EXAM3_G19_Thoracic_Wall_Breast Flashcards
What is the Angle called that starts from your epigastric fossa and opens/runs downward along the lines along the left and right costal margins?
Subcostal angle
What is the landmark that marks your xiphoid process? hint- saucer indent
Epigastric Fossa
the manubrium U shape is called the
Jugular notch
What ribs are considered True ribs?
False ribs?
Floating ribs?
Ribs 1-7 True ribs
Ribs 8-10 False ribs
Ribs 11-12 Floating ribs
The cartilage of the false ribs form the Border of cartilage called the?
COSTAL MARGIN
What are the two costovertebral articulations (synovial) ?
- Joint of head of rib
2. Costotransverse Joint
Where does the VAN run on a rib?
Costal Groove
Vertebral levels for
Jugular notch
Sternal angle (transverse thoracic plane)
Xiphoid process
JN- T2
SA- T4/T5 IVD
XP- T9
What joint articulates with the transverse process and the facet of the rib?
Costotransverse joint
Manubrium articulates with what?
Clavicles and 1st ribs
What is just lateral to the jugular notch on the manubrium?
Clavicular notch
The xiphisternal junction marks what at T9 vertebral level?
Inferior border of the heart
The 1st sternocostal joint is different than all the other rib joints, how?
Synchondrosis- Bone cartilage Bone
All others are synovial and allow movement
what is the joint between two cartilages of ribs? what type of joint is it?
Interchondral joints (synovial)
What is the rib cartilage joint called? what kind of movement?
costochondral joints (Normally no movement)
What are the openings of the thoracic rib cage called?
Superior thoracic aperture (thoracic inlet)
Inferior thoracic aperture (thoracic outlet)
C3,4,5 keep the diaphragm alive by providing all the motor and MOST of the sensory of the diaphragm. What supplies the rest of the sensory to the diaphragm?
Subcostal nerves and Intercostal nerves at the corner edges of the diaphragm where it meets the ribs on the left and right side
Axilla, nipple, and umbilicus are landmarks for what dermatome levels?
Axilla- T2
Nipple- T4
Umbilicus- T10
The nerve map = dermatome map in thoracic. WHY?
b/c no plexus formation
T4 intercostal nerve branches at the rib angle to form collateral branches. What is the branch called at the Midaxillary line and parasternal line?
Lateral cutaneous branch (MAL)
anterior cutaneous branch (PSL)
where do collateral branches of intercostal nerve branch relative to the ribs?
rib angle
Anterior rami of t12 spinal nerve does not follow a costal groove so what is it called?
Subcostal nerve
The anterior rami of T1-T12 course along the costal groove (PAIRED as VAN). What muscles are they coursing between?
(what is this space called?)
Innermost intercostals and internal intercostals
called the NEUROVASCULAR PLANE
Paradoxical movement causes a mediastinal shift due to fractured ribs during inspiration, this is called a ?
Inspiration causes shift ____ from fractured ribs
Expiration causes shift ______ fractured ribs
Deoxy air stuck in lungs- decreases efficiency of respiration
Flail
Inspiration force mediastinum away from fracture
Expiration pushed mediastinum toward fracture
During forced inspiration ribs are _____ and muscles ____. conversely during forced expiration ribs are _____ and muscles ____.
Elevated- muscles contract-inspiration
Depressed- muscles relax- expiration
What vert level is landmark for CAVAL opening?
T8
What vert level is landmark for Esophageal Hiatus?
T10
What vert level is landmark for aortic hiatus? what courses with aorta through this ?
T12
azygous vein
Muscles from sternum to ribs on the posterior surface of the anterior rib cage?
Transversus thoracic
Muscles from ribs skipping to superiorly other ribs on anterior side of posterior thoracic rib cage.
these muscles are in the same plane as what muscles?
Subcostal muscles
Same plane as innermost intercostal muscles
What is the space called between the innermost intercostals and the internal intercostals?
Neurovascular plane
Innermost intercostals have the same fiber direction as?
Interosseous part of internal intercostals
What muscles extend from rib angle to costochondral joint (lateral portion of intercostal space)? - seen on the interior of the rib cage.
These muscles have the same fiber direction as what muscles?
innermost intercostals
same fiber direction as interosseous part of internal intercostals
The internal intercostal muscles have what two parts? What are the functions of each?
- interchondral part (elevates ribs)
2. interosseous part (depresses ribs)
Internal intercostals extend from the sternum all the way to where?
rib angle- then medial to rib angle its replaced with a membrane (posterior part of rib cage towards vertebra)
The primary rib elevators extend from the vertebrae medially until the _____. where it is replace by the _____ membrane.
Costochontral joint then replaced by
EXTERNAL INTERCOSTAL MEMBRANE
In normal radiograph, the right hemidiaphragm is slightly higher than the left. During inspiration, the right dome normally intersects ribs____ to ___ at the ____ line.
5th - 7th ribs at midclavicular line
Lesion to phrenic nerve causes ______ of ipsilateral dome
Elevation
Anterior Thoracic wall is supplied blood by 3 arteries
- internal thoracic (branched off of subclavian a)
- superior epigastric a. (branch of internal thoracic)
- musculophrenic a. (branch of internal thoracic)
Thoracic aorta has landmarks what what vert levels?
T5-T12
Internal thoracic artery has landmarks at what vert levels? What happens at this level?
T6- Branches to Superior epigastric (down abs) Musculophrenic a (follows costal margin laterally)
Posterior intercostal arteries mostly originate from thoracic aorta and accompany intercostal nerve, they anastomose with anterior intercostal artery and can form ____ branches. The T12 artery is the ____.
collateral
subcostal artery
The anterior cutaneous branch (artery) comes from ?
Internal thoracic artery (anterior thorax)
Anterior intercostal artery is a branch of the ___ a. or the ____ a.
internal thoracic artery OR
musculophrenic artery
Anterior venous drainage MIBS
Musculophrenic > Internal thoracic > brachiocephalic > SVC
Posterior venous drainage
Subcostal, posterior, anterior intercostals, collaterals, cutaneous Drain into: Azygous> SVC
landmark vertebral level for nipples? what is the better estimate?
T4 vert level
T4 dermatome is better estimate
Accessory nipples called?
Accessory breasts called?
Polythelia
Polymastia
Mammary gland is a modified ____ gland
Modified Apocrine sweat gland
Parenchyma of breast is called a
Lobule
What is the feature of the breast where most breast cancer arises from ?
Lactiferous duct
What are the enlarged structures in areola that look like papillary muscles?
Lactiferous sinus
What anchors mammary glands to skin?
Suspensory ligaments of cooper
Medial artery supply for breast
Internal thoracic artery
Lateral artery supply for breast
Lateral thoracic artery
Posterior intercostal artery
Venous drainage of breast
Mainly into Lateral thoracic vein
some into- internal thoracic v and posterior intercostal v.
What are the anterior, posterior, and lateral lymph nodes in the arm? Where do they drain into?
Anterior- pectoral nodes
Posterior- subscapular nodes
Lateral- Humeral nodes
All drain into central nodes>Apical> Supraclavicular>
75% of lymph for Axillary nodes (pectoral, humeral, subscapular) flow from nipple to tail and up into the ___
central > apical> RLD or TD
Remaining lymph from medial breast flows into
parasternal nodes or abdominal nodes (contralateral side)
What is the tail called of the boob? what % of cancer here?
65% axillary tail (upper outer )
Upper inner 15%
Lower inner 5%
Lower outer 10%
Blockage of lymph drainage (edema) of breast leads to the orange peel sign which is called?
Peau d’ orange
Suspensory ligaments pulled by tumor growth causes
Large dimpling of the nipple
Breast elevation when contracting pectoralis major is indicative of cancer invasion into the….
Retromammary space
