Term
sternum (via costal cartilage) |
|
Definition
where do ribs 1-7 attach? |
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Term
|
Definition
which ribs are TRUE ribs? |
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Term
cartilage that attaches to cartilages of ribs superior |
|
Definition
where do ribs 8-10 attach? |
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Term
|
Definition
which ribs are FALSE ribs? |
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Term
have cartilages ending in posterior abdominal wall |
|
Definition
where do ribs 11-12 attach? |
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Term
|
Definition
which ribs are FLOATIONG ribs? |
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Term
|
Definition
what forms the infrasternal angle? |
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Term
|
Definition
area that separates ribs and costal cartilages |
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Term
bounded by 1st thoracic vertebrae, 1st pair of ribs, and superior border of the manubrium |
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Definition
what are the borders of the superior thoracic aperture? |
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Term
(inferior most ribs?) closed by the diaphragm |
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Definition
what are the borders of the inferior thoracic aperture? |
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Term
through the diaphragm or behind it |
|
Definition
where must structures pass that travel between the thoracic and abdominal cavities? |
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Term
inferior and superior costal facets of adjacent thoracic vertebrae |
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Definition
what do the articular facets of the head of a rib articulate with? |
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Term
costal facet of transverse process of vertebrae of the same number (ex: rib 6 with vertebrae 6) |
|
Definition
what does the tubercle of a rib articulate with? |
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Term
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Definition
the costal groove is in the (inferior/superior) side of the rib |
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Term
synovial, arthroidal(plane/gliding) joint except in the first rib = synchondrosis |
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Definition
part of the rib that forms a joint with the sternum, what kind of joint is this |
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Term
superior is on the superior border of the vertebra, inferior is on the inferior edge of the vertebrae (so it is reversed in its relationship to the rib with the top of the joint surface being the inferior costal facet) |
|
Definition
describe the location of the superior costal facet, inferior? |
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|
Term
1)head 2)neck 3)tubercle 4)angle 5)costal groove 6)shaft 7)sternal end |
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Definition
what are the 7 parts of the rib? |
|
|
Term
|
Definition
what side of the rib is the angle on? |
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|
Term
|
Definition
most superior part of the sternum |
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Term
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Definition
important in trachiotomy, on the central superior border of the manubrium |
|
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Term
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Definition
part of the manubrium that forms a joint with the clavicle |
|
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Term
|
Definition
where is the sternal angle? |
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Term
you want to prevent jamming the xyphoid process into the liver |
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Definition
why do you need to position your hands carefully when doing CPR? |
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Term
bifurcation of the trachea |
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Definition
what is deep to the anterior projection of the sternum? |
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|
Term
manubrium, body, xyphoid process |
|
Definition
list the 3 parts of the sternum |
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Term
|
Definition
manubriosternal and _________ joints fuse and become synostosis in older persons |
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Term
failure of fusion between halves of sternal bars during development |
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Definition
what causes sternal cleft/foramen? |
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Term
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Definition
what should you not confuse the sternal foramen for? |
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Term
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Definition
most common congenital deformity of the anterior wall of the chest , in which several ribs and the sternum grow abnormally. This produces a caved-in or sunken appearance of the chest. It can either be present at birth or not develop until puberty. |
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Term
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Definition
disorder sometimes considered to be cosmetic; however, depending on the severity, it can impair cardiac and respiratory function and cause pain in the chest and back, caused by overgrowth of bone |
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|
Term
1) costotransverse joints 2)costochondral joints 3)interchondral joints 4)sternocostal joints |
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Definition
name all of the joints that exist with ribs (4) |
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Term
|
Definition
which ribs do rotation at the costotransverse joints? |
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Term
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Definition
which ribs do gliding at the costotransverse joints? |
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|
Term
ribs 11-12 do not articulate with transverse processes |
|
Definition
which ribs do not have costotransverse joints? |
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Term
primary cartilaginous joints, usually do not experience movement |
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Definition
what type of joint is a costochondral joint? is it a very mobile joint? |
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Term
plane synovial joints between costal cartilages 6-9, fibrous articulation between cartilages 9&10. |
|
Definition
what type of joints are interchondral joints? and where are they located? |
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|
Term
joints between costal cartilage and sternum 1st = cartillaginous joints 2-7 are synovial plane joint |
|
Definition
what kind of joints are sternocostal joints? which ribs are involved? |
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Term
anteriorly, posteriorly(sagitally), and transversely |
|
Definition
what directions does the lung expand in inspiration? |
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|
Term
surface tension with the other layer of pleura (parietal pleura) |
|
Definition
what holds the pleural layer of the lungs (visceral pleura) out? |
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|
Term
pressure decreases, air flows in |
|
Definition
as the volume of the lungs increases, what happens to the pressure, and how does this drive the direction of air flow? |
|
|
Term
elastic recoil and relaxation of the diaphragm
also abdominal muscles (can't cough up mucous if there is a spinal cord injury affecting them) |
|
Definition
what is the main cause of expiration for the lungs? |
|
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Term
|
Definition
when the lateral most part of the ribs are elevated and the transverese diameter of the thorax increases this is called a _____ _____ ________ |
|
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Term
|
Definition
when the ribs are elevated at the neck (esp ribs 2-6) resulting in an increase in the anterior-posterior diameter of the thorax it's called a _____ ______ ______ |
|
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Term
|
Definition
what raises the ribs during inspiration |
|
|
Term
|
Definition
which ribs are shorter and more curved? |
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Term
sagittal-upper ribs transverse-lower ribs |
|
Definition
which ribs increase in sagittal diameter? in transverse? |
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Term
1)external intercostal 2)internal intercostal 3)innermost intercostal 4)transversus thoracis |
|
Definition
list the intercostal muscles |
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|
Term
origin: lower border of ribs insertion: superior border of rib below |
|
Definition
attachments of the external intercostal muscles: |
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|
Term
elevate ribs stiffen thoracic wall |
|
Definition
action of the external intercostal muscles |
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|
Term
anterior-inferior (hands in pockets)
fill in posterior part of intercostal space and ends at the intercostal margin |
|
Definition
which direction do the fibers of the external intercostal muscles run? what part of the intercostal space do they fill? |
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|
Term
external intercostal membrane |
|
Definition
non-muscular membrane on the anterior(Sternal) end of the external intercostal muscles made up of a continuation of the EI muscle's epimyseum. |
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|
Term
origin: inferior border of 1 rib insertion: superior border of rib below (Same as innermost intercostals) |
|
Definition
attachement site of the internal intercostal muscles: |
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|
Term
posterior inferior(90 degrees to external intercostals)
go from sternum to the posterior angle of the rib (don't meet the vertebral border) -same as innermost intercostals |
|
Definition
how are the fibers of the internal intercostal muscles oriented? how much of the intercostal space do they span? |
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|
Term
|
Definition
what is the action of the internal intercostals? |
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|
Term
origin: inferior border of 1 rib insertion: superior border of rib below (same as inner intercostals) |
|
Definition
attachment site of the innermost intercostal muscles |
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|
Term
posterior inferior(90 degrees to external intercostals)
go from sternum to the posterior angle of the rib (don't meet the vertebral border) -same as internal intercostals |
|
Definition
how are the fibers of the internal innermost muscles oriented? how much of the intercostal space do they span? |
|
|
Term
|
Definition
action of innermost intercostal muscles |
|
|
Term
the intercostal Nerve, Artery, and Vein |
|
Definition
what runs between the internal and innermost intercostal muscles? |
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|
Term
same layer as the internal intecostal, spanning more than 1 level of ribs |
|
Definition
where are the subcostal muscles found? |
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|
Term
costal cartilage of ribs 2-6, and internal surface of sternum and xiphoid process |
|
Definition
transversus thoracic muscles attachements: |
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|
Term
|
Definition
transversus thoracic muscles action |
|
|
Term
|
Definition
what layer of muscles are the transversus thoracic muscles in? |
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|
Term
internal thoracic artery and vein aka internal mammary |
|
Definition
neurovascular bundle between internal and innermost layer of intercostal muscles that runs parallel(and parasagittal) to the sternum |
|
|
Term
the internal thoracic artery because there are plenty of anastamoses with blood vessels and collateral circulation to the thorax |
|
Definition
what blood vessel in the thorax is often used as a graft for a coronary blockage? |
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Term
|
Definition
where does the internal thoracic artery originate? and vein drain? |
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|
Term
anteriorly: internal intercostal artery posteriorly: posterior intercostal arteries these vessels anastamose on the anterior lateral body wall |
|
Definition
what vessels form the collateral blood supply to the intercostal muscles? |
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Term
1)levator costae 2)serratus posterior superior 3)serratus posterior inferior 4)scalene muscle |
|
Definition
what are the posterior muscles of the thoracic wall (accessory respiratory muscles)? |
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|
Term
transvers processes of C7 to T12 vertebrae |
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Definition
|
|
Term
Superior surfaces of the ribs immediately inferior to the preceding vertebrae |
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Definition
|
|
Term
|
Definition
levator costae innervation |
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|
Term
|
Definition
|
|
Term
spinous processes of thoracic vertebrae |
|
Definition
serratus posterior superior origin |
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|
Term
|
Definition
serratus posterior superior insertion |
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|
Term
|
Definition
serratus posterior superior innervation |
|
|
Term
elevate the ribs which aids in inspiration |
|
Definition
serratus posterior superior action |
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|
Term
spinous process of lumbar vertebrae |
|
Definition
serratus posterior inferior origin |
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|
Term
|
Definition
serratus posterior inferior insertion |
|
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Term
|
Definition
serratus posterior inferior innervation |
|
|
Term
primarily proprioceptive, but also depress the lower ribs, aiding in expiration |
|
Definition
serratus posterior inferior action |
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|
Term
transverse process of cervical vertebrae |
|
Definition
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|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
primarily neck flexion, but help hold neck steady to elevate ribs when you need to take a deep breath |
|
Definition
|
|
Term
just below the costal groove on the inferior border of the ribs |
|
Definition
where are the intercosta nerve/artery/vein found in relation to the ribs? |
|
|
Term
(most superior) Vein artery nerve (most inferior)
(VAN) |
|
Definition
what is the order of structures in the subcostal neurovascular bundles? |
|
|
Term
posterior branch of posterior intercostal arteries |
|
Definition
what blood vessel runs next to the dorsal rami? |
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|
Term
posterior intercostal artery |
|
Definition
what blood vessel comes off the aorta and runs between the internal and innermost intercostal muscle layers? |
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|
Term
comes off in lateral body wall and runs superficial to external layer of intercostal muscles.
does not anastamose, just overlaps the posterior branch |
|
Definition
where does the lateral branch of the posterior intercostal artery come off? does it anastomose with the posterior branch? |
|
|
Term
the lateral cutaneous nerve |
|
Definition
what structure follows the lateral branch of the posterior intercostal artery |
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|
Term
sensory and sympathetics to the corresponding dermatome |
|
Definition
what info is carried in the lateral cutaneous branch of the intercostal nerve? |
|
|
Term
somatic motor neurons to intercostal muscles, + sensory & sympathetics to the body wall dermatome
NOTE: the ANS does control breathing, BUT, the nerves to the intercostal muscles are somatic motor neurons, not sympathetic neurons!!!!! |
|
Definition
what info is carried by the intercostal nerves? |
|
|
Term
parietal pleura, so there is sharp localized pain with pleurisy |
|
Definition
which layer of pleura receives somatic sensory innervation? |
|
|
Term
sweat glands, arrector pili muscles, and smooth muscles of the vessels of the body wall. NOT breathing muscles |
|
Definition
What do the sympathetics in intercostal nerves go to? |
|
|
Term
ventral rami (but not all ventral rami are intercostal n., ex: t1 branches to the brachial plexus) |
|
Definition
Intercostal nerves are ______ ____ |
|
|
Term
|
Definition
what side of the body is the azygous system located on? |
|
|
Term
superior vena cava above, inferior vena cava below the diaphragm |
|
Definition
where does the azygous system drain above the diaphragm? below? |
|
|
Term
no, so it's alright if it gets blocked, as there are alternate routes of blood flow |
|
Definition
does the azygous system have valves? |
|
|
Term
ascending lumbar vein - There are 2 ascending lumbar veins, the left one is continuous with the hemizygous vein, the right continuous with the azygous vein |
|
Definition
what is the azygous vein called below the diaphragm? |
|
|
Term
superior: accessory hemizygous to superior intercostal vein
inferior: hemiazygous vein |
|
Definition
what are the branches off the azygous system on the left side? |
|
|
Term
|
Definition
how many vessels normally cross from the azygous to the hemiazygous system? |
|
|
Term
nipple:T4 umbillicus: T10 inguinal ligament: T12 |
|
Definition
what markers are used to identify dermatomes, and what are they? |
|
|
Term
|
Definition
what dermatome does appendicitis pain go to? |
|
|
Term
|
Definition
what dermatome does Myocardial infarction pain go to? |
|
|
Term
superior border of the ribs because the neurovascular bundle lies just below the inferior border of each rib |
|
Definition
where would you put the needle when you perform a thoracocentesis? |
|
|
Term
|
Definition
chief muscle of inspiration |
|
|
Term
relaxed: dome contracted: flat |
|
Definition
shape of the relaxed diaphragm, contracted? |
|
|
Term
|
Definition
what forms the floor of the thoracic cavity and the roof of the abdominal cavity? |
|
|
Term
ventral rami(on each side) of C3, 4 and 5 keep the diaphragm alive |
|
Definition
what nerves innervate the diaphragm? |
|
|
Term
there is paradoxical movement, one side pushes on the abdomen, which pushes the other side up so it does the opposite of what it should |
|
Definition
what happens when there is paralysis of 1/2 of the diaphragm(hemidiaphragm)? |
|
|
Term
the right side, because of the presence of the heart on the left side |
|
Definition
what side of the diaphragm is always higher? why? |
|
|
Term
|
Definition
contraction of the diaphragm affects volume/presure in the thorax and ____ |
|
|
Term
1) peripheral muscular layer with fibers converging on the tendon 2) aponeurotic central tendon fused with the inferior surface of the pericardium |
|
Definition
what are the 2 parts of the diaphragm, where are they located? |
|
|
Term
|
Definition
what are the 3 parts of the muscular part of the diaphragm? |
|
|
Term
right: 1st 3 lumbar vertebrae left: first 2 lumbar vertebrae |
|
Definition
where does the right crus originate? the left crus? |
|
|
Term
yes! the esophagus passes through the right crus at T10 |
|
Definition
are the crus contractile? what structure do they wrap around? |
|
|
Term
median arcuate ligament, it is non-contractile and anterior to the aorta, so the aorta is not affected by diaphragm movements |
|
Definition
what ligament passes over the aorta between the two crura? why is this significant? |
|
|
Term
psoas and quadratus laborum |
|
Definition
meDIAL and lateral arcuate ligaments pass over what muscles? |
|
|
Term
in the central tendon at T8-T9 disc
yes, contraction of the diaphragm WIDENS this lumen |
|
Definition
where is the vena caval foramen for the inferior vena cava? is this area contractile? |
|
|
Term
inferior vena cava, RIGHT phrenic nerve, lymphatic vessels |
|
Definition
what structures run through the vena caval foramen? |
|
|
Term
through the right crus at T9-T10
yes, contraction of the diaphragm CONSTRICTS this lumen (put pressure on abdominal cavity with inspiration, want the esophagus to be constricted so that it is not pushed up through the diaphragm) |
|
Definition
where is the esophageal hiatus? is this area contractile? |
|
|
Term
esophagus, vagal trunks, esophageal branches of the LEFT gastric vessels (something about portal hypertension with cirrhosis of the liver) |
|
Definition
what structures go through the esophageal hiatus? |
|
|
Term
|
Definition
what happens when the muscles around the esophageal hiatus are weakened? |
|
|
Term
poeterior to the diaphragm between crura at T12
doesn't pierce the diaphragm, so contraction has no affect on blood flow |
|
Definition
where is the aortic hiatus? is this contractile? |
|
|
Term
aorta thoracic duct (lymph) azygous vein |
|
Definition
what is located in the aortic hiatus? |
|
|
Term
1) pericardiophrenic arteries - runs with phrenic nerve 2) musculophrenic arteries - anterior margins of diaphragm 3) superior phrenic arteries - posterior part of diaphragm 4) inferior phrenic arteries - inferior surface of diaphragm |
|
Definition
what vessels supply blood to the diaphragm? list each vessel and what part of the diaphragm they supply |
|
|
Term
the internal thoracic artery |
|
Definition
what artery do the pericardiacophrenic and musculophrenic arteries come off? |
|
|
Term
in lymphatic vessels through the venacaval foramen (why we see liver cancer and right side lung cancer together) |
|
Definition
where do cancers spread from abdominal to thoracic cavities? |
|
|
Term
musculophrenic (the other branch is the superior epigastric) this branching happens around the 6th intercostal space |
|
Definition
when the internal thoracic artery branches, it becomes the _____ which supplies the remaining anterior costal arteries |
|
|
Term
the AORTA above the diaphragm, before the hiatus, (inferior is the same below the hiatus) |
|
Definition
what artery do the superior phrenic arteries come off of? |
|
|
Term
|
Definition
what is the motor innervation of the diaphragm? |
|
|
Term
phrenic nerve to the central portion and intercostal nerves T7-T12 to the peripheral parts |
|
Definition
what is the sensory innervation of the diaphragm? |
|
|
Term
septum transversum->central tendon dorsal esophageal mesentery peripheral rim of body wall pleuroperitoneal membranes |
|
Definition
the diaphragm is formed from the fusion of which 4 embryonic structures? |
|
|
Term
the septum transversum develops from cervical myotomes then migrates caudally to form the anterior part of the diaphragm |
|
Definition
why is the diaphragm innervated by cervical spinal cord segments? |
|
|
Term
-foramen Morgagni -foramen Bochdalek -Deficiency of the whole central tendon -Congenitally large esophageal hiatus |
|
Definition
what 4 congenital defects can lead to hernia? |
|
|
Term
|
Definition
which are more common, acquired or congenital hernia? |
|
|
Term
middle age when the esophageal hiatus has weakened and widened |
|
Definition
when do acquired hernia's usually occur in patients? |
|
|
Term
|
Definition
what are the two types of hiatus hernia? |
|
|
Term
|
Definition
upper stomach and lower esophagus slide up when the patient bends over or lies down, causing REGURGITATION |
|
|
Term
|
Definition
cardia remains in normal position and fundus rolls upward (no regurgitation) |
|
|
Term
|
Definition
the breast contains ____ lobules of glandular tissue lying within fatty tissue |
|
|
Term
the nipple, via lactiforous ducts |
|
Definition
where do mammary glands drain |
|
|
Term
|
Definition
pigmented area around the nipple |
|
|
Term
|
Definition
connective tissue strips that attach to the dermis and support the lobules of the breast |
|
|
Term
|
Definition
a potential space exists between breast tissue and the pectoral fascia called the ____ |
|
|
Term
normally there is no connection between the breast and pectoral fascia, but if there is a tumor, the breast can become anchored to the pectoral fascia inhibiting this motion |
|
Definition
sometimes there is an assymmetry between breasts as one does not glide up and down the thoracic wall like it should, what might cause this? |
|
|
Term
the lymph nodes have cancerous emboli in the channels and lymph builds up and swells around the hair follicles which are anchored to the dermis. |
|
Definition
what causes the orange peel appearance in some types of breast cancer? |
|
|
Term
the lactiferous ducts can become retracted (due to cancer) pulling in on the nipple |
|
Definition
what can cause the nipple to become inverted? |
|
|
Term
no, they go to the surface independently |
|
Definition
do lactiferous ducts join together before draining out the nipple? |
|
|
Term
upper inner upper outer lower inner lower outer axillary tail
you can also use a clock face to describe the breast |
|
Definition
what are the regions of the breast? |
|
|
Term
there are lots of lymph nodes that travel through the axilla, and it is a common sight of cancer |
|
Definition
why is the axillary tail of the breast important? |
|
|
Term
internal thoracic-medial breast lateral thoracic artery-lateral breast thoracoacromial artery-superficial shoulder and upper breast posterior intercostal arteries (branches from thoracic aorta) |
|
Definition
arterial blood supply to the breast comes from the mammary branches of what vessels? (what part of the breast does each vessel supply?) |
|
|
Term
axillary vein internal thoracic vein |
|
Definition
what are the venous vessels of the breast? |
|
|
Term
|
Definition
what percent of lymphatic drainage is to the axillary lymph nodes |
|
|
Term
|
Definition
which axillary lymph nodes do not normally carry lymph? |
|
|
Term
subscapular->drains down posterior thoracic wall, not the breast usually |
|
Definition
which axillary lymph node can be palpated on the axillary fold if it is enlarged (where does it drain?) |
|
|
Term
lateral, subscapular, pectoral, central, & apical |
|
Definition
list the lymph nodes of the axilla |
|
|
Term
|
Definition
what percentage of lymphatic drainage is to infraclavicular, supraclavicular, and parasternal nodes |
|
|
Term
|
Definition
if there is cancer in this lymph node, it means that cancer has likely spread to the venous system |
|
|
Term
|
Definition
which lymph node goes to the supraclavicular without going to the axillary node? |
|
|
Term
|
Definition
if breast cancer moves from one breast to the other, what lymph vessel does it travel through? |
|
|
Term
|
Definition
which breast lymph node receives drainage from the upper limb? |
|
|
Term
pectoral->central->apical |
|
Definition
where does the pectoral lymph node drain? from there? |
|
|