What is the distribution fo the following intercostals nerves?
4.2.2. 1st
4.2.3. 2nd
4.2.4. 3-6th
4.2.5. 7-11th

4.3. Identify the phrenic nerve.
4.3.1. What is its origin/root value?
4.3.2. What structures does it supply? [JOANNA]
4.3.3. Where is referred pain from the phrenic nerve commonly sited? [GAYA]
4.3.4. What are the effects of phrenic nerve injury?[GAYA]

5. Surface & Clinical Anatomy

5.1. Identify and describe the significance of the following surface markings: [DAKSHA]
5.1.1. Jugular (suprasternal) notch
5.1.2. Manubrialsternal joint
5.1.3. Costal margin
5.1.4. Midclavicular line
5.1.5. Midaxillary line
5.1.6. Paravertebral line
5.1.7. T4/ T5 vertebral spines

5.2. What are the indications and anatomical basis for the following common surgical approaches to the thorax?
5.2.1. Median sternotomy [DIVYA]
5.2.2. Postero lateral thoracotomy [DIVYA]
5.2.3. Locate and draw on consenting peers the key thoracic dermatomes (e.g. T2, T10).[DAKSHA]

5.3. List the steps involved in the following procedures (with emphasis on relevant anatomy): [DIVYA]
5.3.1. Intercostal nerve block
5.3.2. Thoracocentesis (pleural tap) 5.3.3. Insertion of a chest tube drain

6. Radiology [JOANNA]
6.1. Study a Chest X-ray (PA view):

6.1.1. Describe a Normal Chest Xray ( PA View)

6.1.2. Why is a Chest XRAY taken in a PA view?

6.1.3. Identify the bony features of the thoracic cage
6.1.3.1. How do you count the ribs in an X-ray?


Do come prepared guys!

Signing off

=D