Changes, such as branching of the _______ ducts, occur in the breast tissues during menstrual periods and pregnancy.
Although __________ are prepared for secretion by mid-pregnancy, they do not produce milk until shortly after the baby is born.
A creamy white to yellowish premilk fluid that may secrete from the nipples during the last trimester of pregnancy and during initial episodes of nursing.
Colostrum is believed to be especially rich in _______, immune agents, and a growth factor affecting the infant's intestines.
In ___ women, the breasts often become large and pendulous.
The breasts in elderly women are usually small because of the decrease in fat and the atrophy of _______ tissue.
For the anatomical location and description of tumors and cysts, the surface of the breast is divided into four quadrants:
Superior lateral, superior medial, Inferior lateral, inferior medial
The ___ breast is more affected breast for cancer compared to the ____ breast because it is usually larger and is composed of more granular tissue.
What quadrant of the breast has the greatest percentage of cancer?
The arterial supply of the breast derives from the:
- Medial mammary branches of perforating branches - Anterior intercostal branches of the internal thoracic artery - Lateral thoracic and thoracoacromial arteries - Posterior intercostal arteries
Medial mammary branches of perforating branches and anterior intercostal branches of the internal thoracic artery originate from the ___________ artery.
Lateral thoracic and thoracoacromial arteries are branches of the ______ artery
Posterior intercostal arteries are branches of the thoracic aorta in these three intercostal spaces:
2nd, 3rd, and 4th
In breast cancer, cancer mostly spreads to the ____. However, for prostate cancer, the cancer spreads to the venous blood and bones.
The venous drainage of the breast is mainly to the axillary vein, but there is some drainage to the _____________
internal thoracic vein.
The _______ of the breast is important because of its role in the metastasis of cancer cells.
Lymph passes from the nipple, areola, and lobules of the gland to the _______
subareolar lymphatic plexus.
Most lymph (> 75%), especially from the lateral breast quadrants, drains to the axillary lymph nodes, initially to the ___ or _____nodes for the most part.
anterior or pectoral
Some lymph may drain directly to other ____ nodes or even to interpectoral, deltopectoral, supraclavicular, or inferior deep cervical nodes.
Most of the remaining lymph, particularly from the medial breast quadrants, drains to the _____lymph nodes or to the opposite breast.
Lymph from the inferior quadrants may pass deeply to ____ lymph nodes (subdiaphragmatic inferior phrenic lymph nodes).
Lymph from the skin of the ____, except the nipple and areola, drains into the ipsilateral axillary, inferior deep cervical, and infraclavicular lymph nodes and also into the parasternal lymph nodes of both sides.
Lymph from the axillary nodes drains into clavicular (infraclavicular and supraclavicular) lymph nodes and from them into the ______ lymphatic trunk, which also drains lymph from the upper limb.
Lymph from the _____ nodes enters the bronchomediastinal lymphatic trunk, which also drains lymph from the thoracic viscera.
When the viscera of the thoracic cavity is sectioned transversely, it is apparent that the thoracic cavity is ____ shaped: a transversely ovoid space deeply indented posteriorly by the thoracic vertebral column and the posteromedial parts of the ribs (heads and necks), which articulate with it.
The thoracic cavity is divided into 3 compartments:
1. Right and left pulmonary cavities 2. Bilateral compartments 3. A central mediastinum
The ____ of the thoracic cavity contain the lungs and pleurae (lining membranes) and occupy the majority of the thoracic cavity.
The ______is a thoracic cavity compartment intervening between and completely separating the two pulmonary cavities, which contains essentially all other thoracic structures - the heart, thoracic parts of the great vessels, thoracic part of the trachea, esophagus, thymus, and other structures (e.g., lymph nodes).
The mediastinum extends vertically from the superior thoracic aperture to the ____ and anteroposteriorly from the thoracic vertebral bodies to the ____
The pulmonary cavities are lined by _________ that also reflect onto and cover the external surface of the lungs contained within the cavities.
pleural membranes (pleurae)
The inner pleural membrane is called the ______
The outside pleural membrane is called the____
During the embryonic period, the developing lungs invaginate (grow into) the _______ canals, the primordia (beginnings) of the pleural cavities.
The invaginated coelomic epithelium covers the primordia of the lungs and becomes the _______.
The epithelium lining the walls of the pericardioperitoneal canals forms the_______
During embryogenesis, the ______ cavities become separated from the pericardial and peritoneal cavities; however, a congenital diaphragmatic defect results in a diaphragmatic hernia connecting the peritoneal cavity with one of the pleural cavities (usually the left one), and the herniation of abdominal viscera into the thorax.
Each lung is invested by and enclosed in a serous pleural sac that consists of two continuous membranes:
visceral and parietal pleura
the ______pleura invests all surfaces of the lungs forming their shiny outer surface.
the ____ pleura lines the pulmonary cavities.
The pleural cavity - the potential space between the layers of pleura - contains a capillary layer of ______ _______ ______, which lubricates the pleural surfaces and allows the layers of pleura to slide smoothly over each other during respiration.
serous pleural fluid
The surface tension of the pleural cavity also provides the _____ that keeps the lung surface in contact with the thoracic wall; consequently, the lung expands and fills with air when the thorax expands while still allowing sliding to occur.
The visceral pleura (pulmonary pleura) closely covers the lung and is adherent to all its surfaces, including the surfaces within the _______ and ______ fissures; it cannot be dissected from their surfaces.
horizontal and oblique
The visceral pleura provides the lung with a smooth slippery surface, enabling it to move freely on the _____.
The visceral pleura is continuous with the parietal pleura at the _____ of the lung, where structures making up the root of the lung (e.g., the bronchus and pulmonary vessels) enter and leave the lung.
The parietal pleura lines the ______ cavities, thereby adhering to the thoracic wall, the mediastinum, and the diaphragm.
The parietal pleura consists of four parts:
costal part mediastinal part diaphragmatic part cervical pleura
The ______ part of the parietal pleura covers the internal surfaces of the thoracic wall.
The ____ part of the parietal pleura covers the lateral aspects of the mediastinum - the mass of tissues and organs separating the pulmonary cavities and their pleural sacs.
The ________ part of the parietal pleura covers the superior or thoracic surface of the diaphragm on each side of the mediastinum.
The ______ pleura of the parietal pleura extends through the superior thoracic aperture into the root of the neck, forming a cup-shaped pleural dome over the apex of the lung (the part extending above the 1st rib).
_____ pleura can be damaged easily, especially in children.
The costal part of the parietal pleura (costovertebral or costal pleura) is separated from the internal surface of the thoracic wall (sternum, ribs and costal cartilages, intercostal muscles and membranes, and sides of thoracic vertebrae) by ________
The endothoracic fascia is an extrapleural layer of loose connective tissue that forms a natural cleavage plane for the surgical separation of the _______ from the thoracic wall.
The ______ part of the parietal pleura covers the lateral aspects of the mediastinum, the partition between the pulmonary cavities.
The mediastinal part of the parietal pleura (mediastinal pleura) continues superiorly into the root of the neck as ______
The mediastinal part of the parietal pleura (mediastinal pleura) is continuous with costal pleura anteriorly and posteriorly and with the _____ pleura inferiorly.
Superior to the root of the lung, the mediastinal pleura is a continuous sheet passing anteroposteriorly between the sternum and the _______
At the ______ of the lung, the mediastinal pleura reflects laterally onto the structures making up the root of the lung and becomes continuous with the visceral pleura.
Inferior to the root of the lung, this continuity between parietal and visceral pleura is an ‘empty’double layer of pleura, the _______, extending between the lung and the mediastinum, immediately anterior to the esophagus.
The _______covers the superior surface of the diaphragm, except along its costal attachments (origins) and where the diaphragm is fused to the pericardium, the fibroserous membrane surrounding the heart.
diaphragmatic part of the parietal pleura (diaphragmatic pleura)
A thin, more elastic layer of endothoracic fascia, the _____fascia, connects the diaphragmatic pleura with the muscular fibers of the diaphragm.
The _______ pleura is the dome-shaped cap of the pleural sac and is the superior continuation of the costal and mediastinal parts of the parietal pleura
The cervical pleura covers the _____ of the lung that extends superiorly through the superior thoracic aperture into the root of the neck.
The summit of the cervical pleura is ______ cm superior to the level of the medial third of the clavicle at the level of the neck of the 1st rib.
2 - 3 cm
The cervical pleura is reinforced by a fibrous extension of the endothoracic fascia - the _________, which attaches to the internal border of the 1st rib and the transverse process of C7 vertebra.
suprapleural membrane (Sibson fascia)
The _____ do not occupy the pulmonary cavities completely during expiration; thus the peripheral diaphragmatic pleura is in contact with the lowermost parts of the costal pleura.
The potential pleural spaces here are the ________, pleura-lined grooves, which surround the upward convexity of the diaphragm inside the thoracic wall.
Smaller pleural ____ are located posterior to the sternum where the costal pleura is in contact with the mediastinal pleura.
The potential pleural spaces here are the costomediastinal recesses; the left recess is potentially larger (less occupied) because of the ______ in the left lung.
The inferior borders of the lungs move farther into the pleural recesses during deep ______ and retreat from them during expiration.
Because of the inferior slope of the 1st pair of ribs and the superior thoracic aperture they form, the cervical pleura and apex of the lung project through this opening into the neck, posterior to the inferior attachments of the ______ muscles.
The lungs and pleural sacs may be injured in wounds to the base of the neck resulting in a _____, the presence of air in the pleural cavity.
The cervical pleura reaches a relatively higher level in ______ because of the shortness of their necks.
infants and young children
The _______is especially vulnerable to injury during the first few years after birth.
The pleurae descend inferior to the costal margin in three regions, where an abdominal incision might accidentally enter a pleural sac: the _______and right and left costovertebral angles.
right part of the infrasternal angle
The small areas of pleura exposed in the costovertebral angles inferomedial to the 12th ribs are posterior to the superior poles of the _____
The pleura is in danger (i.e., a ______ may occur) from an incision in the posterior abdominal wall when surgical procedures expose a kidney, for example.
Entry of air into the pleural cavity (pneumothorax), resulting from a penetrating wound of the parietal pleura from a bullet, for example, or from rupture of a pulmonary lesion into the pleural cavity (bronchopulmonary fistula), results in _______of the lung.
____ ribs may also tear the visceral pleura and lung, thus producing pneumothorax.
The accumulation of a significant amount of fluid in the pleural cavity (________) may result from ______ (escape of fluid into the pleural cavity).
hydrothorax, pleural effusion
With a chest wound, blood may also enter the pleural cavity (________).
Hemothorax results more commonly from injury to a major intercostal or internal thoracic ______ than from laceration of a lung.
If both air and fluid (________, if the fluid is blood) accumulate in the pleural cavity, an air-fluid level or interface (sharp line, horizontal regardless of the patient's position, indicating the upper surface of the fluid) will be seen on a radiograph.
During inspiration and expiration, the sliding of normally smooth, moist pleurae makes no detectable sound during auscultation of the lungs (listening to breath sounds); however, inflammation of the pleura, _______, makes the lung surfaces rough.
pleuritis or pleurisy
Friction (pleural rub) is detectable with a _______
______ sounds like a clump of hair being rolled between the fingers.
The __________ of pleura may also cause the parietal and visceral layers of pleura to adhere (pleural adhesion).
____ pleuritis is marked by sharp, stabbing pain, especially on exertion, such as climbing stairs, when the rate and depth of respiration may be increased even slightly.