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Below is a sample chapter from the Gross Anatomy & Radiology Study Guide, 2010 ed.
3- Anterior Chest Wall
Netter's: Bony Framework of Thorax p185
Anterior Thoracic Wall p188-191
Topography of Lungs: Anterior View p196
1. What are the 3 segments of the sternum?
manubrium, body, and xiphoid process
- What is the name of the location where the manubrium and the body of the sternum meet?
sternal angle (angle of Louis)
- The costal cartilage of which rib articulates at the sternal angle?
2nd
2. Which rib articulates at the xiphoid-sternal junction?
7th
3. Where does the nipple lie on males?
4th intercostal space (midclavicular line)
4. Where is the 2nd intercostal space located? Where is the subcostal space located?
All intercostal spaces lay below the rib. (eg, 2nd intercostal space is below the 2nd rib)
The subcostal space is found below the 12th rib.
5. At what rib level does the internal thoracic (internal mammary) artery bifurcate. What 2 arteries are formed at this bifurcation?
• rib 6
• superior epigastric and musculophrenic arteries
6. Where are the following imaginary lines found?
midsternal line from jugular notch, through the middle of the sternum, to the xiphoid process
midclavicular line midpoint of the clavicle
anterioaxillary line where pectoralis major meets the axilla (armpit)
midaxillary line midpoint of axilla (armpit)
posterioaxillary line where latissimus dorsi meets the axilla (ECA p65)
7. What are the 4 spinal curvatures, and when do they develop?
Thoracic and sacral curvatures are seen at birth.
Cervical curvature develops after the baby begins to lift its head
Lumbar curvature develops when the baby stands and begins to walk. (ECA p272)
8. What are the 3 categories of ribs, and which ribs belong to each category?
• vertebrocostal (true) ribs 1-7 attach directly to sternum
• vertebrochondral (false) ribs 8-10 attach to cartilage of the rib directly above
• vertebral (floating, free) ribs 11-12 no anterior attachment
9. True or False? The lungs end at the first rib.
False, the lungs continue above the first rib.
10. What can be found in the costal groove of a rib in order from superior to inferior?
VAN- vein, artery, nerve
- When inserting a needle into the chest (thoracocentesis), is it best to insert above or below the rib?
Inserting above the rib insures that you will not damage the VAN found on the inferior surface of the rib.
(ECA p72)
- Between what muscles can the VAN be found?
between the innermost and internal intercostal muscles
11. What do Langer's lines represent?
lines of tension of collagen underneath the skin
- Is heavy scarring more or less likely to occur if an incision is made perpendicular to Langer's lines?
more likely (It is best to make an incision parallel to Langer's lines.)
Netter's: Mammary Gland, Arteries of, and Lymph p182-184
12. What are the four quadrants of the breast?
upper medial, lower medial, upper outer, lower outer (ECA p60)
13. Is breast located in superficial or deep fascia?
superficial fascia
- What is the name given to the region between the mammary glands and the deep fascia?
retromammary space
- What anchors the breast to the superficial fascia?
Suspensory Ligaments of Cooper
14. What is the function of the Glands of Montgomery found on the areola of the breast?
lubrication to prevent chaffing and irritation (esp. during pregnancy and breast feeding)
15. How many lactiferous ducts can be found in the nipple?
15-20
16. To where does the majority of lymphatic fluid drain from the breast?
• axillary lymph nodes (>75% drains here) •¬ lateral breast
• internal thoracic (parasternal) nodes •¬ medial breast
• to the opposite breast •¬ medial breast
• abdominal (inferior phrenic) nodes •¬ inferior breast
- Why is it important to understand where lymph drains?
Cancer metastasis frequently follows lymph drainage.
17. Which arteries supply the breast?
• internal thoracic (internal mammary) artery (including anterior intercostal artery branches)
• posterior intercostal arteries
• lateral thoracic artery
- What artery provides the chief blood supply to the breast?
internal thoracic artery (AKA internal mammary artery)
18. What is the meaning of the terms polymastia, polythelia, and gynecomastia?
polymastia- extra breast(s)
polythelia- extra nipple(s)
gynecomastia- male breasts
19. Along what line do the breast/nipples develop?
embryonic mammary ridge (AKA milk line)
20. What are 4 physical findings in advanced breast cancer, and what do they indicate?
• increased vascularity = excessive growth and nutrient use ® increased blood supply to area
• orange peel (peau d'orange)= lymph node involvement/blockage ® edema and thickened skin
• dimpling = suspensory ligament involvement
• nipple retraction / bleeding = lactiferous duct involvement (ECA p60)
- True or false? Nipple retraction is always a sign of breast cancer.
false
- How many patients presenting with a bloody discharge from the nipple will have breast cancer?
about 1 in 10
19. In which quadrant is breast cancer most commonly found?
upper outer quadrant
- As a result, where can most breast cancer metastasis be found?
axillary nodes
20. True or false? Breast cancer can occur in both males and females.
True, about 1.5% of breast cancers occur in men.
Muscles of Anterior Chest Wall
21. What is the origin, insertion, action, and nerve supply of the pectoralis major?
O: clavicle, sternum, costal cartilage of ribs
I: humerus
A: adduction, medial rotation, flexion
NS: lateral and medial pectoral nerves from the brachial plexus
23. What is the origin, insertion, action, and nerve supply of the pectoralis minor?
O: ribs 3-5
I: coracoid process
A: scapula forward, raises ribs in forced inspiration
NS: medial pectoral nerve
- What nerve pierces the pectoralis minor muscle?
medial pectoral nerve
24. What is the origin, insertion, action, and nerve supply of the serratus anterior?
O: ribs 1-8
I: vertebral border of scapula
A: prevents scapula winging, abducts arm above 90 degrees (ECA p420)
NS: long thoracic nerve
25. Which muscles originate on ribs 3-6 and help keep the internal thoracic (internal mammary) artery and vein down on the anterior chest plate?
transverse thoracis muscles
26. What are the intercostal muscles, and what are their actions?
external- inspiration (Netter's p189)
internal- expiration
innermost- expiration (hint: in-muscles give expiration, ex-muscles give inspiration)
- In what direction do the external and internal intercostal muscles run?
external- from lateral to medial going down (same direction as your hand in your pocket)
internal- from medial to lateral going down (same direction as your hand touching your face)
