What are the lines of reference for thoracic cavity?
1) mid-sternal (jugular notch to belly button)
3) subcostal (runs horizontal and lines up underneath ribcage)
What are the axillary lines?
1) anterior axillary line
2) mid-axillary line
3) posterior axillary line
Anterior axillary line corresponds to what muscle?
Where is a chest tube usually placed?
Mid-axillary line in the 6th intercostal space
Posterior axillary line lines up with what muscle?
Lateral border of the latissimus dorsi
What are the posterior reference lines?
1) scapular lines
2) posterior median line
3 parts of the sternum
What 3 things articulate with the manibrium?
2) cartilage of first rib
3) cartilage of second rib
Which ribs have cartilage that attach to the sternum?
How many cervical vertebrae?
How many thoracic vertebrae?
How many lumbar vertebrae?
How many sacral vertebrae?
How many coccyx vertebrae?
How many total vertebrae?
Intervertebral foramen are formed by
intervertebral notches (nerves go through these)
1-7 (attach to sternum)
8-10 (attach to 7th rib cartilage)
On the head of the rib, there are two articulating surfaces that articulate with what?
What lies in the costal groove?
Intercostal nerve or vein
What is a typical rib?
Rib that has 3 attachments: body/pedicle and transverse process of it's own vertebrae, and body of vertebrae above it
What is the significance of Langer's lines?
They correspond to the alignment of collagen fibers in the dermis. Therefore surgical incisions parallel to these lines often heal with less scarring.
Significance of mammallary crease?
It is always in the same place, even when breasts droop--it's where breast attaches and is usually around the 6th rib
Each secretory unit of the breast...
has a duct that leads milk out towards nipple to the lactiferous sinus
What are the two main arteries that supply the breast?
Lateral thoracic (axillary artery) and internal thoracic (subclavian artery)
Lymphatics of the breast?
Lateral drainage by axillary lymph nodes and medial drainage by parasternal and both dump into clavicular nodes
What are some physical findings on breast exam?
- retracted nipple
- peau d'orange
- less mobile
How is dimpling of the breast caused?
if there is a carcinoma, it can cause involvement and retraction of suspensory (cooper's) ligaments which causes retraction of skin and thus dimpling
What can cause nipple retraction?
Carcinoma involvement of mammary ducts can cause the ducts to shorten and retract
What is peau d'orange
Skin edema that looks like orange peel, caused by obstruction of lymphatics (skin can become thick, hard, and orange)
Warm breasts is a sign of
more vasculature, can occur during different times of cycle or lactation, or carcinoma can recruit more blood vessels
What is the "milk line"?
Mammallary ridge--line from armpit down through nipple/breast and down to groin where breast tissue can develop
supernumerary breasts (more than 2)
extra nipple, third nipple, usually in chest area and looks like a mole
male breasts (usually endocrine problem)
Where can you find the cephalic vein?
between deltoid and pectorals major
What are the 3 origins of the pectoralis major?
What are the 2 heads of the pectoralis major?
- sternocostal (sternum and ribs)
What is 2 major movements of pectoralis major?
- adducts the arm
- some medial rotation of arm
Where does the cephalic vein dump into?
Axillary vein (goes through clavipectoral fascia to get there)
Where does the pectoralis minor attach?
- coracoid process of scapula and down to ribs 2-5
What is the major functions of the pectoralis minor?
- Depress shoulder
- Accessory muscle to inspiration by raising the rib cage
The neurovascular bundle located in the shoulder includes
- thoracoacromial artery
- thoracoacromial vein
- lateral pectoral nerve
What nerves innervate the pectoralis major?
- lateral pectoral nerve supplies upper part
- medial pectoral nerve supplies lower part
What nerve innervates the pectoralis minor?
medial pectoral nerve
What fuses at the rectum to form a complete muscle layer over rectum? Where else do they converge?
- the 3 tenia coli longitudinal muscles
Where is the cecum?
it's the pouch below the ileocecal junction that the appendix branches off
What is the opening to the appendix called?
Where will you normally find the appendix?
- 2/3 are retrocecal
- 1/3 are pelvic
What is the projection origin of appendix from cecum? Found 1/3 way from ASIS to umbilicus
The sigmoid colon has a very long _________ which causes what kind of complication?
- sigmoid mesocolon
- volvulus (rotation of gut on its mesentery which can lead to strangulation of the tissue) usually have to surgically remove
The rectum is complete covered by _____________. It is lined by _________. It has 3 ___________ which help support feces.
- longitudinal (tenia coli mergence)
- smooth mucosa
- semicircular rectal valves/folds