Thorax Flashcards
1
Q
Jugular notch is at vertebral level of
A
T2
2
Q
Sternal angle is at vertebral level of
A
T4/t5
3
Q
Xiphoid process is at vertebral level of
A
T9
4
Q
True ribs:
A
1-7
5
Q
False ribs attach to
A
costal cartilage ABOVE
6
Q
False ribs:
A
8-10
7
Q
Floating ribs have
and are
A
no attachment anteriorly
11 and 12
8
Q
Typical ribs
A
3-9
9
Q
Head of the rib articulates with
A
Vertebral body superiorly
Corresponding vertebral body
10
Q
Tubercle articulates with
A
Corresponding transverse process
11
Q
Atypical ribs
A
1,2
10, 11, 12
12
Q
Rib fractures commonly occur
A
anterior to angle of the rib
13
Q
Tx for rib fracture
A
Intercostal nerve block
14
Q
Most commonly fractured rib
A
5-10
15
Q
Fracture of these ribs indicate severe injury
A
1 and 2
16
Q
Lower rib fracture, suspect
A
Liver or splenic injury
17
Q
Paradoxical chest movement
A
Flail chest
18
Q
Flail chest
A
2 separate fractures in more than or equal to 3 contiguous ribs
1 costochondral junction
2 angle
19
Q
Compression of C8, TI, inferior trunk of brachial plexus or subclavian artery by cervical rib may result in
A
TOS
20
Q
V5 lead placement
A
AAL 5th ICS
21
Q
V6 lead placement
A
MAL 5th ICS
22
Q
V4 lead placement
A
MCL 5th ICS
23
Q
Elevates ribs
Inspiration
A
External intercostals
24
Q
Depresses the ribs
A
Internal intercostals
25
Occupies costal groove
Intercostal Vein, Artery, Nerve
26
Supplies thorax
Internal thoracic artery 1-6 (anterior intercostal)
One fingerbreadth lateral to sternal margin
27
Musculophrenic artery supplies
7-9 intercostal space
28
Posterior supply of thorax
Superior intercostal artery (1-2) from Posterior intercostal artery
Thoracic aorta:
Internal costal artery (3-11)
Subcostal artery
29
Associated with Turner’s
Upper extremity hypertension with radiofemoral delay
Coarctation of aorta
30
Coarctation of aorta radiographically reveals
Ribnotching from collaterals
| 3 sign because of distal constriction
31
One way valve with displacement of mediastinum to opposite side and subsequent decrease in venous return
Tension pneumothorax
32
Management for tension pneumothorax emergency
Needle thoracostomy
33
Needle thoracostomy anterior and lateral approach
2nd ICS MCL (anterior)
| 2nd ICS AAL (lateral)
34
Definitive management for tension pneumothorax
Chest tube AAL or MAL above the 5th (4th or 5th) rib since diaphragm reaches this high during expiration
35
Incision site for emergent thoracotomy
4th or 5th ICS
| Lateral margin of sternum to the AAL
36
Indication for CTD
>1500 ml
| > 200ml/h x 4 hours
37
Site of thoracentesis for pleural fluid
9th ICS MAL
Done at end of expiration
Needle angled upwards
38
Breast innervation
2nd to 6th intercostal nerves
39
Duct development hormone
Estrogen
40
Lobule development hormone
Progesterone
41
Nipple level and dermatome
4th ICS
| T4 dermatome
42
Sebaceous breast glands
Glands of Morgagni tubercles/Montgomery
43
Rare most common on axilla
Polymastia
44
Accessory nipple
Most common congenital breast anomaly
Failure of complete regression of milk streak
Most common location: inferior to breast
Polythelia
45
90% of amastia is associated with
Poland syndrome
46
Unilateral congenital absence of pectoralis major (most common), pectoralis minor, ribs and breast or nipple
Poland syndrome
47
Lack of both breast tissue and nipple
Amastia
48
With breast tissue but lacks nipple
Athelia
49
Without breast tissue but with nipple
Amazia
50
Most abdundant breast tissue hence most common location of beast cancer
Upper outer quadrant
51
Less vascular area of breast
Inferior quadrant
52
Most common cause of amazia
Iatrogenic
53
Dimpling of skin is attributed to
retraction of Cooper’s ligament
54
Edema, obstruction of subcutaneous lymphatics
Orange peel Pea de orange
55
Supplies breast medially
Internal thoracic artery
56
Supplies breast laterally
Axillary artery and lateral thoracic a
Thoracoacromial branch
Highest thoracic artery
57
Paget’s disease histology
Rete pegs of breast
| Epithelial extension
58
Regional breast nodes
| 75% of the breast drains to the
Axillary nodes
others Internal mammary node
59
Nodes beneath pecs minor Level II
Interpectoral rotter node
60
Mammography is done annualy for screening at age
40
61
Annual mammography and PE
40 years and older
62
No removal of NAC, Levels I, II and III and pectoralis major and minor
Removal of only the breast tissue containing lesion with small rim of external tissue
Lumpectomy
63
No removal of NAC, breast tissue and pectoralis major and minor
Only removed are levels I and II
Axillary node dissection for staging
64
No removal of NAC, Levels I, II and III and pectoralis major and minor
Only removed is breast tissue
Subcutaneous with nipple sparing mastectomy
65
No removal of Levels I, II and III and pectoralis major and minor
Only removed are NAC and breast tissue
Total/Simple Mastectomy
66
Removal of NAC, breast tissue, Levels I and II
Sparing of level III and pectoralis major and minor
Modified radical mastectomy
67
Removal of NAC, breast tissue and Levels I, II and III and pectoralis major and minor
Radical Mastectomy
| Halstead Mastectomy
68
Boundaries of chest
```
Superior: clavicle
Inferior: diaphragm
Lateral: rib cage
Anterior: sternum
Posterior: vertebral body and ribs
```
69
Most common sign of blunt chest injury also in fracture of scapula, first rib, sternum suggesting massive force of injury
Rib fracture
70
50% of flail chest injuries are accompanied by
pulmonary contusion
71
Major cause of respiratory compromise
Pulmonary contusion
Tx: PEEP
72
Costochondritis
Teitz syndrome
73
Vit D deficiency in children
Rachitic rosary
Harrison groove
Rickets
74
External intercostal action:
Elevates ribs
Expands thoracic cavity
Inspiration
Creates partial vacuum causing inflow of air extending downward and anterior from rib to rib
Pulls ribcage upward and outward during inspiration
75
Internal intercostals action:
```
Depress and retracts ribs
Compresses thoracic cavity
Expels air
Extends upward and inferiorly
Pulls ribcage downward during forced expiration
```
76
Sine qua non breast cancer
Spiculated density with ill defined margin
