Diaphragm and Breast

Question 1

describe the path of fibres in the diaphragm

Answer 1

From posteriorly, fibres arch upwards into a dome on either side, then descend anteriorly to insert into a central tendon

Question 2

what is the origin of the diaphragm

Answer 2

Sternal part: Posterior aspect of xiphoid process

Costal part: Internal surfaces of lower costal cartilages and ribs 7 12

Lumbar part: Medial and lateral arcuate ligaments , bodies of vertebrae L1-L3 (+intervertebral discs), anterior longitudinal ligament

Question 3

The central tendon is derived from the ______

Answer 3

septum transversarium

Question 4

The muscular part of the diaphragm is derived from _____

Answer 4

an inner layer of body wall which originates in the neck (cervical myotomes),

Question 5

which dome is slightly higher - left or right

Answer 5

right dome positioned slightly higher than the left because of the liver

Question 6

what is superior to the diaphragm

Answer 6

the three serous membranes, parietal pleura & visceral
pleura, and pericardium

Question 7

what is inferior to the diaphragm

Answer 7

The abdominal diaphragm is in direct contact with the liver, stomach, and spleen.

Question 8

what are the three main openings in the diaphragm

Answer 8

caval opening, esophageal hiatus , aortic hiatus

Question 9

what passes through the caval opening

Answer 9

inferior vena cava
branches of right phrenic nerve

Question 10

what passes through the esophageal hiatus

Answer 10

anterior and posterior vagal trunk, esophagus

Question 11

what passes through the aortic hiatus

Answer 11

Descending aorta
Azygos vein
Thoracic duct

Question 12

at what vertebral level is the caval opening

Answer 12

T8

Question 13

at what vertebral level is the esophageal hiatus

Answer 13

T10

Question 14

at what vertebral level is the aortic hiatus

Answer 14

T12

Question 15

The splanchnic nerves, the right & left greater, lesser and
least pass through ___

Answer 15

the crura individually

Question 16

The hemi-azygos vein passes through _____

Answer 16

the left crus

Question 17

The sympathetic trunks pass ______

Answer 17

pass posterior to each medial arcuate ligament to enter the abdomen

Question 18

The subcostal nerves and vessels pass

Answer 18

posterior to the lateral arcuate ligament, to enter the abdomen

Question 19

describe motor innervation of the diaphragm

Answer 19

comes from the ipsilateral phrenic nerves (C3-C5).
These nerves innervate the diaphragm from its abdominal surface after they penetrate it.

Question 20

describe sesnsory innervation of the diaphragm

Answer 20

phrenic and 6th to 11th intercostal nerves

Question 21

what is the diaphragm supplied by

Answer 21

the inferior phrenic arteries from the abdominal aorta

Question 22

what supplies the costal margin of the diaphragm

Answer 22

The musculophrenic branch of the internal thoracic artery which gives off the lower 5 intercostal & subcostal arteries

Question 23

what is a clinical perspective for the diaphragm

Answer 23

Diaphragmatic hernia

Question 24

what are key events in diaphragm movement

Answer 24

The intra-thoracic pressure falls and intra-abdominal rises

The vena caval orifice is pulled widely open by its attachment to the central tendon

The oesophageal opening is closed by the contraction of the
right crus sling

The aortic opening is not affected

Question 25

what level is a breast at

Answer 25

rib 2 - 6

Question 26

which muscles does the breast overlie

Answer 26

P.Maj / S.Ant / Rectus Abdominis / Ext. Oblique

Question 27

what is under the areolae

Answer 27

lactiferous sinuses

Question 28

what veins drain the breasts and where do they drain to

Answer 28

internal thoracic / (L) thoracic & intercostal veins drain to axillary vein

Question 29

what is the blood supply of the breasts

Answer 29

perforating branches of the ITA branches of AXA (axillary artery) - (L) thoracic & thoracoacromial arteries cutaneous branches of the ICA’S in 3rd - 5th spaces

Question 30

what is the nerve supply of the breast

Answer 30

cutaneous branches of the ICN’s (intercostal nerve) T2 - T6

Question 31

describe the lymph drainage of the breast

Answer 31

pectoral group of axillary lymph nodes parasternal nodes intra mammary lymph vessels

Question 32

The lateral arcuate ligament is a thickening or condensation of fascia on what muscle?

Answer 32

thoracolumbar fascia

Question 33

What neural structures pierce the crura of the diaphragm

Answer 33

greater, lesser, least splanchnic nerves sometimes sympathetic trunk

Question 34

What structures do the crura of the diaphragm originate from inferiorly

Answer 34

upper lumbar vertebral bodies and discs

Question 35

how many ducts are in the adult female breast

Answer 35

15-20

Question 36

Where is muscular part of the diaphragm derived from embryologically?

Answer 36

Cervcial myotomes

Question 37

The parietal pleura covering the peripheral edges of the diaphragm are innervated by what nerves?

Answer 37

lower intercostal nerves