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Anatomy ICOM > Thoracic Wall And Breasts > Flashcards

Thoracic Wall And Breasts Flashcards

1
Q

Thorax

A

Area between neck and abdomen

*rib cage and what is inside

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2
Q

Chest

A

Thorax + pectoral girdle

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3
Q

Thoracic cavity compartments

A
  1. Central mediastinum
  2. Right pleural cavity
  3. Left pleural cavity
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4
Q

Boundaries of thorax

A 
1. Superior thoracic aperture
  A. Manubrium
  B. Rib 1 and costal cartilage
  C. T1 vertebra
2. Inferior thoracic aperture
  A. Xiphoid process
  B. costal margin
  C. Rib 12 
  D. T12 vertebra
  E. Diaphragm - fills space
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5
Q

T4-T5 landmarks

A
  1. Sternal angle on transverse plane
  2. Ascending aorta ends and arch begins
  3. More posterior aortic arch ends and thoracic (descending) aorta begins
  4. Trachea bifurcates
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6
Q

Root of neck

A 
Junction area between thorax and neck
1. Viscera
  A. Trachea
  B. Esophagus
2. Nerves
  A. Sympathetic trunks
  B. Vagus
  C. Phrenic
  D. Roots/trunks of brachial plexus
3. Veins
  A. Subclavian - upper limbs
  B. Venous angle - where veins and lymphatic meet
  C. Anterior jugular vein
  D. Jugular venous arch - connects anterior jugular veins
4. Arteries
  A. Subclavian and branches
    *Part 1 (medial)
       1. Vertebral
       2. Internal thoracic - posterior side of anterior wall
       3. Thyrocervical
          A. Suprascapular
          B. Transverse cervical 
          C. Inferior thyroid (ascending cervical)
     *Part 2 (posterior)
        1. Costocervical trunk
           A. Superior (supreme) intercostal
           B. Deep cervical
     *Part 3 (lateral)
         1. Dorsal scapular
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7
Q

Thoracic outlet syndrome

A 
Disorders that occur when vessels or nerves between clavicle and rib 1 are compressed
*symptoms depend on structure compressed
1. Neurogenic
  A. Most common
  B.compression of brachial plexus
2. Vascular
  A. Veins/arteries compressed
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8
Q

Layers of thoracic wall

A
  1. Skin
  2. Superficial fascia
  3. Pectoral fascia
  4. Skeletal elements, musculature, neurovascular bundle
  5. Endothoracic fascia - internal
  6. Pleura
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9
Q

Thoracic cage

A
  1. Thoracic vertebrae and IVD
    A. T1, T10-T12: one full facet
    B. T2-T8: typical (one full and 2 demifacets on each side)
    C. T9 - one full facet and one Demi facet
  2. Ribs - 12 pairs
    A. True ribs (1-7): attaches sternum
    B. False ribs (8-10): rib above shares costal cartilage
    C. Floating ribs (11-12): no anterior articulation
  3. Sternum
    Coastal cartilage and joints
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10
Q

Typical ribs structure

A

Ribs 3-9

  1. Two demifacets
  2. Head
  3. Neck
  4. Tubercle w/ facet
  5. Angle
  6. Strong costal groove
  7. Shaft
  8. Sterna end (pitted)
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11
Q

Atypical ribs

A

A. Rib 1: shorter, single facet on head, scalene tuberacle, subclavian artery groove

B. Rib 2: shorter, tuberosity for serratus anterior

C. Ribs 11 and 12: rudimentary

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12
Q

Sternum

A
  1. Manubrium: clavicular notch, jugular notch, 1st costal notch, sternal angle
  2. Corpus sterni (body): costal notches
  3. Xiphoid process
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13
Q

Costovertebral joints

A 
1. Costotransverse joints: 
  A. Associated ligaments
    1. Costotransverse
    2. Lateral costotransverse
    3. Superior costotransverse
2. Joints of head ribs
  A. Associated ligaments
    1. Intra-articulate: internal between rib and vertebral bodies
    2. Radiate: external
3. Sternocostal
   A. R1 and manubrium 
   B. R2 and sternal angle
   C. R3-7 and body
4. Interchondral
5. Costochondral
6. Manubriosternal
7. Xiphisternal
8. Intervertebral
9. Stenoclavicular
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14
Q

Intercostal muscles

A
  1. External intercostal
  2. Internal intercostal
  3. Innermost intercostal
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15
Q

External intercostal muscles

A
  1. Fxn: elevates ribs (inspiration)
  2. Prox and distal: infero -anterior from rib tubercle to costochondral joint
  3. Innervation: 1-11th ant. Rami thoracic sp. n. (Intercostal n)
  4. Supply: intercostal a.
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16
Q

Internal intercostal muscles

A
  1. Fxn:
    A. Interosseous part: depresses ribs (expiration)
    B. Interchondral part: elevate costal cartilage (inspiration)
  2. Prox and distal: supero-anterior from costal angle to sternum
  3. Innervation: intercostal n (1-11)
  4. Supply: intercostal a.
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17
Q

Innermost intercostal muscles

A
  1. Fxn: depresses ribs (expiration)
  2. Prox and distal: supero-anterior along lateral surface of thoracic wall
  3. Innervation: intercostal n. (1-11)
  4. Supply: intercostal a.
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18
Q

Subcostal muscles

A
  1. Fxn: depresses ribs (expiration)
  2. Prox and distal: from lower margin rib to inner surface of ribs 2-3 (fibers blend w/ innermost intercostal muscle)
  3. Innervation: 12th thoracic sp. n
  4. Supply: subcostal a.
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19
Q

Transversus thoracis

A
  1. Fxn: weakly depresses ribs (expiration)
  2. Prox: inner surface of sternum
  3. Distal: inner surface of ribs 2-6
  4. Innervation: 2-6th thoracic sp. n.
  5. Supply: intercostal a.
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20
Q

Neve branching in thoracic wall

A

From ventral rami of T1-T12 spinal n.

  1. Lateral cutaneous
  2. Anterior cutaneous
  3. Collateral
  4. Muscular
  5. Rami communicans
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21
Q

Thoracic wall cutaneous dermatomes

A
  1. T4 = nipple

2. T10 = umbilicus

22
Q

Thoracic wall arterial supply

A
  1. Posterior intercostal a.: mostly arise from thoracic aorta
    A. Upper 2 arise from superior intercostal a.
  2. Anterior intercostal a.:
    A. From internal thoracic a. -> supply spaces 1-6
    B. From musculophrenic a. -> supply spaces 7-9
  3. Occlusion thoracic aorta -> effect lower 9 intercostal muscles
23
Q

Thoracic wall venous drainage

A
  1. Anterior intercostal veins -> internal thoracic veins -> brachiocephalic veins
  2. Posterior intercostal veins -> azygos system
    A. Lower left side (7-11) -> hemiazygos
    B. Upper left side (1-6) -> accessory hemiazygos
    C. Hemiazygos and accessory hemiazygos -> azygos
24
Q

Herpes zoster

A

Shingles

1. Distributed along dermatome associated w/ infected ganglion

25
Q

Intercostal nerve block

A

Local anesthetic injected in intercostal space

1. Usually not complete loss of sensation because of nerve overlap

26
Q

Diaphragm

A
  1. Fxn: primary muscle of inspiration
  2. Attachments: costal margin, xiphoid process, L1-L3 vertebrae
  3. Innervation:
    A. Phrenic nerve (C3, C4, C5): motor to all and sensory to most
    B. Intercostal and subcostal (T6-T12): sensory to periphery of diaphragm
27
Q

Thorax changes in breathing

A
  1. Elevation and depression of diaphragm -> vertical dimension change
  2. Pump handle -> anterioposterior dimension (ribs 1-6)
  3. Bucket handle -> lateral dimension (ribs 10-11)
28
Q

Passive inspiration

A

Bucket and pump handles raised
1. Contract:
A. Diaphragm
B. External intercostals

29
Q

Passive expiration

A

Bucket and pump handles lowered
1. Relax:
A. Diaphragm
B. External intercostals

30
Q

Forced inspiration

A

Contract:

  1. Diaphragm
  2. External intercostals
  3. Sternocleidomastoid
  4. Trapezius (superior)
  5. Pectoralis minor
  6. Scalenes
31
Q

Forces expiration

A 
1. Relax:
  A. Diaphragm
  B. External intercostals
2. Contract:
  A. Abdominal muscles
32
Q

Breast

A
  1. External: nipple and areola (and glands)
  2. Internal: Axillary tail (tail of Spence) = adipose and mammary tissue
  3. Retromammary space: between breast and pectoral fascia
  4. Lactiferous ducts
  5. Lobules of mammary gland
  6. Lactiferous sinus
  7. Suspensory (Cooper’s) ligaments
  8. Lymphatic drainage
    A. Axillary lymph nodes (75% drains here)
    1. Pectoral (initial drainage)
    2. Subscapular
    3. Humeral
33
Q

Anterior median (midsternal) line (AML)

A

Intersection of median plane w/ anterior thoracic wall

34
Q

Midclavicular line (MCL)

A

Passes thru midpoint of clavical

1. Parallel to AML

35
Q

Anterior Axillary line (AAL)

A

Vertical along anterior Axillary fold formed by inferolateral border of pectoralis major
1. Spans from thoracic cage -> humerus

36
Q

Midaxillary line (MAL)

A

Runs from apex of axillary fossa

1. Parallel to AAL

37
Q

Posterior axillary line (PAL)

A

Vertical along posterior fold formed by latissmiss Doris and teres major

38
Q

Posterior median (midvertebral) line (PML)

A

Vertical along tips of spinous processes

39
Q

Scapular lines (SLs)

A

Intersect inferior angles of scapula

1. Parallel to PML

40
Q

Superior thoracic aperture

A

Structures passing thru:

  1. Trachea
  2. Esophagus
  3. Lung apices
  4. Brachiocephalic veins
  5. Brachiocephalic trunk
  6. Left common carotid a.
  7. Left subclavian a.
  8. Vagus n.
  9. Phrenic n.
  10. Recurrent laryngeal nerves
  11. Sympathetic trunk
  12. Lymphatics
41
Q

Breast vasculature

A
  1. Subclavian a. And v.
  2. Axillary a. And v.
  3. Internal thoracic a. And v.
    A. Perforating branches
  4. Lateral thoracic a. And v.
    A. Medial mammary branches
    B. Lateral mammary branches
    C. Mammary branches
42
Q

Breast innervation

A 
Derive from anterior and lateral cutaneous branches of 4-6th intercostal n.
1. Supraclavicular n.
2. Intercostal n.
  A. Lateral mammary branches
  B. Medial mammary branches
43
Q

Pectus carinatum

A

Pigeon chest

  1. Chest juts out due to unusual growth of sternum, ribs, and cartilage
  2. Usually no symptoms, sometimes SOB
  3. Tx: braces
44
Q

Pectus excavatum

A

Funnel chest

  1. Sunken sternum
  2. If severe, may interfere w/ heart and lung fxn
  3. Can be surgically corrected
45
Q

Flail chest

A

Can be caused by multiple rib fractures

1. Changes lung movement in breathing

46
Q

Breast cancer

A
  1. Carcinomas
    A. Often adenocarcinomas
    B. Form epithelial cells of lactiferous ducts
  2. If enter lymphatics -> lymphodema ->
    A. Peau d’orange sign (edema of skin)
    B. Nipple deviation/retraction
  3. If invade glandular tissue and fibrosis -> dimpling
47
Q

Polymastia

A

Accessory breast

48
Q

Polythelia

A

Accessory nipple

49
Q

Amastia

A

No breast dev.

50
Q

Gynocomastia

A

Breast hypertrophy in males after puberty

  1. Age
  2. Drug-related
  3. Hormone imbalance
  4. Change in sex hormone metabolism in liver
  5. Should be explored further

Anatomy ICOM (34 decks)

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