Breast/Thoracic Wall/Lungs

Question 1

Pectoralis Major

Lateral innervation

Answer 1

C5-7 (lateral pectoral nerve)

Question 2

Pectoralis Major

Medial innervation

Answer 2

C8 and T1 (medial pectoral nerve)

Question 3

Pectoralis Major

Origin

Answer 3

Clavicular and sternocostal heads

Question 4

Pectoralis Major

Insertion

Answer 4

The crest of the greater tubercle (humerous)

Question 5

Pectoralis Major

Movement

Answer 5

Upper arm:

Flexion (upper fibers better)

Adduct

Internal rotaion (horizontal flexion)

Can also extend with flexed elbow (lower fibers)

Question 6

Pectoralis Major

Blood supply

Answer 6

Internal thoracic
lateral thoracic
intercostal
Pectoral branches of thoracoacromial trunk

Question 7

Pectoralis minor

Origin

Answer 7

Ribs 3-5

Question 8

Pectoralis minor

Insertion

Answer 8

Medial border of the coracoid process

Question 9

Pectoralis minor

Innervation

Answer 9

Medial (C8 and T1)
Pectoral nerve

Question 10

Pectoralis minor

Movement

Answer 10

Stabilizes scapula
Elevates rib cage

Question 11

Where does the interal thoracic artery originate and what are its branches?

Answer 11

The subclavian arteries give rise to the internal thoracic arteries.

The internal thoracic arteries give rise to the anterior intercostal arteries before dividing into the epigastric and musculophrenic arteries inferiorly

Question 12

What does the musculophrenic artery arise from and what does it divide into?

Answer 12

Arises from the interal thoracic artery and gives rise to anterior intercostal arteries 6-9

Question 13

What artery supplies the rectus abdominus?

Answer 13

The epigastric artery (from internal thoracic)

Question 14

Where is the neurovascular bunds of the ribs located?

Answer 14

The NV bundles runs along the inferior edges of the upper ribs

Question 15

Serratus anterior

Origin and insertion

Answer 15

Origin - upper borders of ribs 1-8

Insertion - medial scapula

Question 16

Serratus anterior

Innervation

Answer 16

Long thoracic nerve (C5-7)

Damage to this nerve creates winging of the scapula

Question 17

What is the functional tissue of the breast?

Answer 17

Glandular lobules

Drain into lactiferous ducts

Question 18

What gives rise to the dimpling (orange peel appearance of breast)

Answer 18

Glandular tumor of the breast pulling/pushing on the Cooper’s (suspensory) ligaments

Question 19

Breast

Blood supply

Answer 19

Medial mammory - internal thoracic

Thoracoacromial trunck -pectoral branches supply upper middle

Later - lateral thoracic (mainly supply serratus anterior)

also intercostals

Question 20

Breast

Lymph node levels

Answer 20

Question 21

Answer 21

Phrenic nerve (C3,4, and 5)

Somatic motor nerve to skeletal muscle

Question 22

Where does the diaphragm receive its sensory nerve supply?

Answer 22

Diaphragmatic and medistinal pleura, and pericardial sac

Question 23

Where does the inferior vena cava cross the diagphragm?

Answer 23

TV 8 through the central tendon

Question 24

Where does the esophagus cross the diaphragm?

Answer 24

TV 10 through the esophageal hiatus

Vagal trunks tavel through diaphragm with esophagus

Question 25

Where does the descending aorta cross the diaphragm?

Answer 25

TV 12 through the aortic hiatus | Thoracic duct also travels with aorta

Question 26

Pain from the organs

Answer 26

sympathetic

Question 27

Where is the horizontal fissue? | Right lung

Answer 27

Midclavicular line at rib 4

Question 28

Where is the oblique fissue of the right lung?

Answer 28

The midclavicular line at rib 6

Question 29

Where does fluid collect in the thorax?

Answer 29

The costodiaphragmatic recess

Question 30

What anatomical feature marks the bottom of the lungs?

Answer 30

Rib 6 - Anteriorly Rib 8 - Laterally Rib 10 - Posteriorly ## Footnote Always a two rib difference between parietal lining and base of lung (pleura is found two ribs lower)

Question 31

What is the parietal pleura innervated by?

Answer 31

Intercostal nerves

Question 32

What is the mediastinal and diaphragmatic pleura innervated by?

Answer 32

The phrenic nerve

Question 33

VATE as it applies to right lung

Answer 33

Question 34

Structure of the left lung

Answer 34

Question 35

Where does the thoracic duct terminate?

Answer 35

The left venous angle

Question 36

Subclavius muscle | Origin and insertion

Answer 36

Origin - rib 1 near costal cartilage Insertion - Clavicle (deep)

Question 37

Subclavius muscle | Innervation

Answer 37

Nerve to subclavius (C5 and 6)

Question 38

Subclavius muscle | Movement

Answer 38

Depress shoulder and lateral clavicle

Question 39

What is the only intercostal muscle that elevates ribs for expiration?

Answer 39

The external intercostal

Question 40

Where doe the posterior intercostal arterites arise?

Answer 40

The descending aorta (form anastomoses with anterior intercostal arteries)

Question 41

SALT

Answer 41

Serratus Anterior Long Thoracic (nerve) or Lateral Thoracic (artery)

Question 42

What gives rise to the lateral thoracic artery?

Answer 42

The axillary artery

Question 43

True ribs

Answer 43

Ribs 1-7 (attach to the sternum)

Question 44

False ribs

Answer 44

Ribs 8-10 (attach to the costal cartilage above)

Question 45

Floating ribs

Answer 45

Ribs 11 and 12

Question 46

What lymph nodes associate with the axillary tail of Spence?

Answer 46

Level I lymph nodes along the pectoral vein and pectoralis major draining the anterior thoracic wall and most of breast.

Question 47

What vein do level I lymph nodes associate with?

Answer 47

The axillary vein (drains deep structures of the upper limbs)