Thorax Flashcards
Where do you put a chest tube?
Midclavicular line + nipple line (5th intercostal space) + mid-axillary line
Where is the point of max intensity?
5th intercostal space on the left side to listen to heart
What is the composition of the female breast?
glandular tissue made up of lobes (15-20) made up of smaller structures of lobules where milk is produced…drains into lactiferous ducts independently onto the nipple
The most important part of the breast exam is the _______ portion
axilla
What is the arterial supply of the breast?
axillary artery –> lateral thoracic artery –> lateral mammary arteries
right common carotid –>internal thoracic artery –> medial mammary arteries
What is the major drainage area of the breast?
axillary area, as well as along arteries in the medial region
Where is the most common location of breast cancer?
upper left quadrant is 60% and goes clockwise from there
What are signs of breast cancer??
abnormal bumps, dimpling, nipple retraction, masses
What does the thoracic cage consist of?
Sternum-> manubrium, body, xiphoid process
12 ribs, thoracic vertebrae
Where is the sternal notch?
T2 & T3
Where is the sternal angle?
T4 & T5
Where is the xiphoid process?
T8 & T9
What is important about the costal groove?
where nerve, vein, and artery are located and essential to avoid in bedside procedures
What is special about the costal angle?
Most common location for fracture
How do nerves run?
with arteries
What coincides with any articulations?
Joints and ligaments
What is unique about how the rib articulates with the spine?
articulates between two vertebrae
What is thoracic outlet syndrome?
repetitive motions of arm that cause pinching and compression of nerves and arteries. Common in women, trauma, can have a cervical rib… can remove this rib, PT, NSAIDS, change activity
What are accessory muscles of respiration?
sternocleidomastoid and scalenes
What are principal muscles of respiration?
external intercostals, diaphragm, internal intercostals*
What are muscles of expiration?
internal intercostals, external oblique, internal oblique, transversus abdominis, rectus abdominus
What muscle elevates the sternum?
sternocleidomastoid
What muscle elevates and fixes upper ribs?
scalenes
What muscle elevates ribs the width of thoracic cavity?
external intercostals
What muscle descends for inspiration and rises for expiration?
diaphram
What nerve innervates the diaphram?
phrenic nerves C3, C4, C5 voluntary and involuntary
Where is the esophageal hiatus?
T10, diaphram
What does the esophageal hiatus consist of?
esophagus, vagus nerves, esophageal arteries
Where is the vena caval foramen?
T8
What does the vena caval foramen consist of?
inferior vena cava, right phrenic nerve
Where is the aortic hiatus?
T12
What does the aortic hiatus consist of?
aorta, azygos vein, thoracic duct
What does the internal thoracic arteries converge and become?
epigastric arteries
What is the arterial supply for the ribs?
internal thoracics on both sides –> intercostal arteries
What is the venous drainage of the ribcage?
Azygos on the right side, hemiazygous + accessory on left that drain into the azygous . follows arterial supply
What does the superior thoracic aperture consist of?
esophagus, trachea, common carotid and subclavian arteries, internal jugular and subclavian veins
What does the inferior thoracic aperture consist of?
large and expandable diaphragm
What does the pectoralis major muscle do?
flexion, adduction, medial rotation
How is the pectoralis major innervated?
lateral and medial pectoral nerves
Where does the pectoralis major attach?
sternum/clavicle and proximal humeral shaft
What does the pectoralis minor do?
scapular stabilization, some protraction
Where is the pectoralis minor?
under pec major, ribs, scapula
What innervates the pectoralis minor?
medial pectoral nerve
What are the attachments of the subclavius muscle?
1st rib, middle 1/3 of clavicle, behind pec major
What is the innervation of the subclavius muscle?
subclavian nerve
What does the subclavius muscle do?
anchors clavicle during movement of shoulder and arm
What is the origin and insertion of the serratus anterior?
O: upper 8 or 9 ribs
I: vertebral border of scapula
What does the serratus anterior do?
draws scapula forward and up, abducts scapula and rotates it, stabilizes vertebral border of scapula
What innervates the serratus anterior?
long thoracic nerve (C5, 6, 7)
What supplies the serratus anterior?
circumflex scapular artery
