Thoracic Wall, breast, and lungs

Question 1

What do mammary glands derive from?

Answer 1

Modified sweat glands

Question 2

Innervation of breast

Answer 2

supraclavicular nerve from cervical plexus, anterior cutaneous nerves 2-6 or 7, and lateral cutaneous nerves 3-6 or 7 (both derived from cutaneous branches of intercostal nerves from ventral roots of T1-T11

Question 3

Vascular Supply of Breast

Answer 3

Lateral mammary artery (from axillary a. then lateral thoracic a.) Medial mammary arteries (1st 4-5 perforating arteries from the internal thoracic arteries derived from subclavian artery) and Lateral mammary arteries from lateral cutaneous arteries (Derived from posterior intercostal arteries from thoracic aorta)

Question 4

75% of breast lymph flow

Answer 4

Goes to axillary nodes (pectoral nodes, central nodes, and apical nodes)

Question 5

20% of breast lymph flow

Answer 5

Goes to parasternal nodes along internal thoracic vessels

Question 6

5% of breast lymph flow

Answer 6

Flows to abdomen (diaphragm or liver) or breast on opposite side.

Question 7

Polymastia

Answer 7

Supernumerary breast

Question 8

Polythelia

Answer 8

Supernumerary nipples

Question 9

Tubercle of rib articulation

Answer 9

Articulates with transverse process of vertebrae

Question 10

Head of rib articulation

Answer 10

Articulates with two vertebral bodies, vertebrae of same number and vertebrae above.

Question 11

True Ribs

Answer 11

1-7

Question 12

False Ribs

Answer 12

8-12

Question 13

External Intercostal Muscles

Answer 13

11 pairs, fibers pass down and forward, anteriorly becomes external intercostal membrane, begin at vertebrae and end at approximately costal cartilage

Question 14

Internal Intercostal Muscles

Answer 14

11 pairs, fibers pass down and backwards (out and down), posteriorly becomes internal intercostal membrane, begin at angle of rib and go to sternum

Question 15

Innermost intercostal muscles

Answer 15

Pass same direction as internal IC muscles (out and down), nerves and vessels lie above these muscles, anteriorly transverses thoracis, posteriorly subcostal muscles

Question 16

Subcostal Muscles

Answer 16

Innermost on posterior thoracic wall, span 2 or more spaces

Question 17

Transverse thoracic muscles

Answer 17

Origin at sternum, insertion at ribs, lie posterior to internal thoracic vessels, four or five slips, lie posterior to the internal thoracic vessels

Question 18

Innervation of intercostal muscles

Answer 18

12 thoracic nerves, 11 intercostal and 1 subcostal. Both muscular and cutaneous branches.

Question 19

Posterior intercostal arteries

Answer 19

9 posterior intercostal muscles, 3-11 that arise from the aorta. Supply the spinal cord, back, and intercostal muscles

Question 20

Anterior intercostal arteries

Answer 20

5-6 anterior intercostal arteries come from internal thoracic artery which is a branch of the subclavian artery. The internal thoracic artery then divides into the superior epigastric artery and musculophrenic artery. Musculophrenic artery provides 3-4 anterior intercostal arteries

Question 21

Supreme intercostal artery

Answer 21

Arises from costocervical trunk/subclavian and gives rise to the first two posterior intercostal arteries

Question 22

Musculophrenic artery

Answer 22

Derived from internal thoracic artery. Gives rise to 3-4 anterior intercostal arteries

Question 23

Anterior Intercostal Veins

Answer 23

6 pairs form the internal thoracic vein, 3 pairs form the musculophrenic vein and drain into the brachiocephalic vein

Question 24

Costal groove

Answer 24

holds Vein, Artery, and Nerve (in superior to inferior order)

Question 25

Where would you want to insert a needle in the thorax in relation to the costal groove?

Answer 25

Close to the upper surface of a rib because the costal groove is on the lower surface.

Question 26

Lobar bronchi

Answer 26

3 on right side, 2 on left side

Question 27

Segmental bronchi

Answer 27

10 on each side

Question 28

Bronchopulmonary Segment organization

Answer 28

Arteries and bronchi are centrally located but veins are found between segments. Veins identify specific segments that can be used for removal.

Question 29

Hilum of Right Lung

Answer 29

Pulmonary Artery is anterior to bronchus

Question 30

Hilum of left lung

Answer 30

Pulmonary artery is superior to bronchus

Question 31

Parasthesia

Answer 31

Abnormal spontaneous sensation of burning, pricking, or numbness. Usually caused by impingement, cutting, or rough handling of a cutaneous nerve

Question 32

Dermatome associated with nipple

Answer 32

T4

Question 33

Retromammary bursa

Answer 33

Space between body of breast and pectoral fascia. Allows breast to be very moveable.

Question 34

Pectoral Nodes

Answer 34

Level 1, lateral to pectoralis minor

Question 35

Central Nodes

Answer 35

Level 2, posterior to pectoralis minor

Question 36

Apical Nodes

Answer 36

Level 3, superomedial to pectoralis minor

Question 37

Manubriosternal joint

Answer 37

Joining of manubrium and sternum. At this level, the second rib articulates with the sternum. This is the sternal angle

Question 38

Ribs 11 and 12

Answer 38

End freely

Question 39

Ribs 8,9, and 10

Answer 39

Articulate with costal segments above

Question 40

Anterior IC veins

Answer 40

Internal thoracic vein and musculophrenic vein follow the same paths as their respective arteries. 5-6 drain into the internal thoracic vein and 3 pairs drain into the musculophrenic. Both of these then go to the brachiocephalic vein.

Question 41

Articulations for ribs

Answer 41

Head of rib articulates with superior costal facet of thoracic vertebra of same number and inferior costal facet of vertebra above. Costal tubercle articulates with the transverse process of the vertebra with the same number