Anatomy Answers
9/3
1. Triangle of auscultation
2. Transverse cervical artery (near spinal accessory nerve)
3. Inferior lumbar triangle of Petit
4. Fascial cleft between superficial (fatty and membrane layers) and deep
5. Intermuscular septum (carries vascular bundles)
6. Protection, sensation, thermoregulation, containment (keeps water
in), synthesis and storage of vitamin D
7. Epidermis (avascular, derivatives are sweat, sebaceous glands, hair),
dermis (vascular, nerve endings), superficial fascia (fatty, membrane),
fascial cleft, deep fascia, subserous facsia (thoracic, abdominal, pelvic
cavities)
8. Superficial fascia
9. Floor of the intertubercular groove
10.
Parallel to tension lines
11.
Dermis
12.
Diarthrosis (synovial) - knee and hip; cartilaginous – spinal cord;
synarthrosis (fibrous) – skull sutures, teeth
13.
Joint capsule, articular cartilage, synovial membrane and fluid,
collateral ligaments (mcl), intra articular ligaments; blood vessels not
to cartilage, few to ligaments
14.
Arthrocentesis: diagnose gout, type of arthritis, infection; treat
inflammation
15.
See diagrams/flashcards
16.
Pedicle and lamina
17.
Cervical (transverse foramen/foramina; small bean bodies, short
bifid process), thoracic (heart bodies, long inferiopostererior spinous
processes, articular faces for ribs), lumbar (large bean bodies, short
square processes)
18.
C1 is atlas, no body (anterior arch), C2 is axis, dens (odontoid
process) fits into anterior arch
19.
Intervertebral foramen made from inferior and superior
intervertebral notches
20.
Intervertebral discs are cartilaginous, made of annulus fibrosus
and nucleus pulposus; facet joints are synovial, made from superior
and inferior articulating process
21.
See note cards
22.
Posterolateral herniaton (more common, around posterior
ligament; central herniation (tear through posterior ligament, could
compress spinal cord): nucleus pulposous leaks out through tear in
annulus fibrosus
23.
Fascia (covering), tendon, ligament, aponeuroses (broad,
sheetlike tendons)
24.
Pars interarticularis
25.
Trapezius, rhomboid major/minor, latissimus dorsi, levator
scapulae, serratus posterior superior/inferior
26.
Although it is innervated by CN XI (spinal accessory nerve,
cervical nerve 11), different fibers going to different parts of the
muscle can activate at different times (can elevate, depress, rotate,
retrace scapula)
8/4: back
2
1. Primary is kyphosis (entirely kyphotic as a baby): thoracic, sacral;
secondary is lordosis: cervical, lumbar; scoliosis
2. Facet joints of sup/inf articulating processes of spine; small amount of
movement allowed to each joint amplifies over the whole
3. Stable: no spinal deformity or neurologic problem, spine can still carry
weight (fracture of spinous/transverse process, fracture of anterior
edge of vertebral body); unstable: difficult for spine to distribute/carry
weight, chance of progression and neurological damage (compression
of whole vertebra, dislocation); natural and unnatural causes
4. Main function to extend vertebral column (bilateral contraction) or
cause lateral flexion (unilateral contraction). All innervated by dorsal
primary rami
a. Superficial intrinsic back muscles: head rotation is unilateral
contraction, neck extension if bilateral
i. Splenius capitis (proximal: upper thoracic vertebra; distal:
mastoid process)
ii. Splenius cervicis: (proximal: upper thorasic vertebra;
distal: transverse process of cervical vertebra); located
deep to sp capitis
b. Intermediate intrinsic back muscles: erector spinae – inferior
attachment at lumbar and thoracic spines, sacrum, iliac crest;
bilat cont causes extension, unilat is lateral flexion
i. “I Love Spaghetti”
1. Iliocostalis: most lateral, divided into iliocostalis
lumborum, thoracis and cervicis
a. Superior attachment is rib angles and cervical
transverse processes
2. Longissimus: beefiest in texture: divided into
thoracis, cervicis and capitis
3
a. Superior attachment is transverse processes
and mastoid process
3. Spinalis: don’t need to know subgroups, runs along
spinous processes
c. Deep intrinsic back muscles
i. Transversospinal group: arise from transverse processes,
attach more cranially to occipital bone or cervical spinal
processes
1. Semispinalis capitis attaches to occipital bone
2. Semispinalis cervicis lies deep to capitis and attaches
proximally to C2
3. Multifidus cross 3-5 vertebra before attaching (most
prominent in lumbar)
4. Rotators cross 1-2 segments and are the deepest
ii. Minor deep back muscles
1. Interspinales attach between adjacent spinous
processes
a. stabilization
2. Intertransversarii attach between adjacent
transverse processes
a. stabilization
3. Levatorus costarum attch from transverse process to
ribs (not very strong, helps w/ respiration)
d. Suboccipital muscles: deep to splenius capitis and semispinalis
capitis; involved with head movement and proprioception;
innervated by suboccipital nerve (C2)
i. Obliquus capitis inferior (attaches to transverse process
C1), obliquus capitis superior (C1 transverse process to
4
skull), rectus capitis posterior major, rectus capitis
posterior minor (both from spinous processes to skull)
5. Longissimus capitis; obliquus capitis inferior
6. Obliquus capitis inferior, obliquus capitis superior, rectus capitis
posteriormajor: site for vertebral artery
7. Transverse: levator scapulae, iliocostalis, longissimus, levatorus
costarum, intertransversarii, obliquus capitis superior/inferior,
splenius cervicis, transversospinal (semispinalis, rotator, multifidus)
8. Muscles that are primarily known for extension can slowly control
flexion by working against gravity (ie epaxial muscles, biceps)
9. See Netter’s (clavicle, trapezius, sternocleidomastoid; spinal accessory,
transverse cervical, supraclavicular, lesser occipital, great auricular
(sp?)
8/4: spinal cord
1. Cervical and lumbar enlargements (around L1) for more neurons to be
supplied to limbs
2. L1-L2 in adults, L3 in infants; conus medullaris
3. Foramen magnum
4. Cauda equina (horse tail) are the dorsal and ventral nerve roots of
T10-Co1 that have to travel inferiorly in v canal to reach proper
intervertebral foramen; filum terminae (terminal fiber) made of pia
mater, goes from conus medullaris to coccyx
5. 31 pairs: C1-C7 exit above eponymous vertebra; C8 is extra, exits
below C7, therefore all the rest enter below eponymous vertebra
6. white matter is myelinated axons, gray is neuronal and glial cells
7. see below
5
a. outermost is dura mater (tough mother) that extends to S2 and
has dorsal sleeves extending to distal end of dorsal root ganglion
and a dural sac
b. next is arachnid membrane that is deep to dura mater but
attached
c. pia mater is stuck to spinal cord, has denticulate ligaments (saw
tooth membranes that help anchor spinal cord to dura mater);
filum terminale is also made of pia mater
8. the dorsal root carries sensory info to CNS so cell bodies are outside,
whereas ventral horn has somatic motor cell bodies (neurons can
cross over once in spinal nerve and can enter either dorsal or ventral
rami); no synapses in ganglion, only cell bodies!
9. See note cards
10.
Epidural space lies superficial to dura mater, contains fat and
internal vertebral venous plexus to drain spinal cord; subarachnid
space contains CSF
11.
L3-L5
12.
T4 is nipple, T10 is umbilical, L1 is lower end of trunk
13.
three
14.
Not all peripheral nerves correspond one to one with spinal cord
levels (form plexus)
15.
One anterior spinal artery, two posterior spinal arteries:
diminish in size as they proceed caudally; segmental arteries at each
vertebral level anastamose w/ vertebral arteries; radicular arteries
supply dorsal and ventral roots
16.
Lumbar arteries in lumbar region, posterior intercostal arteries
in thoracic region, branches of vertebral, ascending cervical, and deep
cervical arteries in cervical region.
6
17.
Deep to semispinalis cervicis
Early Embryology
1. cytotrophoblasts
2. fetal component of placenta; extraembryonic mesoderm (made from
hypoblasts) and cytotrophoblast
3. –trophoblast splits in two layers (syncytioblast, cytoblast)
-embryoblast splits in two: epiblast, hypoblast
-two cavities develop: amnionic cavity, primitive yolk sac
-hypoblast moves in two waves: exocoelomic membrane (secretes
extraembryonic mesoderm), definitive yolk sac
4. hypoblast
5. oocyte ruptures from follicle, fertilized by sperm in ampula, becomes
zygote
-day 1-5: cleavage from 2 cell to 8 cell stage, then compaction and
morula (16 cell) – get inner cell mass (embryoblast) and outer cell mass
(trophoblast)
-day 5/6: “hatching” from zona pellucida, icm migrates to embryonic
pole, blostocoel forms
-day 7: trophoblast becomes syncytiotrophoblast (secretes hcg) and
cytotrophoblast, starts invading uterine lining
-day 8: embryoblast forms bilaminar disc: epiblast and hypoblast; late
day 8: amniotic cavity forms as epiblast involutes, hypoblast starts to
involute to primitive yolk sac
-days 9-10: exocoelomic membrane forms around yolk sac, blastocyst
keeps invading uterus; primary villi and lacunae form
7
-day 11: embryo is totally embedded, exocoelomic membrane has
secreted extraembryonic mesoderm that separate cytotrophoblast from
exocoeolomic and epiblast cells
-day 12: chorionic cavity formed from apoptosis of extraembryonic
mesoderm; exocoelomic membrane secretes 2nd wave of cells to become
definitive yolk sac
-week 3: gastrulation!
6. to signal to corpus luteum to continue producing progesterone
7. uterine fundus (on top); around day 7
8. lacunae, will connect to uterine vessels (spiral arteries)
9. By day 12; still exists surrounding chorionic cavity on either side and
connecting stalk
10. umbilical cord: only part of embryoblast derived material to not become
embryo proper
11. second wave of exocoelomic membrane expansion; primitive can remain
as cysts
12. buccophoaryngeal membrane and cloacal membrane (epiblast and
hypoblast stick together). The primitive node (pit) is rostral and the
streak runs caudally
13. primitive streak and node
14. ectoderm: nervous system and epidermis ; mesoderm: skeletal, muscle,
cartilage and bone, dermis, kidneys and gonads ; endoderm: linings of gi,
respiratory, urogenital and pharyngeal pouches of head and neck
15. 8 cell stage; around day 5/6 (same time icm and blastocoel are forming)
16. 1: cleavage, morula ; 2: blastulation (Week of twos) ; 3: gastrulation ; 4:
neurulation
17. protection against polyspermy, prevents early implantation, filter to
allow uterine secretions to reach it, protection from mother’s immune
system, keeps blastomeres together
8
Neurulation
1. glial cells, schwann cells, c cells of thyroid, adrenal medulla, skin pigment
cells, spinal autonomic and cranial nerve ganglion, dermis of face and
neck, meninges, connective tissues, some bones, conotruncal region of
heart
2. notochord is made of mesoderm that invades through primitive node and
moves cranially to prechordal plate; remnants found in nucleus pulposus
of vertebral discs
3. anterior and posterior neuropores
-exancephaly/anencephaly (cranioschisis)
-spina bifida cystica: meningomyelocele (both spinal cord and meninges
protrude) or meningocele (just meninges protrude). Spina bifida oculta is
less sever, ust and absence of portion of vertebral arch
4. mesoderm organizes laterally in 3 layers:
-paraxial: somites (give rise to bones (axial skeleton), muscles and skin of
back and skull)
-intermediate: urogenital: kidneys and gonads
-lateral:
-somatic: serosa of body cavities and bones of appendicular skeleton
-splanchnic: smooth gi muscle, serosa of organs; deep lining of body
wall cavities
5. notochord induces ectoderm to form (cranially moving rostrally), starts to
overproduce and fold up to create neural tube; neural groove forms in
middle of plate due to mounding on lateral edges
6. starts out as primary villi; becomes secondary when extraembryonic
mesoderm invades cytotrophoblast and embryonic vessels form in
mesoderm; tertiary villi when villi capillaries make vascular connections with
9
embryonic heart and cytotrophoblast cells fully penetrate
syncytiotrophoblast and anchor to uterus
lacuna pool with blood, intervillous spaces
7. intraembryonic coelom fill between somatic and splanchnic: will become
pericardial, pleural and periotoneal spaces
8. somites (also form bones and muscles of axial skeleton)
9. overgrowth of paraxial mesoderm
10. neurulation to neural tube, paraxial mesoderm upgrowth causes amnion
and ectoderm to move inferiorly to envelope all, yolk sac is swallowed up,
intraembryonic coelem (between somatic and splanchninc mesoderm) will
become body cavity
11. heart (mesoderm) starts to form rostrally, droops down and wraps more
caudally around gut, some portion of yolk sac is incorporated into gut, other
is herniated down a bit
12. septum transversum develops rostrally with heart
13. foregut: lower repiratory, pharynx, esophagus, stomach, beginning of
duodenum ; midgut: remainder of small intestine, much of large intestine ;
hindgut: rectum, anal canal and some urogenital
Autonomic Nervous System
1. sympathetic (fight or flight), parasympathetic (rest and digest)
2. sym: intermediolateral cell column of T1 to L2 ; para: cranial nerves 3, 7,
9, 10 and S2-S4 (preganglion parasympathetic fibers are long except in head)
3. see chart (entry in white ramus communicans, exit through grey);
postganglionic sympathetic neurons travel out ventral and dorsal rami
4. only sympathetic
5. visceral sensory fiber
6. splanchnic nerve
10
-greater splanchnic nerve: T5-T-9 to celiac ganglion
-lesser splanchnic nerve: T9-T10 to superior mesenteric and
aorticorenal ganglia
-least splanchnic nerve: T11 to aorticorenal ganglion
*also an inferior mesenteric ganglion!
7. they hitch a ride with arteries (why it is convenient to be located near
aorta)
8. sympathetic: pre and post ganglionic ; parasympathetic: only
preganglionic (don’t synapse until organ wall) *visceral sensory fiber would
also pass through
9. collateral ganglion
10. white ramus communicans
11. ciliary, otic, pterygopalatine, sphenopalatine
radiology
1. Radiograph: xray photons come from xray source, go through patient, hit
detector
-CT: much higher xray does stored in gantry is directed circularly around
patient (also hold detector), who is rolled through on a bed
-Ultrasound: a transducer produces sound waves that go into patient and
then bounce back to transducer
-MRI: strong magnetic fields and radio waves to image protons (found in fat
and water): magnet surrounds patient bed
2. radiopaque (no penetration, highest attenuation, appears white);
radiolucent (complete penetration, appears black), partial penetration is
grey scale
3. atomic number, thickness
4. gas, fat, fluid/soft tissue, bone/calcium, metal
11
5. iodine and barium, only iodine intravenously! These highly attenuate xray beam
6. frontal (right is on the left) and lateral (use spine for positioning)
7. advantages: great contrast, 3D so eliminates superimposition of images
(unlike radiography)
disadvantages: high dose of radiation
8. axial: it is like looking up from patient’s feet. Right is on the left ; coronal
and sagital are same as radiograph
9. hypoattenuating, isoattenuating, hyperattenuating ; Hounsfield units with
water as 0. You can change the “window” to change contrast
10. enteric contrast (iodine or barium) and intravenous (iodine only) ; iodine
is water soluble. You see enhancement after contrast has been added, look
for brightening of vessels, organs
11. Ct has higher contrast, no superimposition compared to radiography
-ct: bone is bright, fat is dark
-mri: bone is dark, fat is bright (unless fat sat)
12. you want to sound waves to go smoothly from transducer to patient, no
skipping
13. amplitude; time of flight
14. bone and gas; nothing
15. Doppler affect: can detect blood vessels, presence/absence of flow,
direction of flow
16. anechoic/echolucent (no reflection) ; hypoechoic masses are darker than
background organ ; hyperechoic/echogenic masses are whiter than
background (reflect more)
17. T2 has bright fluid, highlights edema (pathology) ; T1 has dark fluid,
highlights anatomy
18. stationary
12
19. fat saturation (makes fat dark) ; vascular contrast (will highlight vessels
and organs for T1)
20. highlight areas of edema in contrast to fat (which becomes darker)
21.signal intensity: hypointense, isointense, hyperintense (brightest) :
masses with organs are described in relation to background
22. gadolinium makes tissues/vasculature bright for T1, increases contrast
23. mri: fat is bright, bone is dark ; ct: fat is dark, bone is bright
radiology – lumbar spine
1. radiography is good for quick check of bones ; ct is for bones ; mri for
marrow
2. contrast injected via lumbar puncture into subarachnoid/thecal space,
image w/ radiography or ct ; this will cause nerve roots to appear darker
than the csf (which will now have higher attenuation). You can view the
contrast as inverted (cortical bones will appear black, csf black) or
conventional (csf lighter, nerve roots dark, cortical bones lighter)
3. cortical bone is low signal intensity for mri, high attenuation for ct (more
dense, less hydrogen
-cancellous bone is higher signal intensity for mri (lower intensity with fat
sat), lower attenuation for ct
4. T2 mri (csf will be light, spinal cord dark) ; also ct myelo
5. T2 mri: dark due to loss of nucleus pulposus. With fat sat, edema is light ;
ct is best for cortical desctruction (bone becomes dark)
6. first vertebra without ribs
7. look for bright aorta
8. the fluid is flowing
9. L1 through intervertebral foramen ; lateral disc compresses L1, central L2
10. inferior is posterior to superior (like roof shingles)
13
11. see slides
12. it is more dense ; if it loses its cushioning, degenerates
13. ct scan
14. spondylosis ; spondylolisthesis
15. dots
16. intervertebral foramen (nerve from above vertebra will be compressed)
9/10: histology study objectives
1. lipid, protein, carbohydrates
2. lipids are most numerous, proteins are most by weight
3. two rows of phospholipids (outer heads with lipid tails facing in) : outer
and inner leaflet ; also intermembrane space
4. phosphatidylcholine, phosphatidylserine, sphingomyelin,
phosphatidylethanolamine
-phosphatidylinositol (inner leaflet, cell signaling)
5. lipids tagged with sugar (carbohydrate in extracellular space): only
external leaflet
6. bacteria membranes
7. selectively permeable barrier (impermeable to water soluble) ; contains
necessary proteins (fluid mosaic model)
8. lipid raft: small, heterogenous portions of membrane enriched with
sphingolipids and cholesterol that compartmentalize cellular processes
-caveolin proteins participate in vesicle traffic
9. peripheral and integral membrane proteins
10. signaling, metabolism, regulation, transport, integration
11. actin (cytoskeleton) (extracellular portions are usually glycosylated)
14
12. glycolipids and glycoproteins attached to moieties of external leaflet:
function in cell adhesion, signaling and ‘self’ recognition
13. inner nuclear membrane (ribonucleoproteins), perinuclear space, outer
nuclear membrane (continuous with rER)
14. rER lumen
15. cylindrical body between inner and outer octagonal rings (8 proteins
each – nucleoporins): size keeps out molecules over 60kDa, all proteins must
have nuclear localization amino acid sequence
16. to keep out large molecules, check for nuclear localization amino
sequence
17. ribosomal and messenger RNA
18. heterochromatin is bunched together and does not allow transcription
19. contains genomic info and controls all cell activity
20. nucleolus is site of rRNA synthesis
-fibrillar center (rRNA genes and RNA polymerase I and signal
recognition particle RNA)
-dense fibrillar component: ribonucleoprotein undergoes processing
-granular component: assembly of ribosomal subunits
21. now called dense fibrillar component
22. organelle that synthesizes protein by matching messenger RNA with
amino acids
23. no, if they are it is only temporarily for protein secretion into rER lumen
24. free ribosomes attached on an mRNA strand
25. bound are attached to rER
26. bound produces secretory and lysosomal proteins ; free produce
proteins to be utilized within the cell
28. both compartmentalized in lumen of rER, secretory in order to leave cell,
lysosomal to protect rest of cell
15
29. stacks of flat lamella/cisternae with holes to allow cytoplasmic flow and
communication between lumena of adjacent layers
30. smooth er is tubules that branch and anastamose
31. rER in organs that produce a lot of proteins (ie spleen)
-sER for lipid synthesis, detox, glycogen metabolism, membrane
formation and recycling (liver)
32. flattend sacs (cisternae) with c shape
33. accepts transfer vesicles from rER, chemically enhances lysosomal and
sectretory proteins and packages them for release
34. cis (concave, closest to rER, receives transport vesicles) ; trans (secretory
vesicles bud off)
35. cis receives transport vesicles ; trans releases secretory vesicles
36: GERL is golgi – er- lysosome pathway
37. protein made by ribosomes, stored in lumen of rER, transferred via
vesicles to cis face of golgi, move through golgi and get modified, releases
via trans face of edges
38. degrade cell waste (proteins, nucleic acids, oligosaccharides and
phosphorlipids)
39. primary is storage site for lysosomal hydrolases, secondary is engaged in
catalytic process
40. membrane bound foreign matter that will join with a primary lysosome
to form a secondary
41.ATP cleaved to ADP, extra hydrogen ions are moved into lysosome to
reduce ph to 5.0 and maintain potency of acid hydrolases stored in lysosome
42. autophagasome and heterophagasome (auto is aged cell component
enclosed by ER ; hetero is material brought in to cell by phagocytosis or
endocytosis)
43. a secondary lysosome full of partially digested material
16
44. endocytosis is receptor mediated phagocytosis but the material enclosed
is an endosome, phagocytosis is cell membrane bringing in particulates to
form phagosome, autophagocytosis is ER enclosing old cell parts – all end
with fusion with primary lysosome
45. if lysosomes don’t receive oxygen, they will release acid hydrolases and
cause rotting ; premature enzyme release can cause disease such as arthritis
and complications from allergic reactions.
46. peroxisome proteins are assembled on free ribosomes and then
imported in; catalase decomposes hydrogen peroxide, peroxisomes used in
biosynthesis of lipid (cholesterol – also bile acid derivatives in liver)
-proteins are targeted to the interior and are not cleaved after
entrance
47. catalase breaks down hydrogen peroxide to water in a peroxisome; can
also oxidize organic compounds, particularly fatty acids for metabolic energy
48. location for atp synthesis so produces energy, also a large source for
calcium ions (matrix granules)
49. inner membrane has many folds called cristae, is far less permeable and
is the site of ETC ; outer membrane contains membrane channel protein
porin that makes it very permeable
50. folding of inner membrane to increase surface space
51. intercristal space/mitochondrial membrane
52. diffuse more readily through outer membrane, need chaperones for
inner
53. site of ATPsynthase complex
54. they are semiautonomous organelles that can direct the synthesis of
their structural proteins (nucleus directs synthesis of enzymes)
55. inner and outer membranes, intracristal space, matrix
8/11: lymphatic system
17
1. drain excess interstitial fluid (10%) and return to the venous system ; filter
fluid
2. lymph capillaries form plexuses in tissues, converge into lymph vessels
(valves direct flow centrally to heart), lymph goes through lymph nodes,
vessels thicken to trunks, drain into either right lymphatic duct or thoracic
duct
-superficial (in superficial fascia) and deep (deep to deep fascia) lymph
vessels
3. right lymphatic duct: drains right upper extremity, right side of head and
thorax, empties into junction of right subclavian and right internal jugular
-right jugular trunk (head and neck)
-right subclavian trunk (right upper extremity)
-right bronchomediastinal trunk (thorax)
thoracic duct: drains everything else, empties into junction of left
subclaivian and left internal jugular veins
-left jugular trunk (head and neck)
-left subclavian trunk (upper extremities)
-left bronchomediastinal trunk (thorax)
-vessels from posterior intercostal and mediastinal regions
-vessels from lower trunk and limbs drain to cisterna chyli
4. initial dilated portion of thoracic duct (anterior to L1-L2 vertebra; vessels
from lower trunk and limbs
5. cells (spread of cancer), 10% of all interstitial fluid, cell products and
debris, pathogens
6. superior vena cava (via brachiocephalic veins)
7. deltoid and pectoralis major; cephalic vein (superficial vein, drains upper
limb and empties into subclavian/axillary); since cephalic vein is superficial,
it is used for procedures like implanting pacemaker leads
18
8. -dorsal scapular nerve innervates rhomboids and levator scapula
-long thoracic nerve innervates serratus anterior (superficial!)
-medial pectoral nerve innervates pectoralis major and minor
-lateral pectoral nerve innervates pectoralis major
-thoracodorsal nerve innervates latissimus dorsi
-axillary nerve innervates deltoid
9. damage to long thoracic nerve
10. ventral primary rami of cervical spinal nerves 5,6,7,8 and thoracic spinal
nerve 1
11. subclavian artery becomes axillary artery at lateral border of first rib
1. subclavian: internal thoracic artery runs deep to ribs
2. axillary artery: superior thoracic artery, thoracoacromial artery, lateral
thoracic artery, subscapular artery
*the 11 posterior and anterior intercostal arteries are the main branches
that supply the thoracic wall
12. pectoralis major: p – sternum, ribs 1-7, clavicle ; d – lateral lip of
intertubercular groove
-pectoralis minor: p – ribs 3-5 ; d – coracoid process
-serratus anterior: p – ribs 1-8 along lateral chest wall ; d – anterior side of
medial border of scapula
-deltoids: p – spine of scapula, acromion, clavicle ; d – deltoid tuberosity (of
humerus)
13. areolar glands are sebaceous glands to lubricate nipples during nursing ;
superficial fascia
14. globular tissue (15-lobes arranged radially around nipple) and fat tissue
(peripheral); glandular tissue that extends toward axilla
15. each lobe has a lactiferous duct that terminates in a lactiferous sinus
that serves as milk reservoir, each empties individually
19
16. Suspensory ligaments (of Cooper): fibrous bands of tissue that run from
membraneous layer of superficial fascia to dermis
17. retromammary space between superficial and deep fascia.
18. internal thoracic artery (perforating and anterior intercostal branches) ;
lateral thoracic and thoracoacromial arteries (from axillary artery) ; posterior
intercostal arteries (from thoracic aorta)
19. subareolar lymphatic plexus, axillary lymph nodes (pectoral, subscapular,
and lateral) empty to central lymph node, apical lymphnode, subclavian
trunk
*can also drain from subareolar lymphatic plexus to abdominal nodes and
contralateral breast or to parasternal nodes and deep lymphatics of internal
thoracic artery
20. parasympathetic: only get somatomotor and sensory and postganglionic
sympathetic innervation (primarily blood vessels)\
21. edema (orange peel appearance) ; traction of suspensory ligaments
causes dimpling ; breast fixed to thoracic wall
22. Anterior: internal thoracic artery ; posterior: thoracic aorta
Thoracic Wall
1. Superior Thoracic Aperture is covered on lateral 2/3 by suprapleural
membranes
2. Inferior Thoracic Aperture ; aorta, esophagus, azygos v., inferior vena cava
and nerves
3. parietal pleura ; endothoracic fascia
4. external intercostals run from vertebral bodies to costrochondral junction
(fibers run “hands in pockets”
-internal intercostals run from sternum to angle of ribs
-innermost intercostals (3 subdivisions)
20
-innermost, subcostal (near vertebral bodies), transversus thoracis
(attach to posterior surface of lower sternum)
5. external intercostal membrane from costochondral junction to sternum,
internal intercostal membrane from ribs to vertebra body
6. In the costal groove, so needle should be inserted well below rib
7. brachiocephalic (gives origin to right common carotid and right
subclavian), left common carotid, and left subclavian arteries
-carotid supplies head and neck
-subclavian supplies upper extremity
8. posterior to the anterior scalenes
-vertebral, internal thoracic and thyrocervical arteries
9. right and left jugular veins and right and left subclavian veins join to form
brachiocephalic veins which drain to superior vena cava
10. juncture of left jugular and subclavian veins (at brachiocephalic vein)
11. phrenic nerves: C3-C5
12. anterior scalene, vagus nerve (CNX), phrenic nerves (C3-C5), sympathetic
chain ganglia, trachea, esophagus, branches of aortal arch (brachiocephalic
artery, left common carotid, left subclavian), subclavian veins, internal
jugular veins, thoracic duct (left side only)
13. xiphoid process, costal cartilages and adjacent portions of 6 inferior ribs
and the more superior two lumbar vertebrae ; lowering of the central
tendon (pulls ribs down)
14. right: first three lumbar vertebrae ; left: first two lumbar vertebrae ;
central tendon
15. innervated by phrenic nerves (C3-C5) for both motor and sensory (also
postganglionic sympathetic fibers for blood vessels)
-superior and inferior phrenic arteries, intercostal arteries, and
internal thoracic arteries supply blood
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16. superior/inferior (diaphragm) ; anterior/posterior (pump handle) ;
lateral/lateral (bucket hadle)
17. quiet: diaphragm ; forced: add inexternal intercostals, scalenes and
sternocleidomastoid
18. quiet: passive recoil ; forced: abdominals, internal intercostals,
transversus thoracis
19. synovial: costovertebral, 2-7 sternocostal joints (ribs 2-7 with sternum),
interchondral
cartilaginous: intervertebral, costochondral, 1st sternocostal joint,
manubriosternal, xiphisternal
8/12: development of body cavities
1. Pericardial, peritoneal, pleural are formed by intraembryonic coelom
(Starting at end of week 3, ending by week 8)
2. Somatic and splanchnin mesoderm, extraembryonic coelom; point of
communication between intra and extraembryonic coelom
3. So there is space for the gut to herniate out for development
4. Proliferation of nervous system
5. Ventral and dorsal mesenteries
6. Parietal
7. Gut (yolk sac)
8. It disappears, except at lesser omentum (joins liver to stomach and
duodenu) and falciform ligament (joins liver to abdominal wall) ;
dorsal mesentery stays behind so blood vessels, nerves and lymphatic
vessels can reach gut
9. Heart tube and pericardial cavity curl downward from rostral position
to ventral aspect of thoracic ; septum transversum (future diaphragm)
moves caudally from caudal to heart tube to between pericardial
cavity and yolk sac.
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10.
Septum transversum, traversed by pericardialperiotoneal canals
on each side of future esophagus
11.
Gut tube, lung buds form from gut tube
12.
Plueroperitoneal folds (posterior to septum transversum) and
plueropericardial folds (made from overgrowth of lung tissue) –
somatic mesoderm
13.
Somatic mesoderm – pleuropericardial folds
14.
Septum transversum (will form the central tendon), plueroperitoneal folds (from somatic mesoderm of body wall), dorsal
mesentery of esophagus (muscular right and left crura), myoblasts
from body wall for muscle
15.
C3-C5 innervate diaphragm
16.
Lung hypoplasia, cardiac compression
Vertebral and Muscle Development
1. Paraxial mesoderm
a. sclerotome (axial skeleton)
b. myotome (skeletal muscles)
c. dermatome (future dermis)
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