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1

Atypical ribs

1 and 2 because of their narrowness

2

The _______ cartilage gives the ribs a little bit of flexibility.

hyaline

3

What vasculature sits in the groove of the first and second rib.

subclavian artery and vein

4

Nerves in the intercostal space come from the __________ chain.

sympathetic

5

Greater Splanchnic nerves

T5-T9, T10

6

Lesser Splanchnic nerves

T10, T11

7

Least Splanchnic nerves

T11, T12; past the diaphragm

8

Pretracheal fascia continues with the ___________ fascia.

endothoracic

9

Most important drainage structure in the thorax.

thoracic duct

10

Typical Spinal Nerves (T2-T11)

main nerve, dorsal root ganglion, connects with both dorsal and ventral portions; Fibers of internal oblique are innervated by those spinal nerves that pass through the muscle fibers (including the intercostals and abdominals)

11

Atypical Spinal Nerves (T1-T2)

T1 divided into two parts (superior and inferior)
associated with stellate ganglion (landmark for numbing all thoracic viscera)

12

Subcostal nerve (T12)

part of lumbar plexus, does not have collateral branch but is destined to simply form a plexus (not meant to work alone)

13

Thoracic Wall Joints

Intervertebral - symphysis (move slightly); Costovertebral - synovial (move freely); Costochondral - cartilaginous (hyaline, flexible); Interchondral - synovial (move freely - have a capsule); Sternocostal- cartilaginous; Sternoclavicular- synovial (not in joint but flows over); Manubriosternal, xiphisternal - cartilaginous

14

The _______ is one of the strongest bones, second to the mandible.

sternum

15

Inhalation

SCM, Scalenes, External intercostal; lungs maximum volume is at base of lung not apex

16

Exhalation

Internal intercostals, rectus abdominis (tonal action for respiration, not flexion), external oblique

17

What are some causes of neurovascular compression in the neck?

Supernumerary ribs (cervical rib), Trauma, Extra muscle or scar tissues in the scalene muscles (anterior and middle), Awkward postural positions, space between T1&T2 intercostal spaces and clavicle are smaller than normal

18

What are some symptoms of neurovascular compression in the neck?

Neuralgic. pain, paresthesia (compressed roots of brachial plexus), Vascular (less common), cyanosis, edema, weak or no pulse; Differential diagnosis - Bursitis, CTS (carpal tunnel syndrome), disc herniation, fibromyalgia, rotator cuff syndrome, MS

19

Branches off the throacic aorta.

subcostals, posterior intercostals

20

First branch of subclavian artery.

internal thoracic artery (anterior intercostals off this)

21

What artery is the lateral thoracic artery a branch of?

axillary artery

22

Anterior intercostal veins drain into?

internal thoracic vein

23

Posterior intercostal veins drain into?

1st to brachiocephalic vv.; 2nd, 3rd & 4th form the Superior intercostal vv.; 4th-11th to the azygos or hemiazygos vv.’s (also an accessory hemiazygos vv.); azygos only seen on Right side of body (no L counterpart); azygos vein is the main vein draining into the IVC

24

Subcostal veins drain into?

inferior vena cava

25

Potential causes of gynecomastia?

puberty; steroid abuse (cycle is about 90 days, can develop in less than 1 cycle); obesity (more prevalent cases tend to not be associated with obesity); marijuana use (questionable); tumors; genetic disorders; chronic liver disease (creates hormonal issue with FSH and LH); side effects of many medications; castration (testicular tumors); Klinefelter Syndrome (congenital malformation); Gilbert's Syndrome (congenital malformation); Aging (movement of fat)

26

Suspensory ligament of the breast.

Cooper's (created by collagen)

27

Breast Microanatomy

Extensive amount of collagen fibers represented by dense regular and dense irregular collagenous tissue; associated to the glands (lactiferous glands and duct glands); Mitosis of epithelial cells creating more ducts from primary ones, increasing circulation; Progesterone levels when high, will potentiate prolactin, creating more ducts and keeps present ducts open (occurs naturally during lactation)

28

Arterial supply of the breast.

Internal thoracic arteries and its perforating branches supply a medial part of the breast. Lateral thoracic artery supplies a lateral part of the breast. Deepest tissues are supplied by intercostal arteries and their branches.

29

Main venous drainage of the breast.

axillary vein

30

Innervation of the breast.

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