(4) Chest Wall, Lungs, and Breasts

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___ nerves arise near the angles of the ribs

collateral

the internal thoracic artery arises from the ____

subclavian artery

the internal thoracic artery divides at the ____ intercostal space

6th

the internal thoracic artery divides into the ___ and ____

- superior epigastric artery
- musculophrenic artery

dermatomes of the thorax

the intercostal nerves are the ___ rami of the first ___ thoracic spinal nerves

ventral; 11

the ventral ramus pf the 12th thoracic spinal nerve is called the ___ nerve

subcostal

the intercostal nerves exit from the vertebral canal through the intervertebral foramen, enter the intercostal spaces, and run between the ___ and ____ intercostal muscles

innermost and internal

the intercostal artery, vein, and nerve runs in the ____ under each rib

costal groove

the _____ runs superior to each rib

collateral neurovascular bundle

the CT between the intercostals is called the ___

internal intercostal membrane

the CT surrounding the costovertebral joint is the ___

radiate ligament

the intercostal artery, vein, and nerve runs ___ to the rib

inferior

the collateral nerve and vessels runs ___ to the rib

superior

because of the location of the intercostal nerve, artery, and vein, you always want to place a needle ____ to the rib

superior

the intercostal spaces 3-11 have posterior intercostal arteries that branch off of the ___

descending thoracic aorta

the artery below the 12th rib is the ____, giving blood to the posterior thoracic wal

subcostal artery

the main blood supply to the anterior chest wall is the ____

internal thoracic artery

the internal thoracic artery is a branch off of the ____

subclavian artery

the internal thoracic artery gives rise to the _____, which supply the intercostal spaces

anterior intercostal arteries

the internal thoracic artery ends at the _____ intercostal space

6th

at the 6th intercostal space, the internal thoracic artery branches into the ___ and _____

superior epigastric and musculophrenic

the superior epigastric artery is always the ____ branch

medial

the musculophrenic artery is always the ____ branch

lateral

the main blood supply to the posterior thoracic wall is the posterior intercostal artery, which is a branch off of the ___

descending aorta

the main blood supply to the anterior thoracic wall is the anterior intercostal artery, which is a branch off of the ____

internal thoracic artery

the ___ is the passageway into the lung tissue

hilum

there are ___ lobes in the right, ___ lobes in the left lung

3, 2

there are ___ oblique fissures

2

there are ___ horizontal fissures

1

the lingula and cardac notch are in the ____ of the ___ lung

superior lobe; left lung

the ____ is a mesenteric fold that extends between the inferior part of the medastinal surface of the lung and the pericardium

pulmonary ligament

the right main bronchi connects to the ___

hilum directly

the left main bronchi is ___ to the aortic arch and ____ to the esophagus

inferior, anterior

in the RIGHT LUNG, the ____ fissure is more anterior and only spans the anterior part of the lung

horizontal

in the RIGHT LUNG, the ____ fissure is anterior and posterior and cuts down through the entire lobe

oblique

the structures that are at the right hilum are the ___ (8 things)

- pulmonary arteries
- pulmonary veins
- superior lobar bronchus
- right main bronchus
- bronchial vessels
- broncho-pulmonary lymph nodes
- inferior lobar bronchus
- middle lobar bronchus

the hilum is surrounded by the ____

pleural sleeve

the pleural sleeve has a folded extension inferiorly known as the ___, which is where the visceral pleura folds in

pulmonary ligament (though it isn't actually a ligament)

in the LEFT LUNG, there is a(n) _____ fissure

oblique

the ____ is in the left superior lobe, and wraps around the base of the heart

lingula

the indent in the left lung for the heart is known as the ___

cardiac impression (cardiac notch)

there are a fair number of lymph glands in the hilum; this means that if there is lung CA, the earliest metastases might manifest as ___

enlarged hilar lymph nodes

the structures that are at the left hilum are the ___ (7 things)

- pulmonary artery
- pulmonary veins
- bronchial vessels
- broncho-pulmonary lymph node
- inferior lobar bronchus
- left main bronchus
- superiror lobar bronchus

___ is an acquired disorder of the major bronchi and bronchioles that is characterized by permanent abnormal dilatation and destruction of bronchial walls

bronchiectasis

bronchiectasis is most commonly found in the ___ lobe

lower

the 2 signs of severe bronchiectasis are ____ and ____

- saccular dilatations
- grape-like clusters with pools of mucus

the breast is a modified ___

sweat gland

the breast is embedded in ____

superficial fascia

the breast has fat and ____ activity contributing to size and contour

secretory

the breast is rudimentary in ___ and ___

males and prepubertal females

the breast overlies ribs __-___ in the young adult female

2-6

the pigmented, projecting nipple is surrounded by a circular, pigmented ____ in adult females

areola

in males and young females, the nipple lies over the ____ intercostal space; in adult females, position of the nipple varies

4th

the breasts are supported by ____ ligaments that attach to overlying skin

suspensory (Cooper)

the breasts are separated from deep fascia over pectoralis major muscle (pectoral fascia) by the ____ space, which allows movement on the chest wall

retromammary space

the mammary gland has ___-__ lobes

15-20

each of the lobes of the mammary gland are drained by a single corresponding ____, which opens on the nipple

lactiferous duct

the ____ is an expansion for each lactiferous duct that is deep to the nipple, and serves as a milk reservoir during lactation

lactiferous sinus

the mammary gland may extend into the axilla as the ___

axillary tail of Spence

the lymphatic drainage of breast pathologically facilitates the metastasis of ___

breast CA

___% of women have malignant tumors of the breast

4

____ tumors of the breast often place traction on the suspensory ligaments (of Cooper), which causes DIMPLING of the skin of the breast

scirrhous (hard) tumors

the breasts lymphatics drain primarily into the _____ lymph nodes

anterior axillary (pectoral)

cells from a tumor in the medial part of the breast would drain towards the _____ nodes

internal thoracic (parasternal) nodes

the breast is split into 4 quadrants, which are ___

superior medial and lateral, inferior medial and lateral

the ___ stages of development are important in premature or delayed puberty

Tanner

there are __ stages of Tanner development

5

____ is the name for accessory nipples

polythelia

____ is the name for accessory breasts

polymastia

____ is the name for adolscent males with breasts

gynecomastia

___% of males get breast CA

1.5

the ____ is the line where extra nipples tend to appear because of the course of nipples through development

mammary ridge

4 signs of breast cancer are ____

- skin dimpling
- edema of the skin
- nipple retraction and deviation
- abnormal contours of the breast

edema of the skin of the breast is known as the ____ sign

Peau d'orange (looks like skin of an orange peel)

a common method of screening for BRCA is ___

mammography

____ is a condition that makes it difficult to screen with mammograms

fibrous cystic disease (not really a disease)

some fibrous tissue and calcification is normal in the breast, but an isolated lesion is ___

an early sign of BR CA

scarring and disfiguration of the skin around the breast is a sign of ____

breast cancer

male thorax

female thorax

from an anterior view, the ____ notch is also known as the suprasternal notch

Jugular

from an anterior view, the jugular notch is in line with the _____ line

anterioe median (midsternal)

from an anterior view, the ____ lines are on either side of the midsternal line

midclavicular

from an anterior view, the ____ angle is a little below the jugular notch

sternal

from a lateral view, the line that is right in the middle of the axilla is the ___

midaxillary line

from a lateral view, the line that is a few inches in front of the midaxillary line is the __

anterior axillary line

from a lateral view, the line that is a few inches behind the midaxillary line is the ____

posterior axillary line

from a posterior view, the the _____ line is in line with the spinous processes

posterior median (midvertebral)

from a posterior view, the _____ lines are lateral to the midvertebral line

scapular

the ____ muscle inserts inferiorly to the axilla

latissimus dorsi

the ____ muscle is in the front of the chest

pectoralis major

digitations of the ___ muscle can be seen on the chest

serratus anterior

the ____ margins are the borders of the bottom of the ribcage

costal

supernumary nipple

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