Chapter 10 Bony Thorax

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1

1. The three structures that make up the bony thorax?

Sternum, Thoracic vertebra and 12 pairs of ribs.

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2. What is the term for the long, middle aspect of the sternum?

Body

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3. The most distal aspect of the sternum does not ossify until a person is approximately how old?

40

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4. The total sternum length on an average adult is?

6 inches

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5. The xiphoid process of the sternum is approximately at te level of

T9 - T10

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6. The sternal angle is at the level of

T4-T5

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7. The sternal angle is also called

Manubriosternal joint

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8. What is the name of the joint that connects the upper limb to the bony thorax?

SC Joint

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9. What distinguishes a true rib from a false rib?

True rib is connected to the sternum by their own costocartilage, false are connected by the costocartilage of the 7th rib

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10. True or False: The eleventh and twelfth ribs are classified as false and floating ribs?

True

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11. The anterior end of the ribs is called the vertebral end.

False

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12. Which aspect of the ribs articulates with the transverse process of the thoracic vertebrae?

Tubercule

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13. List the structures found within the costal groove of each rib?

Artery, Vien, and nerves

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14. Which end of the ribs is most superior - the posterior vertebral ends or the anterior sternal ends of the ribs?

Posterior vertebral end

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15. Approximately how much difference in height is there between the anterior sternal end and posterior vertebral end of the ribs?

3 to 5 inches

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16. Which rib articulates with the upper lateral aspect of the manubrium of the sternum?

First (anterior sternal end)

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17. The bony thorax is widest at the lateral margin of which ribs?

8th or 9th

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18. Joint movement type of: First sternocostal

Immovable - synarthrodial

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19. Joint movement type of: First through twelfth costovertebral joints

Movable - diarthrodial (plane or gliding)

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20. Joint movement type of: First through tenth costochondral unions (between costicartilage and ribs)

Immovable - synarthrodial

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21. Joint movement type of: First through tenth costotransverse joints (between ribs and transverse process of T vertebrae).

Movable - diarthrodial (plane or gliding)

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22. Joint movement type of: Second through seventh sternocostal joints (between second and seventh ribs and sternum).

Movable - diarthrodial (plane or gliding)

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23. Joint movement type of: Sixth through ninth interchondral joints (between anterior sixth and ninth costal cartilage).

Movable - diarthrodial (plane or gliding)

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24. Joint movement type of: Ninth and tenth interchondral joints between the cartilage.

Fibrous - syndesmosis

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25. What is unque about the true ribs

Each rib attaches to the sternum by its own costicartilage

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26. What is unique about the floating ribs

They do not connect to anything anteriorly

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27. True or False: It is virtually impossible to visulize the sternum with a direct PA or anteroposterior projection

True

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28. True or False: A large "deep-chested" (hypersthenic) patient requires more obliquity for a frontal view of the sternum as compared with a "thin-chested" (asthenic) patient.

False

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29. How much rotation should be used for the oblique position of the sternum for a large, "deep-chested" patient

approximately 15 degrees

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30. What is the advantage of performing an ostostatic (breathing) technique for radiography of the sternum

It blurs lung markings and ribs which improves visability of the ribs

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31. What is the main reason that a SID of less than 40 inches should not be used for sternum radiography?

Increase in patient dose expecially skin does.

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32. What other modality is available to study the sternum of routine RAO and lateral radiographs do not provide suffient information

CT or Nucular medicine

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33. An injury to the region of the eighth or ninth rib requires the above or below diaphragm technique

Above

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34. To properly elongate and visualize the axially aspect of the ribs, the patients spine should be rotated away or towards the area of intrest?

Away from

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35. Which projection AP or PA and anterior or posterior oblique should be performed for an injury to the anterior aspect of the ribs?

PA and anterior oblique

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36. Which two rib projections should be performed for an injury to the right posterior ribs?

AP and Posterior oblique RPO to shift the spine away from the area of interest.

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37. If the physician suspects a pneumothorax or hemothorax has occured as a result of a rib fracture which additional radiographic projection(s) should be performed in addition to the routine rib projection?

Erect PA and lateral chest

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38. A Flail chest is defined as ?

Pulmonary injury caused by blunt trauma to two or more ribs

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39. Osteolytic metastases of the ribs produce what radiographic appearences?

Irregular bony margins

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40. What is the definition of pectus excavatum?

Depressed sternum caused by congenital defect

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41. A proliferative bony lesion of increased density is generally termed?

osteoblastic

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42. True or False: MRI provides a more diagnostic image of rib metatses as compared with nuclear medicine

False

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43. True or False: patients can develope osteomyelitis as a postoperative complication following open heart surgery.

True

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44. What is the perferred study of the sternum RAO or LAO

RAO because it places the sternum over the heart to provide a uniform background for added visibility of sternum

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45. Where is the CR centered for the oblique and lateral projections of the sternum?

Midsternum

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46. What other position can be performed if the patient cannot assume a prone position for the RAO sternum

LPO

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47. What is the recommended SID for a lateral projection of the sternum

60-70 inches to reduce magnification created by long OID

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48. What criteria applies to a radiograph of an oblique sternum for evaluation

The entire sternum should lie over the heart shadow and be adjacent to the spine.

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49. What is the CR for a PA projection of the sternoclavicular joints

Level of T2 - T3

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50. What type of breathing instructions shoud be given to the patient for a PA projection of the sternoclavicular joints

Suspended respiration on inspiration

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51. How much rotation is reccomeneded for an anterior oblique of the sternoclavicular joints

10 to 15 from PA position

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52. Which specific oblique position best demonstrates the left sternoclavicular joint adjacent to the spine?

LAO

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53. What are three points that must be included in the patient's clinical history before a rib series?

The nature of the trauma, the location of the rib pain and whether paitent is coughing up blood.

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54. Where is the CR for an AP projection of the ribs for an injury located above the diapragm?

3-4 inches below jugular notch at the level of T7

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55. What two specific oblique positions can be used to elongate the left axillary ribs?

RAO or LPO elongates the left axillary ribs

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56. What position and projection should be performed for an injury to the right anterior ribs

LAO position and PA projection

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57. How many degrees of rotation is required for an oblique projection of the axillary ribs

45 degrees

58

58. SID for a bilateral rib study on a adult patient

72 inch SID

59

59. True or False: The recommended kV range for a digital study of the unilateral, lower ribs is 80-90 kv

True