ALL THE THINGS Flashcards
What are the true ribs?
Ribs 1-7
Why are true ribs called “true”?
connect directly to sternum via costal cartilage
Which of the true ribs is sort of odd?
rib 1 because it is very short and C-Shaped
What are the false ribs?
ribs 8-10
Why are false ribs called “false”?
connect directly to the sternum via the costal cartilages above them
What are the floating ribs?
ribs 11-12
What is weird about the floating ribs?
have no attachment to the sternum at all
Where do you find the neuromuscular bundle? (which ribs)
On the inferior border of the superior rib
Where do you find the neuromuscular bundle? (Between what layers of muscle)
between the internal intercostal and innermost intercostal muscles
What is the order of the neuromuscular bundle (NMB)?
VAN: Vein - Artery - Nerve
Which rib is “privileged”?
rib 2 because it is longer and thinner than rib one and is attached at two points
Where do common rib fractures occur?
the middle of the ribs along the posterior angle (ribs 3-10)
What is Flail Chest?
If a rib is broken and loses attachment to the structures that contain it in the thoracic cage
What movement is associated with Flail Chest?
paradoxical movement
What is paradoxical movement?
the segment around the broken rib looks as if it is moving in the opposite direction of the breath motions.
What else can paradoxical movement lead to?
hypoventilation due to insufficient ventilation
What are the 3 major dermatomes?
T4 - Nipples (MOST IMPORTANT FOR NWOSU)
T7 - Xiphoid Process
T10 - Umbilicus
What is Herpes Zoster’s precursor?
Chicken pox (Varicella)
Where are Herpes Zoster infections commonly latent?
Dorsal root ganglia of one spinal level
What happens when the Herpes Zoster virus leaves latency?
the area that is serviced by that sensory root (dermatome) receieve a pattern of blistered lesions
What term is used to describe the blistered lesions of Herpes Zoster?
herpetic
What are the important levels of the Sternum that we should consider?
Manubrium, sternal body, and xiphoid process
Where is the manubrium found?
T3/4
Where is the sternal body found?
T5-9
Where is the xiphoid process found?
T10/11
A Sternal puncture is commonly performed to obtain what?
bone marrow
Where are sternal fractures common?
Mid body and transverse ridge fractures followed by the manubrium
Where are fractures commonly incorrectly predicted?
xiphoid process
What two notches are visible on the manubrium?
clavicular notches on the sides and the jugular notch in the middle
What is another name for the sternal angle?
manubriosternal joint
What is Thoracic outlet syndrome?
compression of the neuromuscular structures contained in the thoracic outlet
What are the causes of Thoracic outlet syndrome?
cervical rib, hypertrophy of Scalene Muscles, or a Pancoast Tumor
What are the symptoms associated with Thoracic outlet syndrome?
pain, numbness, tingling in the arms. brachial plexus compression. Ischemic muscle pain. Subclavian artery compression
Describe Horner’s Syndrome
Psuedo-ptosis - droopy eyelids
Anhydrosis - can’t sweat
Miosis - pupil constiction
PAM IS HORNY!
What is the cause of Horner’s syndrome?
compression of the Stellate
What is the Stellate?
Superior cervical ganglion - is compressed causing Horner’s
What is the Thoracic Diaphragm?
a musculo-tendinous partition that is the principle muscle of inspiration
How is the Thoracic diaphragm innervated?
Phrenic nerve C3-4
What also provides sensory innervation to the Thoracic diaphragm?
lower 6-7 intercostal nerves
What are the three thoracic apertures?
T8 - IVC
T10 - Esophagus
T12 - Aorta
What passes through thoracic aperture T8?
Phrenic nerve C3-5
What passes through thoracic aperture T10?
Vagus Nerve
What passes through thoracic aperture T12?
Azygous nerve and thoracic duct
What do the external intercostals assist with?
forced inspiration
What do the internal and innermost intercostals assist with?
forced expiration
What happens to the diaphragm during inhalation?
Contracts and flattens as the lungs fill with air. (Descends)
What happens to the diaphragm during exhalation?
relaxes and moves upward as the air is released
What are the 2 congenital diaphragmatic hernias?
Morgagni and Bochdalek Hernia
What are the 2 acquired diaphragmatic hernias?
Rolling and Sliding Esophageal Hernias
Describe Morgagni Hernia
anterior herniation of the diaphragm
Describe Bochdalek hernia
Posterolateral herniation of the diaphragm that causes compression to the left lung
What do Bochdalek hernias lead to?
hypoplasticity due to compression of the left lung
Describe Rolling esophageal hernias
The cardia of the stomach rolls up through the esophageal hiatus. Hernia is to the side of the LES
Describe Sliding esophageal hernias
The cardia of the stomach along with the lower esophageal sphincter slide up through the esophageal hiatus.
What can be caused by sliding esophageal hernias?
severe acid reflux due to the disruption of the LES
Name the significant ligament of the breast?
Suspensory Ligament of Cooper
What is significant about the suspensory ligament of Cooper?
some breast cancers can cause these ligaments to pull down and cause the appearance of an orange peel (dimples)
What is are the common signs of breast cancer?
dimples and inversion of the nipple
What region of the breast is known as the million dollar space?
Retro-mammary space
What are common complications seen during mastectomies?
winged scapula due to damage to the long thoracic nerve. Leads to unopposed retraction of the rhomboids
Where is the first place you’d look for breast cancer?
Pectoral lymph nodes
