Anatomy (Breast & Thoracic Wall)

Question 1

Retromammary Space

Answer 1

• allows breast to move against pectoralis major

Question 2

Mammary Gland Innervation

Answer 2

• Intercostal nerves 4-6 (ventral primary rami)
• Contain somatomotor, somatosensory, & autonomic fibers

Question 3

Breast Innervation

Answer 3

• Sensory fibers
• Sympathetic fibers (blood vessels and smooth muscle in skin and nipple)

Question 4

Lymphatic Drainage of Breast

Answer 4

• Subareolar lymphatic plexus then..
• Axillary nodes (most), pectoral (anterior), subscapular (posterior), lateral, central, apical then..
• Parasternal nodes then..
• Abdominal nodes

Question 5

Malignancy in Breast (5)

Answer 5

• derived from epithelial cells of lactiferous ducts
• usually spreads through lymphatics, but venous system is worse
• inference of lymph drainage produces edema of skin (orange peel)
• can thicken suspensory ligaments (fingertip sized dimples)
• can fix breast to thoracic wall

Question 6

Endothoracic Fascia

Answer 6

• separates parietal pleura from thoracic wall

Question 7

Costal Groove

Answer 7

• “VAN” from superior to inferior
• Vein
• Artery
• Nerve
• Located below each rib

Question 8

Needle Location for Thoracocentesis

Answer 8

• superior to a rib so you don’t hit “VAN”

Question 9

Vein that Drains Brain

Answer 9

• Internal jugular veins (left & right)

Question 10

Phrenic Nerve

Answer 10

• Innervates diaphragm
• C3, C4, C5

Question 11

Fibers in Diaphragm

Answer 11

Somatomotor - skeletal muscle

Somatosensory

Postganglionic Sympathetic - blood vessles

Question 12

Diaphragm Contraction

Answer 12

• Inspiration
• Lowers central tendon

Question 13

Vena Cava Foramen Contents

Answer 13

• Inferior vena cava

Question 14

Esophageal Hiatus Contents

Answer 14

• Esophagus
• Vagus Nerve

Question 15

Aortic Hiatus Contents

Answer 15

• Aorta (then is called abdominal aorta)
• Azygos vein
• Thoracic duct

Question 16

Thoracic Cavity Expansion During Inspiration (3)

Answer 16

Superior/Inferior - action of diaphragm

Anterior/Posterior - ribs pump handle movement

Lateral - ribs bucket handle movement

Question 17

Quite Inspiration Muscles

Answer 17

• Diaphragm

Question 18

Quiet Expiration Muscles

Answer 18

• Passive recoil

Question 19

Forced Inspiration Muscles

Answer 19

• Diaphragm
• External inercostals
• Scalenes
• Sternocleidomastoid

Question 20

Forced Expiration Muscles

Answer 20

• Abdominal wall muscles
• Internal intercostals
• Transversus thoracis

Question 21

Intervertebral Joints

Answer 21

• Cartilaginous
• Intervertebral discs

Question 22

Costochondral Joints

Answer 22

• Cartilaginous
• Between rib and cartilage

Question 23

First Sternocostal Joint

Answer 23

• Cartilaginous
• Between first rib and manubrium

Question 24

Manubriosternal Joints

Answer 24

• Cartilaginous
• Between parts of sternum

Question 25

Xiphisternal Joint

Answer 25

• Cartilaginous
• Between xiphoid process and sternum

Question 26

Costoverterbral Joints

Answer 26

• Synovial
• Between head of rib and vertebrae OR
• Between transverse process and costal tubercle

Question 27

Second - Seventh Sternocostal Joints

Answer 27

• Synovial
• Betweeb ribs 2-7 and sternum

Question 28

Interchondral Joints

Answer 28

• Synovial
• Between adjacent cartalige on ribs not connected to sternum