THORAX ANATOMY LAB 1: LEARNING OBJECTIVES Thoracic Wall, Pleural Cavities, and Lungs

Primary Learning Objectives

1. Define thorax and state the structures that form its anatomical boundaries. 2. Describe the locations and boundaries of the superior thoracic aperture (clinical: thoracic outlet) and the inferior thoracic aperture. Identify the costal arch (margin) and state the ribs that form the arch. 3. Identify and palpate the bones that compose the sternum (manubrium, body, and xiphoid process) and associated osteological features: jugular notch, clavicular notch, and sternal angle. 4. For the sternal angle, identify its associated vertebral level, state its anatomical relationship to the trachea and aorta, state its significance in creating an anatomical division of the mediastinum, and identify the ribs that join the sternum at its location. 5. Identify and palpate the clavicle, sternum, ribs, costal cartilages, intercostal spaces, and thoracic vertebrae. 6. Differentiate true ribs from false and floating ribs. 7. Identify the following osseous features on a rib: head, neck, rib (costal) tubercle, body, shaft, and the costal groove. 8. State the weakest region of the rib that is commonly fractured and describe the anatomy and physiology involving flail chest. 9. Describe the possible clinical manifestations of supernumerary ribs. 10. Identify the following rib joints: costovertebral (costotransverse joint and vertebral body joint) and sternocostal. 11. Identify the transversus thoracis muscle, the external, internal, and innermost intercostal muscles, and state their innervation, blood supply, and functions. 12. State the structures that compose the neurovascular bundle within each intercostal space and identify each neurovascular bundle by number. 13. Identify the neurovascular bundle inferior to the twelfth rib and state the names of each structure composing the bundle (subcostal artery, subcostal vein, and subcostal nerve). 14. Differentiate anterior intercostal arteries from posterior intercostal arteries and state from which larger artery each branch. 15. Describe the purpose of an intercostal nerve block, and indicate the location within an intercostal space the needle is inserted. 16. Identify the internal thoracic (mammary) artery and its following branches: musculophrenic, superior epigastric, and anterior intercostal arteries. State what each branching vessel supplies. 17. Explain collateral pathways for blood flow if a blockage occurs in the aorta distal to the origin of the subclavian artery. Correlate this collateral flow to pathologic radiographic features. 18. Describe and identify the boundaries of the thoracic cavity and its subdivisions: mediastinum, pulmonary cavity, pleural cavity, and pericardial cavity. 19. Differentiate parietal pleura from visceral pleura, and identify the named regions of parietal pleura. 20. Identify the location of the endothoracic fascia and state its clinical significance. 21. Identify the costomediastinal and costodiaphragmatic (costophrenic) recesses and state the clinical significance of the costodiaphragmatic recess as a potential space for fluid accumulation. 22. Define pleural effusion, hemothorax, pneumothorax, and compare an open tension pneumothorax to a spontaneous pneumothorax. 23. Define pleuritis and distinguish the patterns of pain expected with inflammation of the visceral pleura versus parietal pleura. 24. Identify the diaphragm, its central tendon, and its right and left domes. State the different serous membranes that cover its thoracic surface versus its abdominal surface. 25. Identify the vertebral levels of the caval hiatus, the esophageal hiatus, and the aortic hiatus. 26. Contrast the sensory innervation of the diaphragmatic pleura on the central region of the diaphragm versus its periphery, and identify the dermatomes where pain from the diaphragm is typically referred. 27. Identify the phrenic nerve, state the nerve root levels that contribute axons to the phrenic nerve, describe its motor and sensory functions, and state to which dermatomes pain from the fibrous pericardium is referred. 28. Describe the action of the diaphragm during contraction and its effect on thoracic volume. 29. State the motor innervation of the diaphragm and describe paradoxical movement resulting from unilateral paralysis. 30. Identify the right and left lungs and describe their anatomical relationship to the mediastinum. 31. Identify the following lung features: lobes, fissures, surfaces, hilum, root, cardiac notch (left lung), and lingula (left lung). Explain the anatomical relationship between the following nerves and the root of the lung: phrenic nerve and vagus nerve. 32. Contrast pneumonectomy, lobectomy, and segmentectomy. 33. Identify the dermatome represented on the anterior thoracic wall at the level of the nipples. 34. Identify the surface anatomy that correlates to the margins of the pleura, lobes of the lungs, and fissures of the lung. 35. Identify the surface locations at which the lung lobes can be auscultated on each side of a patient.