S&d Test 2: Ant. Thoracic Wall & Breast

Front 1

Contents of thoracic wall?

Back 1

sternum, 12 ribs, 12 thoracic vertebrae

Front 2

Contents of thoracic cavity?

Back 2

mediastinum, pleural cavities

Front 3

Functions of thorax

Back 3

breathing, protection of vital organs, conduit for structures to pass from neck to abdomen

Front 4

Name one of the complicated thoracic cage injuries.

Back 4

Multiple rib fractures, leading to flail chest with paradoxical movements (can lead to pneumothorax)

Front 5

Diagnosis of compression of neurovascular structures due to narrowed thoracic outlet.

Back 5

Thoracic outlet syndrome

Front 6

Symptoms of TOS.

Back 6

pain in neck, shoulder; numbness/weakness in arm and hand; diminished radial pulse

Front 7

Describe the intercostal spaces.

Back 7

11 intercostal spaces and 1 subcostal space (below rib 12)

Front 8

What landmark can be used to find the 2nd rib/intercostal space?

Back 8

Sternal angle (of Louis)

Front 9

Where is the external intercostal membrane located?

Back 9

between the costal cartilage on the anterior side of the thorax

Front 10

Where does the intercostal vasculature lie?

Back 10

In the costal groove along inferior margin of superior rib, passing in plane between the inner two muscle layers (also, small collateral branches are superior to the inferior rib)

Front 11

Describe the order of the intercostal vasculature.

Back 11

Superior to Inferior (VAN). Vein, artery, nerve

Front 12

Purpose of intercostal muscles

Back 12

Keep intercostal space rigid, preventing them from bulging out during expiration and being drawn in during inspiration.

Front 13

Three layers of intercostal muscles

Back 13

External, internal, innermost

Front 14

Innervation of external, internal, and innermost intercostal muscles

Back 14

Intercostal nerves (T1-T12)

Front 15

Action of external intercostal muscles

Back 15

Most during inspiration, elevate ribs, support intercostal space (down and in fibers)

Front 16

Action of internal & innermost intercostal muscles

Back 16

Most during expiration, support intercostal space, depress ribs (down and out fibers)

Front 17

Where is the internal intercostal membrane located?

Back 17

next to vertebrae

Front 18

Where is the innermost intercostal muscle located?

Back 18

Lateral thoracic wall

Front 19

Where are the subcostal muscles? Job?

Back 19

Internal surface of posterior ribs; depress ribs

Front 20

Where are the transversus thoracis? Job?

Back 20

Muscles on inside of sternum; depress costal cartilage

Front 21

Where are levatores costarum? Job?

Back 21

Segmental muscles of back (innervated by dorsal rami), elevate ribs

Front 22

What are the two main branches of the ventral rami of the intercostal nerves?

Back 22

lateral cutaneous nerve and anterior cutaneous nerve

Front 23

There are 11 pairs of intercostal nerves. Which are typical? What do those inferior to the typical nerves do?

Back 23

T3-T6 are typical; T7-T11 innervate the abdominal wall

Front 24

Dermatome of the umbilicus?

Back 24

T10

Front 25

What type of anesthesia could be used for a rib fracture?

Back 25

intercostal nerve block on posterior aspect

Front 26

Where is the preferred site for a needle decompression (for something like a tension pneumothorax)?

Back 26

2nd or 3rd intercostal space at midclavicular line or 5th intercostal space at midaxillary line (regardless, in the middle of the intercostal space)

Front 27

Two types of intercostal arteries and their origination.

Back 27

Anterior intercostal arteryposterior intercostal artery

Front 28

Origination of anterior intercostal artery

Back 28

upper 6 from internal thoracic artery, lower 5 from musculophrenic artery

Front 29

Origination of posterior intercostal artery

Back 29

upper 2 from superior thoracic artery, lower 9 from thoracic aorta

Front 30

Major branches of internal thoracic artery

Back 30

anterior intercostal arteries 1-6; superior epigastric artery; musculophrenic artery

Front 31

Describe venous drainage of thoracic wall.

Back 31

Intercostal veins drain into azygos system posteriorly and internal thoracic veins anteriorly

Front 32

Describe the lining of the pleural cavities.

Back 32

Parietal pleura on wall of cavity, visceral pleura lines lung itself; potential space lies between the two pleura

Front 33

4 boundaries of the mediastinum

Back 33

Sternum, thoracic vertebrae, superior thoracic aperture and inferior thoracic aperture

Front 34

Contents of Superior mediastinum

Back 34

thymus, great vessels, trachea, esophagus, nerves

Front 35

3 parts of the inferior mediastinum

Back 35

anterior, middle, posterior

Front 36

Contents of anterior mediastinum

Back 36

thymus, fat, small vessels, lymph nodes

Front 37

Contents of middle mediastinum

Back 37

heart, pericardium, origins of great vessels, smaller vasculature, nerves

Front 38

Contents of posterior mediastinum

Back 38

aorta, thoracic duct, azygos and hemiazygos veins, esophagus and its plexus, sympathetic trunks, splanchnic nerves

Front 39

Name 4 possible anterior mediastinal masses + signs/symptoms

Back 39

thymoma, thyroid mass, teratoma, lymphoma; retrosternal pain, cough, dyspnea, SVC syndrome, choking sensation

Front 40

Name 4 possible middle mediastinal masses + signs/symptoms

Back 40

lymph nodes, aortic aneurysm, vascular dilation, cysts; retrosternal pain, cough, dyspnea, SVC syndrome, choking sensation

Front 41

Name the two layers of the pericardium.

Back 41

External: fibrous pericardium, Internal: serous pericardium

Front 42

Arteries supplying fibrous pericardium

Back 42

internal thoracic (including pericardiacophrenic and musculophrenic), inferior phrenic artieries, and aorta

Front 43

Nerves for fibrous pericardium

Back 43

general sensory fibers of phrenic nerve

Front 44

Serous pericardium is divided into what two layers?

Back 44

parietal layer and visceral layer (epicardium)

Front 45

Which two layers in the pericardium adhere to one another on the cadaver?

Back 45

fibrous pericardium and parietal layer of serous pericardium

Front 46

What does the transverse pericardial sinus separate?

Back 46

arteries from veins

Front 47

What does the oblique paricardial sinus separate?

Back 47

Formed by a reflection onto the pulmonary veins of the heart

Front 48

What is cardiac tamponade?

Back 48

Collection of blood in pericardial cavity, preventing heart from expanding fully

Front 49

Signs of cardiac tamponade.

Back 49

Jugular vein distenstion, muffled heart sounds, difference between SBP and DBP narrows

Front 50

Treatment of cardiac tamponade

Back 50

Drainage of fluid from pericardial cavity by needle of intercostal space near sternum

Front 51

Base of breast is above which ribs?

Back 51

2-6, nipple at 4th intercostal space

Front 52

What is the name of the lateral extension of breast tissue?

Back 52

axillary process (tail of Spence)

Front 53

Three main parts of breast

Back 53

glandular tissue, adipose tissue, and connective septa

Front 54

What are the small protuberances on the areola?

Back 54

openings of sebaceous glands on surface

Front 55

How many glands in normal breast?

Back 55

10-20 individual lobes

Front 56

What does each gland have?

Back 56

lactiferous duct that opens by lactiferous sinus on nippe

Front 57

What separates the breast tissue from deep fascia on pectoralis major/serratus anterior?

Back 57

retromammary space

Front 58

What do the suspensory ligaments (ligaments of Cooper) do?

Back 58

attach mammary glands to overlying dermis

Front 59

Vascular supply to breast

Back 59

Medial-internal thoracic, Lateral-axillary, posterior intercostals from aorta; same veins for drainage

Front 60

Describe path for lymph drainage in breast.

Back 60

Pectoral (anterior)->central nodes->apical nodes (receive from all other axillary nodes, so trouble if cancer gets here)->right lymphatic duct of thoracic duct

Front 61

When tumor growth blocks superficial lymphatic channels, what can present? What about tumors pulling on connective tissue ligaments?

Back 61

orange peel appearance; nipple retraction

Front 62

What nerve can a mastectomy injure?

Back 62

long thoracic (winged scapula)