2020

Anatomy guidelines
Thorax region

A complete
explanatory
description of
thorax region
highlighted with
important topics,
how to study and
what to study
according to the
pattern of UHS.

Hafiz Helper series

www.hafizhelperseries.com
 Thorax Guidelines

INTRODUCTION

Total chapters = 9

15% paper Cover Thorax Region

8 MCQs & 1 SEQ

Recommended Book: BD

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Chapter # 1
Introduction
Start of this chap imp from viva and MCQs point of view
- ATYPICAL RIBS are 1, 2, 10, 11, and 12
- TYPICAL RIBS are 3 to 9
- TRUE RIBS are 1 to 7
- FALSE RIBS are 8 to 12
- TRUE RIBS are also called vertebrosternal ribs 1 to7
- vertebrochondral ribs are 8 to 10
- Floating ribs/ vertebral ribs are 11 and 12
MOST IMP TOPICS
- Superior aperture/ inlet of thorax
- Inferior aperture/ outlet of thorax

• LARGE OPENING IN THORACOABDOMINAL

DIAPHRAGM (Table)
The Nerve Supply of Diaphragm is important:
Its nerve supply is:
- Phrenic nerve
- lower six intercostal nerves
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Functions of diaphragm are important & it is not

mentioned in BD
So, its functions are:
- Muscle of inspiration
- Muscle of abdominal straining
- Weight lifting muscle
- It acts as THORACOABDOMINAL pump

3 shapes of thorax u must now

- -Human adult thorax is oval
- -Infants is circular
- -Quadrupeds in which antero posterior diameter is
greater than transverse diameter

NOW IMP CLINICALS OF THIS CHAP

- Cervical rib (important)
- Thoracic inlet syndrome

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Most imp topic

The boundaries of inlet, outlet and large openings of
diaphragm.

Bony features
- Body, pedicles, lamina, *vertebral foramen *
- *vertebral canal* (thorough whole length of
vertebral column)
- Spinous process
- Transverse process

VERTEBRAL COLUMN DISTRIBUTION

- TYPICAL
2 TO 8
- ATYPICAL
1, 9, 10, 11 AND 12
- Heart shape body
- Ligaments name and their position must be known
- Typical Rib is simple
- Memorize at least one feature of each Atypical
Vertebrae

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T1: sup. Costal facet comp

T9: sup. Costal demi facet
T10: single comp costal facet
T11: transverse process does not have articular facet
T12: transverse process is small with 3 tubercles.

Sternum
- Length 17 cm long (longer in males than females)

Parts of sternum:
• Pro sternum (manubrium)
• Meso sternum (body)
• Meta sternum (xiphoid process/ xiphisternum).
- Sternal angle / angle of Louis = 163°
- -Between T4 and T5 intercostal space tracheal
bifurcation.
- Fusion of xiphoid process with body at 40 years of
age.

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VERTEBRAL COLUMN
Total vertebrae 33
- Primary curvature (birth) {thoracic and sacral}
- Secondary curvature (postural) {cervical and lumbar}
- Coronal/ lateral curvature (thoracic)

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Chapter 2

Bones

Joints

Respiratory
movements

Out of these 3 from written point of view JOINTS are

Very important (especially CHONDROSTERNAL JOINT)
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IMPORTANT QUESTION
Give type of 1st condrosternal joint and type of other
CHONDROSTERNAL joints?
1st CHONDROSTERNAL joint is PRIMARY
CARTILAGINOUS JOINT the 2nd to 7th are SYNOVIAL
JOINT.
NOTE:
For VIVA professors usually ask about the types of joints,
so u all must memorize the types of joints

Examples: name all secondary cartilaginous joint?

manubriosternal joint.
Every joint between IV discs.

NOTE:
These Questions are most frequently asked by professors
For bones
- Features of ribs 3 to 9 mn
- Angle of rib
- VAN relation (vein, artery, nerve)

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- Head, neck, tubercle, shaft

- Costal groove

• For viva point of view mostly typical rib and first rib
is asked, 1st rib is smallest and easily identifiable
- POINTS OF IDENTIFICATION must be known

• Bones are only imp for VIVA. However MCQs may

come regarding with their attachments and bony
features
• Bones are not important for SEQs except orbit (head
and neck region)

For RESPIRATORY MOVEMENTS

- Respiratory muscles
- Most prominent role in respiration is played by
diaphragm

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CLINICALS
1- PUMP HANDLE MOVEMENTS (Most IMP)
• Vertebrosternal ribs
• Anteroposterior diameter increases.

2- BUCKET HANDLE MOVEMENTS (Most IMP)

• vertebro-chondral ribs
• Transverse diameter increases

3- NEEDLE THORACOTOMY (IMP) it's from SNELL not

mentioned in BD
4- Scoliosis
5- Spina bifida
6- FUNNEL CHEST (Most IMPORTANT)
7- PIGEON CHEST (Most IMPORTANT)
8- Manubristernal puncture

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9- Cervical rib (it’s already done in chap 1 too and it is

IMPORTANT too)
However a question may be asked on which artery the
pressure comes? SUBCLAVIAN ARTERY

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Chapter # 3
WALL OF THORAX

- intercostal muscles (most imp of this chap) muscles

origin and insertion with nerve supply and action.
- intercostal nerve (with diagram of spinal cord
formation)
- Branches of intercostal nerve (v imp, may also come
in seqs so remember at least one name.
- intercostal arteries:
- {each intercostal space contains 1 post. intercostal
artery with its collateral branch and 2 anterior
intercostal arteries}
- Post. intercostal arteries (11 total, and 1 in each
space)
▪ {1st and 2nd arises from sup. intercostal
artery &
- 3rd to 11th arises from descending thoracic aorta.}
- Ant. intercostal arteries (9 spaces anteriorly, 2
intercostal arteries in each space)
- {upper 6 arises from internal thoracic artery &
- 7 to 9 arises from musculophrenic artery}
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- This information about arteries is more than enough

however realtions would be covered from this
diagram.

- Give a read to lymphatics too.

- Internal thoracic artery not much important.
- azygos vein (imp)
- thoracic sympathetic trunk (its branches are imp
specially medial branches, seqs may come from
ganglia and splanchnic nerve)

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In short if we talk about MOST IMP TOPICS these are:

1. Intercostal muscles (origin, insertion, nerve supply,
action)
2. Branches of intercostal nerve
3. Azygos vein (hemi, accessory) mainly azygos {course,
tributaries}
4. Branches (especially medial) of thoracic sympathetic
trunk.

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Chapter # 4
THORACIC CAVITY AND PLEURA

- Visceral / pulmonary pleura

- Parietal pleura (costal, diaphragmatic, mediastinal
and cervical )
- No need to memorize surface markings
- Comparison of visceral and parietal pleura (table)
- NERVE SUPPLY OF PLEURA (important)
- Give a read to blood supply, lymphatic’s and 2
recesses of pleura.( BCZ ITS ALREADY COVERED IN
THAT COMPARISON TABLE )
- Structure that are passing (it’s through diaphragm).
• Openings are also in thoracoabdominal
diaphragm.

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Important Clinicals:
1- Pleurisy (Pleural effusion)
2- pneumothorax (presence of air in pleural cavity)
3- haemothorax ( presence of blood in pleural cavity)
4- hydropneumothorax (presence of both air and fluid
in pleural cavity)
5- Empyema (presence of pus in pleural cavity).
6- paracentesis thoracis

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Chapter # 5
LUNGS

Most frequently asked SEQs from this chapter

FISSURES AND LOBES OF LUNGS

BRONCHOPULMONARY SEGMENTS

MEDIASTINAL SURFACES OF RIGHT AND LEFT LUNG

• green table+ diagrams of rt. & Lt. Lung

CONTENTS OF ROOT OF THE LUNG

• 9 contents

CLINICALS
- Carina
- Postural drainage
- Auscultation of lung (4th rib on both sides)
- bronchoscopy.
- bronchopulmonary segments.
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MCQS a lot of from bronchial tree topic

Examples
1. Trachea divides at the level of lower border of T4
vertebrae.
2. Right principal bronchus length 2.5 cm long.
3. Left principal bronchus length 5 cm long.
4. Right bronchus makes an angle of 25°
5. Left bronchus makes an angle of 45°
6. Even the MCQs may come from that comparison
table of right and left lung
a. Example:
7. Lobes in right lung: 3 lobes.
8. Lobes in left lung: 2 lobes.

CARDIAC NOTCH (Important)

The below described things must be known by every

student:
- conical shape of lung
- Apex of lung (detail)
- base of lung (detail)
- Three borders of lungs (detail)
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- Two surfaces of lungs (detail)

- Lingula ( tongue- shaped projection)
- oblique & horizontal fissures extend (last 2 points of
surface marking)
- arterial supply (1 bronchial artery on right side & 2
bronchial arteries on left side)
- venous drainage (bronchial vein , pulmonary vein)
- lymphatic drainage (BRONCHOPULMONARY LYMPH
NODES)
- Superficial & deep lymphatics
- Nerve supply (parasympathetic & sympathetic)
- Bronchial tree(IMP)

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Chapter # 6
MEDIASTINUM
This whole chapter is important do not miss a single
thing.
- Post. mediastinum (repeat as a SEQs a bit more than
other mediastinum, its boundaries and contents)
- Every single mediastinum is imp.

CLINICALS
- MEDIASTINITIS (important)
- MEDIASTINAL SYNDROME its causes, symptoms all
- Extend of prevertebral layer of deep cervical fascia.

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Chapter # 7
PERICARDIUM AND HEART

PERICARDIUM
1. Fibrous and serous pericardium.
MCQS
- conducting system
- Structure of heart (all)
Give Read to topics:
- Contents, blood and nerve supply of pericardium
- Percardial effusion (clinical) *
- Grooves or sulci*
- Dextrocardia* (clinical)
- The pink box below conducting system. (clinical) *
- Angina pectoris (clinical).
NOTE:
But, if anyone aiming to get distinction in anatomy, then I
would suggest, go through complete chap, because our
exam a question came from embryo (related to heart).Its
answer is also mentioned in BD this chap.
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Important SEQ'S from HEART

Right Coronary Artery.

Left Coronary Artery.

Coronary bypass
Clinicals from pink box

CORONARY SINUS
Most Important

CONDUCTING SYSTEM
important

Foetal Circulation

Fibrous skeleton.

Cardiac dominance
• Imprtant for both SEQs and VIVA

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Chapter # 8
SUPERIOR VENA CAVA, AORTA
AND PULMONARY TRUNK

- AORTA (MOST IMP) (COMP)

- ARCH OF AORTA (INFERIOR RELATION, asks
repeatedly, but do comp topic of aorta)
- Patent ductus arteriosus (clinical)
- Aortic arch aneurysm
- (clinical)

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Chapter # 9
TRACHEA, OESOPHAGUS
&THORACIC DUCT

- Mainly thoracic duct is imp (Complete), but

tributaries often ask separately too.
- Constructions of oesophagus (important SEQs ,also
ask in MCQs too) 4 points
- Give a read to trachea

CLINICALS
- Tracheostomy
- oesophageal varices
- achalasia cardiac**

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