Anatomy Thorax Breast/throacic Wall/lungs

Front 1

What causes dimpling of the breast

Back 1

invasion of cancer to the suspensory ligaments

Front 2

What major vessel supplies the breast?

What major vessel drains the breast?

Back 2

1. Lateral thoracic (and throacoacrombial) artery--> Axillary artery -AND- internal thoracic --> subclavian artery

2. 1. Lateral thoracic vein--> Axillary artery -AND- internal thoracic --> subclavian artery

Front 3

Where does 75% of lymph drain in the breast?

Back 3

laterally to the axillary lymph nodes: mainly the pectoral group (but some directly to the axillary nodes)

Front 4

Where does the remaining lymph in hte breast drain?

Back 4

parasternal lymph nodes (including possibly the other breast)

Front 5

where does the lymph from the lower breast quadrant drain?

Back 5

inferior phrenic abdominal nodes

Front 6

What causes a leathery, thickened appearance of the breast?

Back 6

interference with the lymph system in the breast (cancer)

Front 7

Trace the general drainage of lymph from the axillary nodes.

Back 7

Axillary nodes--> subclavian lymphatic trunk --> bronchomediastinal trunks

Front 8

what innervates the breasts?

Back 8

4-6th anterior and lateral branches of the intercostal nerves

sensory to the skin and sympathetic to the blood vessels and overlying smooth muscle of the skin and the nipples.

Front 9

What does orange peel appearance of the breast indicate?

Back 9

resulted from edema due to poor drainage of the lymph --> cancer

Front 10

T/F breast cancer is less serious in men

Back 10

false, because it is identified late it may have already metastasized

Front 11

where do supernumerary breasts and nipple lie?

Back 11

along the milk line

Front 12

which is the most common site for breast cancer? Why?

Back 12

superolateral portion, because it has the most glandular tissue

Front 13

where do tumors of the breast spread?

Back 13

skull and the spine

Front 14

What effect does a child's circular shaped chest have?

Back 14

breathing is done mostly by the diaphram... later when their ribs become oblique he will breath with his lungs

Front 15

what effect does the eventual fusion of the manubrium and the body of the sternum have in old age?

Back 15

repiratory difficulty

Front 16

when aspirating a chest, where should a needle be inserted? (just inferior, or just superior to the rib?

Back 16

just superior, but being careful not to go to close to the rib or else you'll injur the collaterals

Front 17

What are the three ways to increase the capacity of the thorax?

Back 17

1. elevate the ribs pushes the sternum forward and enlarges anterior and posterior

2. bucket handle elevation of the ribs expands the transverse diameter, which is also increase by ribs 8,9,10 passing backwards

3. the diaphram contracts and increases the vertical diameter of the throax

Front 18

What are the two accessory muscles of respiration?

Back 18

1. any muscle attached to the ribs that pass the upper extremity of the neck

2. the latissimus dorsi and the pectoralis muscles elevate the ribs when the arms are fixed

3. also the scalene muscles

Front 19

Why would you have pain in the abdomin if you have a disease affecting the chest wall and pleura?

Back 19

the thoracic wall and the diaphram share teh same nerve supply

Front 20

what is the function of Sibson's fascia (suprapleural membrane)?

Back 20

prevents pleura from projecting up into the neck upon deep inspiration.

Front 21

What are the subcostal nerves?

Back 21

they are what would be the intercostal nerves of the 12 ribs

Front 22

What effect do these muscles have on the ribs?

1. External intercostals
2. Internal intercostals
3. Innermost intercostals
4. Transverse thoracic
5. Serratus posterior superior
6. Serratus posterior inferior

Back 22

1. External intercostals: eleveate the ribs
2. Internal intercostals: depress the ribs
3. Innermost intercostals: elevate the ribs
4. Transverse thoracic: depress the ribs
5. Serratus posterior superior: elevate
6. Serratus posterior inferiordepress

Front 23

What are dermatomes?

Back 23

band-like skin areas supplied by dorsal ramus, and the anterior and lateral branches of the ventral ramus (intercostal nerve)

Front 24

Why do teh dermatomes arrange in segmental fashion?

Back 24

b/c the throacoabdomnal nerves arise from segments of the spine

Front 25

what are the group of muscles supplied by a pair of intercostals?

Back 25

myotomes

Front 26

what connects the spinal cord to the intercostal nerves?

Back 26

grey and white communicantes

Front 27

For the following: Grey and white communicantes:

1. Which are myelinated?
2. which is preganglionic
3. which is postganglionic
4. which is sympathetic
5. which is parasympathetic?

Back 27

white: myelinated, preganglionic, sympathetic

Grety: unmyelinated, postganglionic, sympathetic.

NOTE: vagus is parasympathetic and the parasympathetic ganglion is in the organs

Front 28

Which 3 vessels (and their tributaries) supply blood to the thoracic wall?

Back 28

1. Thoracic artery: through posterior and subcostal arteries

2. subclavian: thorugh the internal throacic and intercostals

3. Axillary: through the superior and lateral thoracic arteries

Front 29

where does the intercostal brachial nerve come from?

What does it supply?

Back 29

lateral cutaneous branch of T2

it supplies the skin covering of the axillary floor

Front 30

Why is there referred cardiac pain radiating down the left shoulder and arm?

Back 30

b/c the intercosobrachial and medial brachial cutaneous (T1,2,3) share a pathway with the visceral afferents from the coronary arteries

Front 31

what are the general attachments of the pectoralis major?

Back 31

sternum, costal cartilages1-6, clavical, to intertubercular groove of the humerus

Front 32

what does the celphalic vein drain?

Back 32

the upper limb into the axillary vein

Front 33

what is a cause of hydrothorax?

Back 33

pleural effusion or a leak from the lung through an opening in the visceral pleura

Front 34

what is a cause of a pneumothorax?

Back 34

fractured ribs

Front 35

what can cause a hemothorax?

Back 35

a chest wound, i.e., injury to a major intercostal vessel rather than a lacerated lung

Front 36

What can cause a chylothorax?

Back 36

lymph from a torn throacic duct

Front 37

which lobe would an anterior exploration elucidate?

which lobe would a posterior exploration elucidate?

Back 37

1. upper lobe of the left and upper and middle lobe of the right.

2. mainly the lower lobes

Front 38

which lung is shorter, wider, heavier and larger?

Back 38

the right lung

Front 39

Which lung has a cardiac notch?

Back 39

the left... next to the linjula

Front 40

At what level does the trachea bifercate?

Back 40

the sternal angle

Front 41

At which rib level is the cardiac notch?

Why is this knowledge of diagnostic value?

Back 41

1. 4-6th costal cartilages

2, it is here that the heart pokes out of the lungs and percussion giving a dull sond indicates the absence of an air filled chamber, and the presence of a fluid filled chamber

Front 42

which main bronchus is more likely to lodge a foreign object?

Why?

Back 42

1. the right

2. it goes straight down

Front 43

which lung has an intermediate lobar bronchus?

Back 43

the right

Front 44

what are the 3 secondary bronchi of the right lung?

what are the 2 secondary bronchi of the right lung?

Back 44

superior, intermediate, and inferior bronchus

superior, and inferior bronchus

Front 45

How is the Carina (in the trachea) characterized in metastatic cancer?

Back 45

it is distorted

Front 46

At what level do the pulmonary arteries arise from the pulmonary trunk?

Back 46

at the sternal angle

Front 47

what is the blood supply to the lungs?

Back 47

the bronchial arteries

Front 48

what do the bronchial veins drain into? (hint: right and left are different)

Back 48

it partly empties into the pulmonary vein (especially at the periphery) and..

Right lung: partly into the azygos
left lung: partly into the accessory hemizygos

Front 49

what is the sympathetic and parasympathetic innervation of the lungs?

Back 49

Para: vagus
symp: sympathetic trunks

Front 50

what are the 3 functions of the parasympathetic innervation of the lungs?

Back 50

broncho dilation

vasodilation

secretion from bronchial glands

Front 51

What are the the visceral afferent parasympathetic innervations of the lungs related to?

Back 51

1. cough reflex
2. stretch reception
3. limits repiratory excursions
4. chemo-pressors

Front 52

where are the sympathetic ganglia for the lungs?

Back 52

paravertebral sympathetic trunk

Front 53

what are the 3 functions of sympathetic stimulation of the lungs?

Back 53

1. inhibit broncho dilation
2. vasoconstriction
3. inhibits glandular excretion

Front 54

1. which is sensitive to pain, visceral or parietal pluera?

2. which area is more sensitive to pain? why?

3. where does one feel referred pain when there is irritation to the mediastinum and central areas of the diaphram of the parietal pleura?

Back 54

parietal pleura

2. the costal pleura...b/c it is supplied by somatic intercostal and phrenic nerves

3. root of the neck and over the shoulder (C3-C5 dermatones)

Front 55

What are the greater splanchnic nerves formed by?

Where do they travel to?

What do they innervate?

Back 55

they are formed by the preganglionic axons from T5-T9 levels of the sympathetic trunk.

they travel from the thorax (piercing the diaphram) to the abdomin to the prevertebral ganglia and synapse with the prevertebral ganglia (i.e., the celiac gangila)

Abdominal organs

Front 56

Where are the cell bodies of the presynaptic sympathetic neurons?

Do effector neurons innervating thoracic structure (e.g., heart and lungs) pass through the white and grey communicantes?

Back 56

in the intermediolateral cell columns (lateral horns) in the spinal cord (between T1-L2 or L3)

Just the white--> then directly to the thoracic organ... only neurons that innervate structures in the thoracic wall, limbs, and neck pass through the grey.

Front 57

What is the destination for neurons passing through grey communicantes?

What route do neurons take to reach the heart?

Back 57

1. Neck, limbs, and thoracic wall (both ventral and dorsal rami)

2. They pass through the white communicantes --> and go directly to the organ (they don't go through the grey communicantes)

Front 58

Which organ is innervated directly by presynaptic sympathetic neurons?

Back 58

medulla of the adrenal gland

Front 59

where do parasympathetic nerves exit the CNS?

Back 59

1. Cranial sympathetic outflow (CNIII, VII, IX, X) at the pons, medulla and midbrain.

2. ventral roots of S2,3,4

Front 60

Which spinal cord levels do the following arise from?

1. Greater splanchnic
2. Lesser splanchnic
3. Least splanchnic

Back 60

1. Greater splanchnic: T5-T9
2. Lesser splanchnic: T10-T11
3. Least splanchnic: T12

Front 61

1. What communicates with the left lung?

1. What communicates with the right lung?

Back 61

1. Aorta, left common carotid, thoracic duct, phrenic & vagus nerves

2. SVC, IVC, right brachialcephalic, azygos, esophogus, phrenic & vagus nerves

Front 62

What is more posterior at the right lung root, the azygos or the esophogus?

Back 62

the esophogus

Front 63

Are the phrenic nerves anterior or posterior to the lung root?

Back 63

anterior

Front 64

What is just posterior to the left lung root?

Back 64

the descending aorta

Front 65

Where does the thoracic duct come in contact with the left lung?

Back 65

superior/anterior

Front 66

1. What position do you find the pulmonary arteries on the left lung? (anterior/posterior/inferior/superior?)

2. What position do you find the pulmonary arteries on the right lung? (anterior/posterior/inferior/superior?)

Hint: RALS

Back 66

1. Left: Superior

2. Right: Anterior

Front 67

Where do you find the azygos and esophogus in relation to the lungs?

Back 67

1. Both are found posterior to the right lung root.

Front 68

Which is more posterior, the aortic arch or the pulmonary arteries?

Back 68

aortic arch apex

Front 69

Which lung is shorter, wider and larger?

Which lung has 3 lobes?

Back 69

Both: Right

Front 70

T/F: the apices of the lungs enter pass through the thoracic aperature?

Back 70

True

Front 71

1. where do you find the cardiac notch on the lung?

Back 71

1. left parasternal @ 4th intercostal space --> moving inferiorly to 6th costal cartilage

Front 72

At which costal cartilage does the pleural reflexion pass intersect the:

1. midclavicular line?
2. midaxilary line?
3. scapular line?

Back 72

1. midclavicular line? 8th costal cartilage

2. midaxilary line? 10th rib
3. scapular line? 12th rib

Front 73

At what vertebra does the lung pleura terminate?

Back 73

12th

Front 74

Where does the oblique fissure of the lungs run? (From the __ vertebra posteriorly --> to the __ costal cartilage anteriorly.)

Back 74

From the 2nd vertebra posteriorly --> to the 6th costal cartilage anteriorly.