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74 Cards in this Set

  • Front
  • Back
What causes dimpling of the breast
invasion of cancer to the suspensory ligaments
What major vessel supplies the breast?

What major vessel drains the breast?
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
Where does 75% of lymph drain in the breast?
laterally to the axillary lymph nodes: mainly the pectoral group (but some directly to the axillary nodes)
Where does the remaining lymph in hte breast drain?
parasternal lymph nodes (including possibly the other breast)
where does the lymph from the lower breast quadrant drain?
inferior phrenic abdominal nodes
What causes a leathery, thickened appearance of the breast?
interference with the lymph system in the breast (cancer)
Trace the general drainage of lymph from the axillary nodes.
Axillary nodes--> subclavian lymphatic trunk --> bronchomediastinal trunks
what innervates the breasts?
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.
What does orange peel appearance of the breast indicate?
resulted from edema due to poor drainage of the lymph --> cancer
T/F breast cancer is less serious in men
false, because it is identified late it may have already metastasized
where do supernumerary breasts and nipple lie?
along the milk line
which is the most common site for breast cancer? Why?
superolateral portion, because it has the most glandular tissue
where do tumors of the breast spread?
skull and the spine
What effect does a child's circular shaped chest have?
breathing is done mostly by the diaphram... later when their ribs become oblique he will breath with his lungs
what effect does the eventual fusion of the manubrium and the body of the sternum have in old age?
repiratory difficulty
when aspirating a chest, where should a needle be inserted? (just inferior, or just superior to the rib?
just superior, but being careful not to go to close to the rib or else you'll injur the collaterals
What are the three ways to increase the capacity of the thorax?
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
What are the two accessory muscles of respiration?
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
Why would you have pain in the abdomin if you have a disease affecting the chest wall and pleura?
the thoracic wall and the diaphram share teh same nerve supply
what is the function of Sibson's fascia (suprapleural membrane)?
prevents pleura from projecting up into the neck upon deep inspiration.
What are the subcostal nerves?
they are what would be the intercostal nerves of the 12 ribs
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
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
What are dermatomes?
band-like skin areas supplied by dorsal ramus, and the anterior and lateral branches of the ventral ramus (intercostal nerve)
Why do teh dermatomes arrange in segmental fashion?
b/c the throacoabdomnal nerves arise from segments of the spine
what are the group of muscles supplied by a pair of intercostals?
what connects the spinal cord to the intercostal nerves?
grey and white communicantes
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?
white: myelinated, preganglionic, sympathetic

Grety: unmyelinated, postganglionic, sympathetic.

NOTE: vagus is parasympathetic and the parasympathetic ganglion is in the organs
Which 3 vessels (and their tributaries) supply blood to the thoracic wall?
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
where does the intercostal brachial nerve come from?

What does it supply?
lateral cutaneous branch of T2

it supplies the skin covering of the axillary floor
Why is there referred cardiac pain radiating down the left shoulder and arm?
b/c the intercosobrachial and medial brachial cutaneous (T1,2,3) share a pathway with the visceral afferents from the coronary arteries
what are the general attachments of the pectoralis major?
sternum, costal cartilages1-6, clavical, to intertubercular groove of the humerus
what does the celphalic vein drain?
the upper limb into the axillary vein
what is a cause of hydrothorax?
pleural effusion or a leak from the lung through an opening in the visceral pleura
what is a cause of a pneumothorax?
fractured ribs
what can cause a hemothorax?
a chest wound, i.e., injury to a major intercostal vessel rather than a lacerated lung
What can cause a chylothorax?
lymph from a torn throacic duct
which lobe would an anterior exploration elucidate?

which lobe would a posterior exploration elucidate?
1. upper lobe of the left and upper and middle lobe of the right.

2. mainly the lower lobes
which lung is shorter, wider, heavier and larger?
the right lung
Which lung has a cardiac notch?
the left... next to the linjula
At what level does the trachea bifercate?
the sternal angle
At which rib level is the cardiac notch?

Why is this knowledge of diagnostic value?
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
which main bronchus is more likely to lodge a foreign object?

1. the right

2. it goes straight down
which lung has an intermediate lobar bronchus?
the right
what are the 3 secondary bronchi of the right lung?

what are the 2 secondary bronchi of the right lung?
superior, intermediate, and inferior bronchus

superior, and inferior bronchus
How is the Carina (in the trachea) characterized in metastatic cancer?
it is distorted
At what level do the pulmonary arteries arise from the pulmonary trunk?
at the sternal angle
what is the blood supply to the lungs?
the bronchial arteries
what do the bronchial veins drain into? (hint: right and left are different)
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
what is the sympathetic and parasympathetic innervation of the lungs?
Para: vagus
symp: sympathetic trunks
what are the 3 functions of the parasympathetic innervation of the lungs?
broncho dilation


secretion from bronchial glands
What are the the visceral afferent parasympathetic innervations of the lungs related to?
1. cough reflex
2. stretch reception
3. limits repiratory excursions
4. chemo-pressors
where are the sympathetic ganglia for the lungs?
paravertebral sympathetic trunk
what are the 3 functions of sympathetic stimulation of the lungs?
1. inhibit broncho dilation
2. vasoconstriction
3. inhibits glandular excretion
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?
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)
What are the greater splanchnic nerves formed by?

Where do they travel to?

What do they innervate?
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
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?
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.
What is the destination for neurons passing through grey communicantes?

What route do neurons take to reach the heart?
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)
Which organ is innervated directly by presynaptic sympathetic neurons?
medulla of the adrenal gland
where do parasympathetic nerves exit the CNS?
1. Cranial sympathetic outflow (CNIII, VII, IX, X) at the pons, medulla and midbrain.

2. ventral roots of S2,3,4
Which spinal cord levels do the following arise from?

1. Greater splanchnic
2. Lesser splanchnic
3. Least splanchnic
1. Greater splanchnic: T5-T9
2. Lesser splanchnic: T10-T11
3. Least splanchnic: T12
1. What communicates with the left lung?

1. What communicates with the right lung?
1. Aorta, left common carotid, thoracic duct, phrenic & vagus nerves

2. SVC, IVC, right brachialcephalic, azygos, esophogus, phrenic & vagus nerves
What is more posterior at the right lung root, the azygos or the esophogus?
the esophogus
Are the phrenic nerves anterior or posterior to the lung root?
What is just posterior to the left lung root?
the descending aorta
Where does the thoracic duct come in contact with the left lung?
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
1. Left: Superior

2. Right: Anterior
Where do you find the azygos and esophogus in relation to the lungs?
1. Both are found posterior to the right lung root.
Which is more posterior, the aortic arch or the pulmonary arteries?
aortic arch apex
Which lung is shorter, wider and larger?

Which lung has 3 lobes?
Both: Right
T/F: the apices of the lungs enter pass through the thoracic aperature?
1. where do you find the cardiac notch on the lung?
1. left parasternal @ 4th intercostal space --> moving inferiorly to 6th costal cartilage
At which costal cartilage does the pleural reflexion pass intersect the:

1. midclavicular line?
2. midaxilary line?
3. scapular line?
1. midclavicular line? 8th costal cartilage

2. midaxilary line? 10th rib
3. scapular line? 12th rib
At what vertebra does the lung pleura terminate?
Where does the oblique fissure of the lungs run? (From the __ vertebra posteriorly --> to the __ costal cartilage anteriorly.)
From the 2nd vertebra posteriorly --> to the 6th costal cartilage anteriorly.