Thoracic Cage and Breast Flashcards
Level of Thoracic Inlet
T1. Duh.
Level of Thoracic Outlet
T11 or T12. Duh.
Neurovascular connections of the thorax
Neck, Upper Ex, Abdomen
Most important landmark of the thorax where all ribs are counted from
sternal angle
Primary functions of the thorax
1) Protect lungs and heart
2) RBC formation
3) Blood aeration via expansion of thoracic cage
Type of joint of sternal angle of Louie
synchondrosis
At around which intercostal space is the sternal angle of Louie located?
2nd
Surface landmarks of the thorax
jugular notch of the manubrium
sternal angle of Louie/manubriosternal junction
sternoclavicular joint
xiphoid process
T or F: In infants, thoracic cage AP>Transverse diameter
False. It is more or less equal. The infant’s thoracic cage is barrel-shaped.
T or F: The transverse diameter of an adult’s thoracic cage is greater than its AP diameter
True
The cavity of the thorax is divided into:
Mediastinum and the Pleurae
T or F: Full size of the lung is achieved during expiration
False. It is during inspiration
Main components of the thoracic cage
Muscle and bone. However, it is also osteocartilaginous which prevents it from getting damaged during proper CPR
Boundaries of the Triangle of Auscultation
1) Inf. Traps
2) Superior Lats
3) Vertebral border of Scapula
4) Rhomboid major (floor)
Where can the space between the 6th and the 7th ribs (aka 6th ICS) be located?
Triangle of Auscultation
Level of Jugular/Suprasternal Notch
T2
What can be found at T9?
Inferior border of the heart, xiphisternal joint on the OPPOSITE side
T or F: Inserting a needle on the xiphoid cartilage will damage the diaphragm and heart
False. This is just right below the inferior border of the heart. No danger here.
The subcostal angle is used in reference for what?
The edge of the liver, which is 2cm below this.
Which ribs’ costal cartilages form the costal margin?
7th-12th
T or F: On the manubrium, the notch is for the 1st costal cartilage (CC), while the depression is for the 2nd CC
False. Depression: 1st CC :: Notch: 2nd CC
The adult length of the manubrium
17cm
T or F: The manubrium slopes downward and forward
True
T or F: The manubrium is concave anteriorly and convex posteriorly
False. It is convex anteriorly, and concave posteriorly.
What major vein runs from the upper left to the lower right side beneath the manubrium? What vein does this connect to?
Left brachiocephalic to Right brachiocephalic
What do the L and R brachiocephalic veins form?
The superior vena cava
The transverse facets of the body of the sternum articulates with what?
3rd-5th CCs
Vertebral level length of the body of the sternum
T5-T9
T or F: The xiphoid is cartilaginous in the youth and ossified in the adult
True
Which ribs are true?
1-7
Which ribs are false?
8-10
Which ribs are floating?
11-12
Which ribs may be palpated?
2-10
T or F: female nipples are located at the 4th ICS
False. This is not always the case as female breasts vary in size and shape. However, male nipples are consistently located at the level of the 4th ICS
Where is the apex beat of the heart located?
5th ICS, approx. 7-9cm from the midsternal line
What is the axillary fold?
It is the area between the ant. fold by the pecs major, and the post. fold by the lats dorsi
Where is the cephalic vein located?
At the delto-pectoral groove
1st most prominent spine/spinous process
C7 aka vertebra prominens
Level of the superior angle of the scapula
T2
Which part of the scapula is subcutaneous?
Spine
Level of the inferior angle of the scapula
opposite T7
T or F: The thoracic inlet is oblique
True
T or F: The thoracic outlet is oblique
True
What closes the thoracic outlet?
The diaphragm
Atypical vs Typical Ribs: How many facets does a typical rib have?
2
Atypical vs Typical Ribs: Which rib is atypical and most sharply curved?
1st
Atypical vs Typical Ribs: Which atypical rib has a prominent tubercle?
1st
Atypical vs Typical Ribs: Which atypical rib has a small tubercle?
11th
The shallow grooves on the 1st rib are for?
The subclavian artery and vein
The eminence of the 2nd rib serves as an attachment for what?
1st and 2nd digitation of the serratus ant.
WHich atypical rib has an ill-defined angle?
11th
T or F: The 12th rib is longer than the 1st
False. It is shorter
Which part of the rib articulates with the vertebral transverse processes?
The tubercle
Part of the rib that is the broadest
Neck
Rib Ossification (order and events)
“7-14-25”
7 weeks: 1 center of ossification
14 weeks: 2ndary center of ossification
25 weeks: Fusion of 2ndary centers of ossification
What does the sternochondral joint consist of?
Synchondroses joints basically attached to the sternum; Rib 1. Ribs 2-7 are also attached to the sternum but they are SYNOVIAL
A joint that is basically just the connection of the costal cartilage and the actual rib bone
Costochondral
The costotransverse joint consists of: rib tubercle + _________
surface of transverse process of inferior
verterbrae to which head is joined
anterior
What kind of movement does the capitular joint produce?
Gliding
The 2 movements of the ribs and sternum
1) Water bucket handle
2) Water pump handle
Pecs Major controls w/c ribs?
1-6
Pecs minor controls w/c ribs?
2-5
Scalenes control w/c ribs?
1-2
What other muscle controls ribs 1-2?
SCMs
How many ext. intercostals are there?
11
What is the direction of the ext. intercostals?
inferomedially (btw, ext. intercostals are those fascia-like muscles that cover the intercostal spaces)
Innervation of intercostals
branches of the intercostal nerve
How many internal intercostals?
11 din
The spleen corresponds to which ribs?
9th-11th
Under which cases and where would the pain be located when the spleen is ruptured?
Trauma to 7th-11th ribs and abdominal pain
Where is the apex beat located?
5th intercostal space
T or F: The superficial fascia contains blood and lymphatic vessels
True
T or F: The deep fascia serves as a barrier to infection
True
T or F: The deep fascia is devoid of fat
True
Percussion of lungs produces what kind of sound?
Resonant
Percussion of the heart produces what kind of sound?
Dull
Where is the neurovascular bundle of the rib located?
Lower border of the rib. Therefore DO NOT insert a needle in this area.
What is the use of thoracentesis?
Drain fluid from lungs, but SMALL AMOUNT ONLY
What are the structures you will pass by IN ORDER when you insert a needle in the 6th ICS for thoracentesis?
skin, subcutaneous layer, serratus ant., ext. intercostals, int. intercostals, pleural cavity
What is the use of the Tube Thoracostomy?
Drain fluid from lungs but LARGE AMOUNT
What is the proper way to do a tube thoracostomy?
30 degrees from horizontal angle, xiphisternal space, directed to the left shoulder, then aspirate
How much amount in the pericardial spacewould cause the heart to stop?
50cc
A precess wherein a needle is inserted in the pericardial cavity
Pericardiocentesis
T or F: The sternal puncture aka bone marrow biopsy via sternum has been abandoned
True. Due to its proxmity to the heart
In a chylothorax, what is ruptured? What enters the pleural cavity?
Thoracic duct. Lymph and emulsified fat
T or F: In tension pneumothorax, air enters the lungs
False. It escapes the lungs and enters the pleural cavity and causes the lungs to collapse
Paradoxical breathing is present in what thoracic condition?
Multiple rib fracture. Aka “flail chest” Btw, paradoxical breathing means that instead of the normal expansion of the chest during inhalation, it contracts. A depression is seen in the affected area.
The long axis of the spleen is located along which rib and its specific area
10th, long shaft
Shape of the breast in nullipara
smooth and conical
Shape of breast in multipara
pendulous and elongated
Shape of breast in old age/emaciated individuals
flattened discs with irregular surfaces
Where are males’ mamary glands found?
intercostal spaces
Rib landmarks for female breasts
2nd-6th ribs
T or F: The breast lies in the deep fascia of the ant. surface of the thorax
False. It lies in the superficial fascia
How much of the mammary gland overlies the deep pectoral fascia of the pecs major?
2/3
How much of the mammary gland overlies the fascia of the serratus major?
1/3
What separates the breast from the pecs maj?
Retromammary space
What kind of tissue is found in the retromammary space?
connective tissue
T or F: The gland tissue is thicker in the periphery of the breast than in the center
False. It is thicker in the center
How many lobes of pyramidal tissue is present in an average breast?
15-20
Place in correct order from inner to outer: lobes, lobules, lactiferous ducts, mammary papilla, alveoli
alveoli, lactiferous ducts, lobule, lobe, mammary papilla
T or F: The Suspensory Ligaments of Cooper are attached to the superficial layer of the deep fascia
False. It is attached to the DEEP layer of the SUPERFICIAL fascia, and gives the breast its posture
What does the varying amounts of fat around the glandular lobe give the breast?
Its shape
When does the branching of the alveoli and ducts occur?
In puberty
When are breasts considered mature?
After pregnancy, at onset of milk secretion. During pregnancy, the glands enlarge and undergo rapid multiplication (hyperplasia and hypertrophy)
Cells in the center of the alveolus undergo fatty degeneration and are eliminated in the first milk as _______?
Colostrum corpuscles
What are the reservoirs of milk (converging beneath the areola)
Tubulactiferi/ Galactophores
T or F: Muscular fibers are present in galactophores
False
T or F: Galactophores have a mucus lining
True
How many lactiferous ducts are there?
15-20
Are there sebaceous glands in the nipple?
Yes there are
What do you call the normal extension of the breast tissue towards or into the axilla?
Axilla of Spence
What do you call the median area between the breasts aka “curbs”?
Sinus Mammarium
What causes the rough surface of the areola?
Tubercles of Montgomery
Lymph from the nipple, areola, and lobules drains to ____?
Subareolar plexus
Lymph drainage of the lateral and inferior portions of the breast (75%)
Along thoraco-acromial and lat. thoracic vessels towards pecs nodes and eventually to axillary nodes
Lymph drainage of medial portion
Parasternal nodes/int. thoracic nodes along int. thora. artery
T or F: Lymph from the medial portion can cross to the opposite breast
True
Lymph drainage of the small superior portion
Supraclavicular nodes
T or F: Inferior phrenic nodes may also receive some lymphatic drainage
True
Veins anastomosing around the base of the nipple is also known as the_______?
Circulus venosus
Innervation of breasts
4th-6th lat and inf. cutaneous nerve branches of the intercostal nerve
T or F: Breast innervation is parasympathetic.
False. It is sympathetic.
The cutting of this nerve causes cutaneous anesthesia in the inner side of the arm and axilla
Intercostobrachial n. (think: intercostals + brachial)
This nerve is usually preserved during axillary dissection but may be sacrificed if it gets in the way
Thoracodorsal n. (nerve to lats dorsi)
Where do supernumerary nipples or accessory breast develop?
Along the milkline from axilla to groin
What is athelia?
Absence of nipple
T or F: Fibroadenoma is malignant
False. It is benign. A solid, solitary movable mass. Painless to tender on palpation
A palpable mass that is hard, immobile, and painful upon palpation, presenting with bloody or watery nipple discharge
Malignant. May be intraductal carcinoma or breast cancer
Predisposing factors to carcinoma
Radiation, family history, hormonal-endogenous or exogenous env., previous benign heart disease
