Regional Anatomy III Week 1

What separates the fibrous septa of the superficial chest?

Suspensory ligaments of Cooper

What is the name of dimpling of the skin on the breast, created by suspensory ligaments?

Peau d'orange

What is responsible for delivering milk to the nipple from each lobule?

Lactiferous duct ("milk/mammary duct")

What is the name of the space between the tissue and deep fascia covering the pectoralis major?

Retromammary space

Which artery has perforating branches to anteromedial breast?

Internal thoracic artery

Which artery branches originate from the axillary artery?

Lateral thoracic and thoracoacromial branches

What artery branches originate from the posterior intercostal arteries?

Lateral mammary branches

What artery branches originate from the internal thoracic artery?

Mammary branches

Where do veins of the breast drain to?

Axillary, internal, lateral, and posterior thoracic veins

Which quadrants of the mammary contain the pectoral group of the axillary lymph node group (ALNG)

Lateral quadrants

Which quadrants of the mammary contain internal thoracic lymph nodes?

Medial quadrants

What is an AKA for internal thoracic lymph nodes?

Parasternal lymph nodes

What is the path of lymph drainage from the mammary?

Nipple, areola, and mammary gland nodules -> subareolar lymph plexus -> >75% ALNG; <25% parasternal lymph nodes

What is the posterior boundary of the thoracic inlet?

Body of T1

What is the anterior boundary of the thoracic inlet?

Superior border of manubrium

What is the lateral border of the thoracic inlet?

1st rib and 1st costal cartilage

What are the borders of the Thoracic outlet?

Body of T12

Inferior border of 12th rib

Tip of 11th rib

Inferior borders of 10th-7th costal cartilage

Xiphisternal joint

What is the aka of the thoracic outlet?

Inferior thoracic aperture

At what vertebral level is the manubrium of the sternum?

T2-T4

What is the AKA for the sternal angle?

Angle of Louis

At what vertebral level is the sternal angle?

T4-T5

At what vertebral level is the Sternal body?

T5-T9

What is the AKA of the sternal body?

Gladeolus

What is the vertebral level of the Xiphoid process?

T10

T or F: the Xiphoid process is never bifid or perforated

False (it can be either)

What portion of the mediastinum contains the thymus?

The anterior division of the inferior mediastinum

What portion of the mediastinum contains the pericardial sac with heart and roots of great vessels and structures that form root of lungs?

Middle division of the inferior mediastinum

What portion of the mediastinum contains the esophagus, vagus nerve, thoracic aorta, azygos vein, and sympathetic trunk?

Posterior division of the inferior mediastinum

What is the name of the beginning of the aorta within the pericardial sac?

Root

What are the branches of the Ascending aorta?

left and right coronary arteries

What are the branches of the aortic arch?

brachiocephalic trunk, left common carotid artery, left subclavian artery

What are the branches of the brachiocephalic trunk?

right subclavian and right common carotid arteries

What structure separates the descending thoracic aorta from the abdominal aorta?

The Diaphragm

At what vertebral level is does the descending thoracic aorta become the abdominal aorta?

T12

What is the motor function of the phrenic nerve?

Control of the diaphragm

What nerve is sensory to the pericardium, mediastinal pleura, central part of diaphragmatic pleura, and the parietal peritoneum on the underside of the diaphragm?

Phrenic nerve

Where can pain of the phrenic nerve refer to?

The shoulder

What nerve crosses left side of aortic arch, passes anterior to root of left lung, descends into the pericardial sac, and reaches diaphragm close to apex of heart?

Left phrenic nerve

What nerve descends along right side of brachiocephalic vein and SVC, passes anterior to the root of the right lung, descends between pericardial sac and reaches the diaphragm on the right side of the IVC?

Right phrenic nerve

What nerve provides visceral motor (parasympathetic) and visceral sensory fibers to esophagus, trachea, lungs, and heart?

Vagus nerve

What nerve is provides motor and sensory fibers to the larynx?

Left recurrent laryngeal nerve

What nerve ascends the larynx?

Right recurrent laryngeal nerve

How many ganglia form the chain of the thoracic sympathetic trunk?

10 or 11

What does the stellate ganglion refer to?

the cervicothoracic ganglion

What two ganglia form the cervicothoracic ganglion?

The first thoracic ganglion and the inferior cervical ganglion

Which ganglia give branches control the thoracic viscera?

The upper (4) ganglia

Which ganglia make up the greater splanchinic nerve?

T5-9

Which ganglia make up the lesser splanchnic nerve?

9 and 10 or 10 and 11

Which splanchnic nerve may be absent?

Least splanchnic nerve

What is the function of the intercostal nerves?

carry motor, sensory, and autonomics

What stage of breast cancer involves abnormal cells in the breast?

Stage 0 (100% SR)

What stage of breast cancer involves a tumour less than 1 inch in size?

Stage 1 (98% SR)

What stage of breast cancer involves a tumour less than two inches in size that may spread to axillary lymph nodes?

Stage 2 (88% SR)

What stage of breast cancer involves a tumour larger than 2 inches across which has spread to axillary lymph nodes

Stage 3 (52% SR)

What stage of breast cancer may involve the first appearance of peau d'orange?

Stage 3

What stage of breast cancer involves cancer that has spread beyond the breast?

Stage 4 (16% SR)

Which mastectomy involves removal of the entire breast, including pectorals and axillary lymph nodes?

Halstead/radical mastectomy

Which mastectomy involves removal of the breast and the ALND, but not pectoral muscles

Modified radical mastectomy (MRM)

Which mastectomy involves removal of the breast without axillary dissection

Total/simple mastectomy

Which mastectomy involves removal of breast, nipple, and areola with preservation of breast skin

Skin-sparing mastectomy

Which mastectomy involves removal of all the breast with preservation of nipple and areola

Nipple sparing/total skin-sparing mastectomy

Which mastectomy involves excision of a quadrant of breast tissue containing disease, including skin and pectoral fascia

Quadrantectomy

Which mastectomy involves excision of a segment of breast tissue with disease without skin or muscle "partial or segmental mastectomy"

Lumpectomy

Which mastectomy involves excision of breast tissue with disease and use of techniques to reshape remaining tissue

Oncoplastic surgery

Which mastectomy involves removal of level 1 and level 2 axillary lymph nodes

Axillary node dissection

Which mastectomy involves removal of the first few axillary lymph nodes that drain the breast, identified using dyes

Sentinel lymph node biopsy