Breast, Thoracic Wall, Lungs

Question 1

List the layers associated with the breast starting with the skin

Answer 1

Epidermis-> Dermis -> Breast in Superficial fascia (subcutaneous tissue) -> retrommary space -> deep fascia -> pectoralis major muscle

Question 2

What is the retromammary space and where is it located?

Answer 2

Allows for movement of the breast. Located between superficial fascia and deep fascia

Question 3

What are the four quadrants of the breast? Where is the axillary tail located?

Answer 3

UOQ, UIQ, LOQ, LIQ

Axillary tail in UOQ (extends into axilla)

Question 4

Describe the ductal system of the breast.

Answer 4

Mammary gland -> 15-20 lobes each with a lactiferous duct -> lobules -> alveoli

Question 5

What are suspensory ligaments?

Answer 5

Connect the lobular tissue with the overlying dermis to support breast

Question 6

What is the blood supply to the breast? What are its branches?

Answer 6

Internal thoracic artery

Branches of the axillary artery and intercostal arteries

Question 7

What are the four lymph pathways for drainage in the breast? What is the most common?

Answer 7

1. axillary lymph nodes (75% of lymph drainage): outer quadrants
2. Parasternal (internal thoracic) nodes: inner quadrants
3. Cervical nodes
4. Abdominal nodes

Question 8

The ribs allow movement in which planes?

Answer 8

Coronal (bucket handle) and saggital (pump handle)

Question 9

True ribs vs. False ribs

Answer 9

True ribs: first 7 pairs articulate with the sternum (breast bone)

False ribs: 11-12 do not articulate with anything

Question 10

Diaphragm: What cavities does it separate? Is is somatic or visceral?

Answer 10

1. Separate thoracic and abdominal cavities
2. Somatic structure - No sympathetic innervation

Question 11

Intercostal spaces

1. What are they? How many
2. What is within these spaces?

Answer 11

1. Between ribs, 11 total
2. Contain intercostal muscles (external, internal, innermost), arteries, veins, and nerves

Question 12

What is thoracentesis? Where should it be performed?

What is the location of the intercostal nerves, arteries, and veins?

Answer 12

1. Remove air/fluid from pleural cavity
2. Needle should be at inferior border of intercostal space or superior to the rib
3. VAN mnemonic: Veins, arteries, nerves at the superior intercostal space

Question 13

2 primary sources of blood supply in the thorax. What does it branch to? What if one artery is blocked?

Answer 13

1. Thoracic aorta (left of sternum) -> posterior intercostal arteries
2. Internal thoracic arteries (parallel to sternum) -> anterior intercostal arteries
3. Anterior and posterior intercostal arteries have anastomoses -> collateral circulation

Question 14

What are the major nerves of the thoracic?

Answer 14

1. Intercostal nerves (T1-T11): efferent innervation to thoracic wall, afferent to overlying skin
2. Subcostal nerve (T12)

Question 15

Upper and lower boundaries of the thoracic cavity

Answer 15

1. Superior thoracic aperture (plane of 1st rib): apex of lung extends above it (prone to injury)
2. Diaphragm

Question 16

Pleural reflection vs. Pleural recess

Answer 16

Reflection: transitioning of one parietal pleura to another

Recess: Overlap of two pleura (costodiaphragmatic recess)

Question 17

How many lobes on each lung?

What are the dominant lobes anteriorly and posteriorly?

Answer 17

Right: 3 lobes (superior, middle, inferior) using 2 fissures (horizontal and oblique)

Left: 2 lobes (upper, lower) using 1 fissure (oblique)

Anterior: upper and middle lobes on the right and upper lobe alone on the left

Posterior: lower lobes on both sides

Question 18

Divisions of the bronchi + how many total

Answer 18

1. Main primary bronchi (2 total)
2. Lobar secondary bronchi (5 total)
3. Segmental tertiary bronchi (many)

Question 19

How many lobar bronchi does the right lung have?

Answer 19

3 lobar bronchi (one for each lobe)

Question 20

What is the intermediate bronchus?

Answer 20

segement of right main bronchus before the middle and lower lobe bronchus branch

Question 21

Which bronchi is more prone to stridor (foreign bodies)? Why

Answer 21

Right bronchus: Larger diameter and more vertical orientation

Question 22

Location of the lungs and pleura in relation to the thoracic cage?

Answer 22

Lung: 6-8-10 (midclavicular=anterior, midaxillary, midscapular=posterior)

Pleura: 8-10-12 (midclavicular=anterior, midaxillary, midscapular=posterior)

Pleura extends to the lowest thoracic (T12) on the posterior side

Question 23

What is the hilum of the lung?

Answer 23

area on the central portion of each lung where the bronchi, arteries, veins, and nerves enter and exit the lungs

parietal and visceral pleural membranes join at hilum

Question 24

What are the two lymph nodes of the lung

Answer 24

1. Bronchopulmonary nodes: lobar and main bronchi at the hilum
2. Tracheobronchial nodes: carina of trachea

Question 25

What are synonyms of sternal angle? Which rib articulates on it?

Answer 25

Sternal angle = Manubrial = Angle of Louis

2nd rib articulates onto sternal angle

Question 26

What is the cupula?

Answer 26

Cervical parietal pleura

Question 27

Where would you perform an intercostal block for anaesthesia?

Answer 27

Place needle in the superior intercostal space to deaden the nerve

Question 28

What external landmark is
used to facilitate counting of
the ribs on physical exam?

Answer 28

Manubrial/Sternal angle (of Louis): articulates with the second rib

Question 29

Where does the tubercle of the rib articulate on with respect to the vertebral level?

Answer 29

On the same level