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Anatomy Test Block III > Chest wall, mammary glands, and lungs > Flashcards

Chest wall, mammary glands, and lungs Flashcards

1
Q

What type of glands are mammary glands?

A

apocrine; modified sweat glands

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2
Q

What portion of the breast extends into the anterior axillary fold?

A

tail of Spence

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3
Q

What type of glands are found in the areola?

A

Montgomery glands (oily sebacesous glands)

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4
Q

What is breast tissue dependent upon?

A

estrogen; if post menopausal, can’t keep up gland structure

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5
Q

What is the purpose of montgomery glands?

A

aid in prevention of skin breakdown during lactiation

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6
Q

Where is arterial blood supply to the breast from?

A

internal thoracic

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7
Q

Venous drainage from the breast is through what vein?

A

axillary vein

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8
Q

Lymph drainage from breast

A

primarily axillary, but also lymph nodes in the chest cavity

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9
Q

What innervates the breast?

A

cutaneous branches of intercostal nerves from T2 to T6.

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10
Q

Suspensory (Cooper’s) ligaments

A

support ligaments that attach from deep fascia of pec to the dermis; contain lobes and lobules between them

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11
Q

What happens to the duct system with pregnancy?

A

it expands under hormones; prolactin causes milk production and oxytocin causes milk let down

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12
Q

What is the blood supply to the breast

A

mainly from internal thoracic a. - it gives off anterior perforating cutaneous arteries (some from lateral thoracic)

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13
Q

Where do the lateral perforating cutaneous arteries that supply the breast stem from?

A

intercostal arteries - supply it laterally

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14
Q

Where is most of the lymphatic drainage from the breast occur?

A

75% to axillary nodes

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15
Q

Sentinel node

A

where the cancer/tumor first drains - if cancer is present, it means it has metastasized

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16
Q

What area of the breast has the highest incidence of cancer?

A

tail of spence; 60%

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17
Q

Why is mammogaphy limited in younger women?

A

denser breast tissue

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18
Q

How do you perform a breast exam?

A

start at nipple and palpate radially making sure to evaluate the tail of spence and axilla, lastly squeeze the nipple to check for discharge

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19
Q

What would the presence of blood discharge from nipple indicate?

A

breast cancer until proven otherwise

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20
Q

galactorrhea

A

milk discharge in absence of lactation or pregnancy; causes: excess prolactin production, pituitary adenoma/prolactinoma (would also have headache/visual defect)(bilateral), medications (SSRIs) bilateral.

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21
Q

What are some changes associated with intraglandular problems and possible malignancy?

A

nipple inversion, dimpling of skin, epidermal edema, lumphedema, peau d’orange

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22
Q

What is the most common benign mammary gland disease?

A

fibrocystic change

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23
Q

fibrocystic change

A

hormonal fluctiations in cycle produce proliferation in CT and cysts. Causes mastalgia, lumpiness/pain. Occurs 20-50 yo - not post-menopausal

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24
Q

What is the tx for fibrocystic change?

A

topical NSAIDs or BC. not good to use hormones and tamoxifen.

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25
Q

Where do supranumerary nipples occur?

A

along the mammary ridges

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26
Q

gynecomastia

A

abnormal mammary development in males without cause; usually in younger males and resolves (don’t want to miss prolactin tumor)

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27
Q

pectus excavatum

A

“funnel chest” - could effect lung fxn if severe but 99% of time don’t need to be corrected

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28
Q

pectus carinatum

A

“pigeon chest” or Keihls chest

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29
Q

Angle of Louis

A

the point where the manubrium articulates w/ the body of the sternum

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30
Q

What are the 3 things that attach to the manubrium?

A

clavicle: to top
1st rib: to side
2nd rib: at angle of louis

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31
Q

If you need to dart the chest, where is that done?

A

2nd intercostal space at the mid clavicular line

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32
Q

What are the true ribs?

A

1-7; their costalcartilages attach directly to sternum

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33
Q

What are the false ribs?

A

8-10; their costal cartilages attach to that of the rib above them

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34
Q

costochondritis

A

inflammation of the costochondral joint; diagnose if can reproduce it by pushing in the chest

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35
Q

What vertebral level is the angle of louis?

A

T4 T5

36
Q

What structure sits right below the angle of louis?

A

heart - top of heart is at angle of louis

37
Q

Why does the diaphragm have a dome structure?

A

it attaches to the zyphoid process in the front but T12 in the back

38
Q

How does a rib articulate w/ the vertebra?

A

a rib will articulate with the transverse process and body of the vertebra with the same number, as well as the body of the one above it. Ex: 7th rib articulates w/ transverse process and body of T7 and body of T6

39
Q

What part of the rib do the VAN run in?

A

costal groove on the inferior surface

40
Q

What determines a good complete chest xray?

A

capturing the 10th rib

41
Q

in regards to the intercostal muscles, where do the VANs run?

A

between the innermost layer and internal layer

42
Q

What intercostal muscle is only found in the lateral wall?

A

innermost

43
Q

the innermost intercostal muscle continues as what?

A

transverses thoracis

44
Q

Why is it vital that needles/chest tubes need to be done on the SUPERIOR surface of the rib?

A

b/c the intercostal VANs run in the costal groove on the inferior surface

45
Q

attachments of tranversus thoracis

A

conects sternum w/ 1 or 2 rubs above them

46
Q

Which pleura adheres to the chest wall?

A

parietal pleura

47
Q

What is the entry point of viscera?

A

hilum

48
Q

What creates the pulmonary ligament?

A

the lung bud grows into the pleura at an angle, creating a fold of reflection where visceral becomes parietal pleura

49
Q

What is it called where lung tissue doesn’t get b/w two layers of parietal pleura?

A

a recess

50
Q

Where does the parietal pleura begin?

A

above the anterior 1st rib (a stab wound there would interrupt parietal pleura)

51
Q

What creates the costodiaphragmatic recesses?

A

The lung cavity goes to T12 but the lung only goes to T10

52
Q

What keeps the lung inflated?

A

the parietal pleura withdrawals oxygen from the pleural cavity which creates negative pressure; if the neg. pressure is released (i.e poking a hole), the lung will collapse on itself

53
Q

What is the other recess that is not clinically relevant?

A

costomediastinal recess

54
Q

What should you see in a normal chest xray?

A

a “sharp” costodiaphragmatic recess angle; right hemidiaphragm higher than the left (b/c of liver); and the lung above the anterior first rib

55
Q

How can you distinguish if fluid is inside or outside the lung?

A

turn pt. on side - if it’s outside of the lung it will pool at the bottom

56
Q

what characteristics would you observe on a chest xray w/ pleural effusion?

A

a shift of the mediastinum away from the side of effusion; blunted chostodiaphragmatic recess

57
Q

Fluid outside vs inside lung

A

outside = pleural effusion

in lung tissue: pulmonary infiltrate

58
Q

What are the characteristics of a simple pneumothroax?

A
  1. ipsilateral decreased breath sounds
  2. respiratory distress
  3. mediastinal shift to pneumo side
  4. exaggerated dome of diaphragm
    absence of pulmonary vascular markings
59
Q

How are ways you can get a pneumothorax?

A

poking a hole in parietal pleura (ex. gun shot wound etc); poking hole in visceral pleura (communicates w/ mouth) like a tall thin young athlete

60
Q

Characteristics of a tension pneumothorax?

A
  1. ipsilateral dec in breath sounds
  2. repiratory distress
  3. mediastinal shift AWAY from dec breath sounds
  4. Flattened hemidiaphragm
  5. falling BP w/ increasing pluse
  6. A cause of PEA
61
Q

What are common causes of tension pneumos?

A

blunt force trauma to chest - car wreck, roofer falling off roof

62
Q

How does the tension pneumo happen?

A

a tear in the visceral pleura creates a flap so every time you breath in, air escapes through the flap into the pleural space so every breath you trap more air, putting tension on the lung and possibly the sup. vena cava = falling bp & rapid pulse

63
Q

PEA in tension pneumo

A

pulseless electrical activity; EKG looks fine but no pulse b/c superior vena cava is compressed so no cardiac output

64
Q

Which way will the trachea deviate in a tension pneumo?

A

away from pneumo side

65
Q

How to treat a tension pneumo

A

don’t send for xray; indentify 2nd intercostal space on effected side and stick in needle to decompress tension and should see immediate return of bp

66
Q

What is the order of branching of the respiratory tree?

A

Trachea, carina, primary (mainstem), secondary, tertiary

67
Q

What is unique to the right primary bronchus ?

A

it is shorter, wider and more in line with the trachea

68
Q

where does the bifurcation of the trachea occur?

A

angle of louis (so a gunshot below angle of louis will not hit trachea)

69
Q

Where is the C shape of the treachea lost?

A

in the secondary (lobar) bronchus and tertiary bronchus

70
Q

Which part of the trachea defines the bronchopulmonary segment?

A

tertiary bronchus

71
Q

bronchopulmonary segments

A

area of lung supplied by a tertiary bronchus and a branch of the pulmonary artery

72
Q

All lobar bronchi are inferior to the pulmonary arteries except for which one?

A

eparterial bronchus

73
Q

eparterial bronchus

A

bronchus going to the right upper lobe - along the right pulmonary artery; relevant on chest xray (hollow structure above all others)

74
Q

which side of the lung has 3 lobes?

A

right

75
Q

oblique fissure divides what lobes?

A

l: upper and lower
r: middle and lower

76
Q

horizontal fissure

A

divides upper and middle on right lung

77
Q

pulmonary ligament

A

reflection of visceral pleura on to the parietal pleura

78
Q

What gives blood supply to the lung?

A

bronchiolar artery and vein - the pulmonary a is carrying deoxygenated blood so it cant supply the lung

79
Q

lymphatic drainage of the lungs

A

is towards the hilum

80
Q

a widened mediastinum due to enlarged nodes is a sign of what?

A

cancerous invasion into lymph nodes

81
Q

Describe the path of the parasympathetics CN X to lungs/heart

A

vagus nerves dive into the cardiopulmonary ganglionated plexus to find postganglionics and then get off and go to the lungs or heart

82
Q

parasympathetics have what effect?

A

decrease diameter of airways and increase glandular secretions - sympathetics do exact opposite

83
Q

What type of drug would be given to open the airways?

A

a sympathomimetic like albuteral/Proventil (mimic sympathetics)

84
Q

What will promote airway constriction?

A

blocking sympathetic tone

85
Q

What drug would be given to decrease secretions ?

A

parasympatholytic - ipratroprium/Atrovent (block parasympathetics)

86
Q

What would be the treatment for asthma attack?

A

nebulizer w/ 5mg albuteral (open airways) and 1 mg atrovent (decrease secretions)

87
Q

Why would you not want to give asthma patients beta blockers?

A

it will block sympathetics which promotes airway constriction

Anatomy Test Block III (5 decks)

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