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Yeah, I give them another minute. Um And then we far away. So. Mhm OK. I think we can get started. Um So good evening everyone. Welcome to our 12th session in the QB cardio. So teaching series of this year. So this is gonna be the first um of two sessions on Thoracic anatomy that Donovan is going to be presenting over the next couple of weeks. So Donovan is a queen's medical student and he's currently in experimental medicine and he's an expert on thoracic anatomy. So you're gonna be in for a treat tonight. Um So we're gonna have uh sessions gonna run for about an hour and then if you have any questions, feel free to pop them in the chat at any point, um We can have AQ and A at the end. Thank you. Thank you very much. I wouldn't say for now, but sure, I'll give it a go. Um Can you let me know? So I'll try share my screen. Just the usual stuff. Let me know if you can see me, hear me, all that good stuff. Um Thank you everybody for joining. Uh Hopefully, this will be somewhat beneficial to you all. Um Yeah, we've been running this teaching series now for, since October. So, however long that is and we've done the topics of cardiology. So started from anatomy and worked out through investigations, management different conditions. So let's go to the thoracic or respiratory side of things. So again, first principles anatomy and work away on from there. Um First thing is, can you see the slides and are they moving? Ok, they're moving fine. Perfect. I don't want to take it as a yes because our cardiac rage Mr cartilage had an issue with us earlier in the year. Good. Oh, my take it is good. Um Yeah, so gonna split thoracic. So that's a huge topic. So, uh this week we're gonna keep it to the thoracic wall. So, er, ribs, vertebrae, muscles, neurovascular bundle. So basically work our way in as well as cover a topic that's quite poorly covered. I think in medical school is breast anatomy. And then in our next session, we'll go through the organs of the thorax. So, obviously, lungs, uh esophagus, thymus, we're not gonna do the heart again. Mister Car cover that diaphragm, lymphatics, et cetera. So that's the line up for this week. And I'd like to start at the sternum. So, front and center and its main role is to support and protect all the uh important great vessels that lie just behind it as well as the heart and the right ventricle especially. And there's three components of the sternum, the manubrium, sternal body, as well as the xiphoid process. Each color coded here. Manubrium, if you know your Latin is handle and it's meant to resemble like the handle of a sword or with your sternal body being the shaft of the sword. And sorry, I have to go back. There's four different notches associated with the sternum. There's the jugular knots which you can feel on yourself if you find your trachea and work down and that bony indent that you feel that's your jugular knot. Then you have a notch on either side for your clavicles, the collarbone to join, you have your first costal knots, costal meaning rib. So you have your insertion point for your first rib as well as your second rib. Now your second rib forms or articulates in a dami facet, a da half a facet, the facet being a depression into the bone and the other half being with the sternal body and the sternal body, then it articulates with ribs two through to seven and there are seven again down at the bottom. There's a Demi facet with the xiphoid process and the xiphoid process. Quite interesting. It's uh cartilages probably in everybody here this evening and bar Glenn, if he's in the crowd, um it'll ossify around the age of 40 interesting trivia. It's at the vertebral level T 10. Now, there's this very important structure here. So the connection between the manubrium and the sternal body, it's called angle of lo or the sternal angle. And you can sometimes feel that on yourself. And it's a very important position for auscultation. So it represents insertion of the second ribs. And so, you know, just beneath either side is your second intercostal space on the right. You're gonna listen for your aortic valve, any pathology there and your left, your pulmonary valve and any pathology associated with it. So that's what her sternum looks like straight on. And now from the side, you'll be able to appreciate the facets and Tammy facets a little bit more. So, again, there's your first costal notes and not depression down your Demi facet angle, fluid at the side hits the vertebral levels T four and the connection between your stern angle and T four is of course your transverse plane of Ludwig and yeah, three down to seven. And your Dey Fawcett with a Cypho down here. So how does this look a little wider then? So your sternal, your sternum at the front and your ribs through your costal cartilage connect to your sternum. And that's for ribs. 137, ribs, 89 and 10, their costal cartilage runs in here and joins with rib seven's costal cartilage. And if you can see in behind you have ribs 11 and 12, they're your floating ribs. They don't connect, they don't have a costal cartilage which then connects into the sternum. So they're floating and they're sod, true ribs, false ribs, floating ribs so true as you're 1 to 7, they connect with your sternum, uh false ribs. 8 to 10. Their costal cartilage runs into seven's costal cartilage and yeah, floating ribs. They don't have any articulation. So you have then two other different ways of classifying ribs. You have your typical ribs and you have your atypical ribs. So starting with what's normal, you have typical ribs and they're so called because they have a head, a neck and a body. The head has two facets. The lower one inferior, one here connects with the corresponding vertebrae and the superior one can access the vertebrae above typically. Then you have just behind your neck and the point where your neck connects with the body is very important because it has this roughened, typical, which is extremely important because this is where the transverse process of the corresponding vertebrae articulates with the rib and along the body. The other prominent thing to look out for is this costal groove and in that costal groove runs your neurovascular bundle and we'll discuss that more in a little bit. But it's one of the most important topics of the thoracic wall. And this little schematic down here shows the uh rough and turbo a little bit better. So if something's typical, you have atypia. So what makes these listed atypical? So the first rib? Well, it's at the top. So it is one facet for articulation with the corresponding vertebrae. None of the above rib two has an extra tuberosity for which serratus anterior, a really thick tendon of which uh it comes from. And this is known as the anchor tendon serratus anterior. Also there's a chro for the anterior scale line on rib one. So rib 10 is a controversial one. So it's atypical because there's only one facet but theoretically, it probably could. And some people, there's an anatomical variation where it does connect to T nine. But through evolution to allow us to move, climb, swim, that seems to be the reason why to allow a bit more movement in your lower rib cage and then you're floating ribs, 11 and 12 of no.