Lecture 6

Question 1

Atypical ribs

Answer 1

1 and 2 because of their narrowness

Question 2

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

Answer 2

hyaline

Question 3

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

Answer 3

subclavian artery and vein

Question 4

Nerves in the intercostal space come from the __________ chain.

Answer 4

sympathetic

Question 5

Greater Splanchnic nerves

Answer 5

T5-T9, T10

Question 6

Lesser Splanchnic nerves

Answer 6

T10, T11

Question 7

Least Splanchnic nerves

Answer 7

T11, T12; past the diaphragm

Question 8

Pretracheal fascia continues with the ___________ fascia.

Answer 8

endothoracic

Question 9

Most important drainage structure in the thorax.

Answer 9

thoracic duct

Question 10

Typical Spinal Nerves (T2-T11)

Answer 10

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)

Question 11

Atypical Spinal Nerves (T1-T2)

Answer 11

T1 divided into two parts (superior and inferior)

associated with stellate ganglion (landmark for numbing all thoracic viscera)

Question 12

Subcostal nerve (T12)

Answer 12

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

Question 13

Thoracic Wall Joints

Answer 13

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

Question 14

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

Answer 14

sternum

Question 15

Inhalation

Answer 15

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

Question 16

Exhalation

Answer 16

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

Question 17

What are some causes of neurovascular compression in the neck?

Answer 17

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

Question 18

What are some symptoms of neurovascular compression in the neck?

Answer 18

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

Question 19

Branches off the throacic aorta.

Answer 19

subcostals, posterior intercostals

Question 20

First branch of subclavian artery.

Answer 20

internal thoracic artery (anterior intercostals off this)

Question 21

What artery is the lateral thoracic artery a branch of?

Answer 21

axillary artery

Question 22

Anterior intercostal veins drain into?

Answer 22

internal thoracic vein

Question 23

Posterior intercostal veins drain into?

Answer 23

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

Question 24

Subcostal veins drain into?

Answer 24

inferior vena cava

Question 25

Potential causes of gynecomastia?

Answer 25

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)

Question 26

Suspensory ligament of the breast.

Answer 26

Cooper's (created by collagen)

Question 27

Breast Microanatomy

Answer 27

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)

Question 28

Arterial supply of the breast.

Answer 28

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.

Question 29

Main venous drainage of the breast.

Answer 29

axillary vein

Question 30

Innervation of the breast.

Answer 30

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

Question 31

The size/shape of the _____ will affect the size/ shape of the diaphragm.

Answer 31

liver

Question 32

Pectoral Implants

Answer 32

Subglandular - massive results without the natural look (May cause problems with breast feeding due to the loss of sensitivity that affects the milk ejection reflex - especially if they go through the alveolar to implant); Submuscular - more natural with lift

Question 33

Pectoralis Major Ruptures

Answer 33

Common Cause: Too much weight while bench pressing; Acute symptoms - Pain, extensive swelling, and ecchymosis (hemorrhage) of the anterior chest wall, axilla, and medial aspect of the affected arm; Chronic symptoms - Complain of weakness and partial loss of shoulder range of motion, without any notable limitation with activities of daily living