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Ch.10 Ribs-Sternum

Procedures Written Practice Questions

Bony thorax consists of what three main parts sternum, thoracic, 12 pairs of ribs
What projection would demonstrate the spine but would show the sternum minimally? AP or PA
Thin, flat narrow bone with three divisions composed of vascular cancellous tissue covered by compact bone sternum
Total length of adult sternum 7 inches
Upper portion of the sternum and measures 2 in. manubrium
Longest part of the bony thorax, whose 4 segments combine at puberty and completely at 25 body of sternum
Most inferior portion of the sternum, composed of cartilage during infancy and youth and ossifies at 40yrs. xyphoid tip
The palpable landmark that is in the uppermost border of the manubrium, located at upper border of the sternum at the junction of the two clavicles. jugular notch (suprasternal, manubrial notch)
At the level of T4-T5 on an average adult and at the end of the manubrium sternal angle
Palpable landmark that is part of the sternum and corresponds to level of T9-T10 xyphoid tip
What corresponds to the level of L2-L3 Inferior costal angle
What joints articulates with each side of manubrium laterally, forming a notch on each side sternoclavicular joint
What is the connection called between each shoulder girdle and bony thorax sc joint
What two structures connect directly to the sternum clavicles and 1st seven pairs of ribs
Depression that is below each clavicular notch and sternoclavicular joint facets for articulation with cartilage of 1st rib
Anterior ribs do not directly unite with sternum with what short piece of cartilage Costocartilage
The 2nd costocartilage connects to the sternum at what level at the sternal angle
Which ribs that have costocartilages connect directly to the body of sternum 3rd-7th ribs
Which ribs connect at the 7th rib costocartilages, which then connects to sternum 8-10th ribs
What are the 1st-7th pairs of ribs considered as true ribs
Each true rib attaches directly to what structure by its own costocartilage sternum
What structures make up the false ribs 8-10th ribs attached with 7th rib costocartilage 11-12th ribs do not have costocartilage
What lies lateral to the neck of the rib, what it articulate with and its purpose tubercle- articulates with the transverse process, and allows attachment of ligaments
In the posterior view of a rib what is demonstrated at the vertebral end head, neck, and tubercles
The area part of the bony thorax with forward angulation angle of the rib
What is the typical measurement of the posterior(vertebral end) of a rib 3-5in. HIGHER than anterior(sternal) end
Which part of the rib is most superior when looking at a chest radiograph posterior rib is more superior, whereas the anterior ribs are inferior - up and downward
Name and purpose of the lower inside margin of each rib and can cause pain during trauma when hemorrhages in that are are involved Costal groove- protects arteries,veins, and nerves (closer to the heart anteriorly)
What are the differences in the ribs if any 1st ribs are short,broad and mostly vertical of all ribs, elongating downward up to the 7th-12th ribs where it then becomes short. The 1st rib is the most sharply curved
Name of joint between costocartilage and sternal ends are called and its significance costochondral union -(1-10ribs) cartilage and bone are bound by periosteum of the bone itself
What type of joint classification would the costochondral junctions (1-10 ribs) be synarthrodial
State classification of sternoclavicular joints and their location Synovial-diarthrodial, between clavial and sternum,
Sternocostal joint(1st) attaches directly to what structure and what is their joint classification manubrium, synarthrodial-diarthrodial
Continuous borders between the costal cartilages of 6-9th ribs interchondral joints
State interchondral joint classification synovial,diarthrodial
Joints between head of ribs and the thoracic vertebral column costovertebral joints (1-12th)
Joints between ribs and transverse processes of the thoracic vertebrae costotransverse joints (1-10)
Why is it difficult to radiograph the sternum in a true AP/PA Thin cortex, within thorax and it's anterior midline structure is in the same plane along t-spine
What position is best to visualize sternum and the amount of rotation, if any. RAO, 15-20 degrees to shift sternum to the left into the homogenous heart shadow
What determines the degree of obliquity in an RAO position for the sternum Size of patient, 15 for barrel chested, 20 for thin-chested
Exposure factors required for sternum analog:40"SID, 65-72kv, low mA, long exposure time 2-3s to compensate for motions,orthostatic breathing
To minimize pt dose, patient's skin should be at what measurement below the surface of the collimator 15"(38cm)
What determines if you perform an AP/PA on a rib study location of pain, extent of pain,cause,stability
Which ribs represents the minimum number of ribs shown above the dome of the diaphragm on full inspiration upper 9 posterior ribs
What is the minimum SID for rib studies and what is the exception 40"SID for unilateral, 72"SID for bilateral
Routine for doing ribs ABOVE the diaphragm erect, expose at inspiration,use low kv(65-70)
Why do we do erect for ABOVE the diaphragm Gravity pulls down the diaphragm, better inspiration,patient comfort and avoid movement
Why do we use inspiration as breathing technique when doing ribs ABOVE diaphragm When taking a deep breath in, diaphragm is pushed down fully to the 9th rib
Why do we lower kV when doing ribs ABOVE diaphragm To better visualize the ribs through the lung tissue and contrast in analog. If site of injury is near the heart, we increase technique to go through the heart shadow as well as lungs
When doing ribs BELOW diaphragm recumbant,expose at expiration, med kV(70-80)analog
Wy do we do recumbant for ribs BELOW the diaphragm to flatten abdomen and better visualization of lower ribs through abdominal structures
We use expiration breathing for ribs BELOW the diaphragm because lifts diaphragm up to the 7th posterior rib, uniform density
Medium kV for ribs BELOW diaphragm to ensure proper penetration,going through muscle, denser area
When doing ribs study, which side is touching the IR site of interest close to IR, rotate spine away to prevent superimposition
If patient has trauma to the left posterior ribs, what are the preferred projections AP,LPO(elongate the left ribs, PO pulls spinous process away from area of interest)
When doing the LPO how are the spinous processes in relation to the left side of injury spinous process are away
What determines if you do a AP/PA for ribs pain anterior(AP), pain posterior (PA) (inpractice: most will do AP)
Patient has trauma to the right anterior ribs, what is the preferred projection PA,LAO(elongate the right ribs, pull spinous process away from area of interest)
Why do department protocols order routine PA/Lateral chest? Rule out pneuomothorax,hemothorax,pulmonary edema and other pathologies
Modality to evaluate skeletal detail and soft tissues with sternum/sc joints CT
Evaluating skeletal pathologies such as mestases,bone scans Nuclear Medicine
Fractures of the 1st ribs are associated with injuries to the arteries, veins
Fractures of the lower ribs are associated with injuries to the lower organs, kidneyes, spleens,liver
Fracture adjacent to the ribs in two or more places by blunt trauma causing pulmonary injury and collapses chest wall, linear lucency flail chest, routine
Fractures in this structure caused by blunt trauma and associated with cardiac injury (hint: near heart) sternum fracture,sternum/CT
Congenital defect characterized by anterior protrusion of lower sternum and xyphoid process pectus carinatum(pigeon chest), routine chest/lateral sternum
Known as funnel chest, deformity of depressed sternum interfering with respiration pectus excavatum
Distructive lesions with IRREGULAR margins osteolytic
Proliferative bony lesions of INCREASED density osteoblastic
Moth-eaten appearance of bone resulting of mixed destructive and blastic lesions osteo-lytic/blastic , NucMed
Localized/generalized bacterial infection of bone and marrow due to postoperative complications of open heart surgery and causes sternum to split osteomyelitis
Routine exam procedures for ribs PA/AP(site of injury)/bilateral, obliques,chest (inpractice: one below diaphragm shot at AP)
Routine exam procedures for sternum RAO, Lateral
Created by: nwfsc