Fractures can cause intracranial bleeding as pterion overlies anterior division of middle meningeal artery and vein. Clinical Points Skull Calvaria Fractures Can occur as a result of direct trauma to the head Can be one of several types: Depressed Produced by hard blows in regions where calvaria is thin Fragment of bone forced inward into brain Linear Most frequent Fracture lines radiate away from point of impact Comminuted - bone broken into several pieces Contre-coup May be no fracture at impact site Brain impacts opposite side of skull and rebounds to site of impact, with resulting bruising May be associated with brain injury When assessing a patient with a head injury the Glasgow Coma Scale GCS is useful..
May present with crepitus on palpation and epistaxis Rarely compromises airway. Le Fort II: Pyramidal-shaped fracture that includes horizontal fracture of both maxillae, extending superiorly through maxillary sinuses, infraorbital foramina, and ethmoids to bridge of nose. Separates central face from rest of skill Places the airway at risk Le Fort III: Includes fractures of Le Fort II plus horizontal fracture through superior orbital fissures, ethmoid, and nasal bones, great wings of sphenoid bones and zygomatic bones.
They all originate embryologically from the second pharyngeal arch and are all innervated by terminal branches of the facial nerve cranial nerve [CN] VII. Additionally, most arise from the bones of the face or fascia, and insert into the dermis of the skin overlying the scalp, face, and anterolateral neck. Sites of lesions of the facial nerve and resulting symptoms Site of Lesion Symptoms Below stylomastoid 1 Facial paralysis mouth draws to opposite side; on affected side, patient unable to close eye or foramen parotid gland wrinkle forehead; food collects between teeth and cheek as a result of paralysis of buccinator muscle.
Hyperacusis as a result of effect on nerve branch to stapedius muscle. Geniculate ganglion 3 All symptoms of 1 and 2 , plus pain behind ear. Injury causes weakness of sternocleidomastoid and trapezius muscles.
The phrenic nerve arises from cervical nerve roots to supply the diaphragm. Irritation of the diaphragm, e. Clinical Points Torticollis In adults, spasm of the SCM can cause pain and turning and tilting of the head torticollis Congenital torticollis can occur in infants due to a fibrous tissue tumor in the SCM that develops in utero Head bends to affected side and face turns away Facial asymmetry can occur, because of growth retardation on affected side page 23 page 24 Clinical Points Thoracic outlet syndrome Caused by compression of the subclavian artery, vein, and roots of the brachial as they emerge from the root of the neck.
Patient may complain of pain, paresthesia in the arm as a result of nerve compression; pallor, coldness, and pain in the arm as a result of arterial compression, or swelling in the arm as a result of decreased venous and lymphatic drainage. Anteriorly, the air enters or leaves the nose via the nares, which open into the nasal vestibule, whereas posteriorly the nasal cavity communicates with the nasopharynx via paired apertures called the choanae.
Anasal septum, usually deviated slightly to one side or the other, divides the nasal cavity into right and left chambers. The anterior third of the nasal septum is cartilaginous and the posterior two thirds is bony.
Divides nasal cavity into two chambers Composed of Bone Vomer Perpendicular plate of ethmoid Septal cartilage Septal cartilage articulated with edges of bony septum Nasal Cavity page 26 page 27 The lateral wall of the nasal cavity is characterized by three shell-like conchae, or turbinates, that protrude into the cavity, and along with their covering of nasal respiratory epithelium, they greatly increase the surface area for warming, humidifying, and filtering the air.
At the most superior aspect of the nasal cavity resides the olfactory region, with its olfactory epithelium and specialized sensory cells for the detection of smells. They are lined with respiratory epithelium, assist in warming and humidifying the inspired air, and drain their mucus secretions into the nasal cavities. Blowing the nose clears the nasal cavity and sinuses of excess secretions. Patient may complain of snoring, abnormal speech, or breathing difficulties when eating Clinical Points page 28 page 29 Epistaxis Nosebleed Common because of rich vascular supply to nose In younger people occurs in the Little's area-where convergence of anterior ethmoidal artery, septal branches of sphenopalatine and superior labial arteries and greater palatine artery In older people can be related to hypertension Treatment involves identifying the source of bleeding and stopping the bleeding by direct pressure, packing the nose or cautery.
From infraorbital and facial vessels superiorly b. Divides tongue into oral and pharyngeal parts b. Apex points to foramen cecum Foramen cecum a. Small pit b. Remnant of embryonic thyroglossal duct Numerous papillae of different types Lingual papillae Vallate a.
Anterior to sulcus terminalis b. Large and flat-topped c. Have taste buds Foliate a. Small folds on lateral side of tongue b. Have taste buds Filiform a. Numerous and mainly arranged in rows parallel to sulcus terminalis b.
Mushroom-shaped b. Found on tip and sides of tongue c. Most of bulk of tongue b. Contributes to protrusion of tongue c. Moves tongue from side to side Hyoglossus a. Depresses tongue b. Aids in retraction Styloglossus a. Mingles with fibers of hyoglossus b. Creates central trough or furrow with genioglossus during swallowing c. Retracts tongue and curls side Palatoglossus a. Largely a soft palate muscle b. Elevates posterior tongue Intrinsic Alter shape of tongue Superior longitudinal: curls tip of tongue superiorly Inferior longitudinal a.
Curls tip of tongue inferiorly b. Incisive fossa behind central incisors transmits nasopalatine nerves via incisive canals b.
Paired greater palatine foramina medial to third molar transmits greater palatine vessels and nerves c. Paired lesser palatine foramina posterior to greater palatine foramina transmits lesser palatine nerves and vessels Mucous secreting palatine glands beneath mucosa Incisive papilla directly posterior to maxillary incisors Palatine raphe a.
Represents line of fusion of embryonic palatal plates Soft palate posteriorly Moveable posterior third suspended from hard palate No bony skeleton Attaches to hard palate via aponeurotic palate a.
Expanded tendineus aponeurosis of tensor veli palatini muscles b. Thick anteriorly Muscular palate tensor veli palatini posteriorly Posterior curved free margin has conical projection: uvula Anatomical features related to the soft palate Arches Join soft palate to tongue and pharynx Palatoglossal arch a. Mucosal fold b. Contains palatoglossus muscle Palatopharyngeal arch a.
Posterior to palatoglossal arch c. Contains palatoglossus muscle Form anterior and posterior boundaries of tonsillar fossa on either side Tonsillar fossae Contain palatine tonsils Masses of lymphoid tissue between arches Fauces Term for passage from oral cavity to oropharynx Bounded by a. Soft palate superiorly b. Root of tongue inferiorly c. Enters gland and branches into two stems b.
Two stems give rise to five branches that emerge from borders of gland Superficial temporal vein a. Runs through deeper part of gland b. Presynaptic fibers from facial nerve via chorda tympani to submandibular ganglion b. It is also a site where pharyngeal tumors can grow undetected for a period of time. Aggregations of lymphoid tissue in the nasopharynx are called adenoids.
They can become enlarged in children, causing obstruction of the nasopharynx and forcing the child to breathe through the mouth.
Apex at superior end b. Vocal process projects anteriorly c. Hyperthyroidism with diffuse goiter Graves' disease Most commons cause of hyperthyroidism in patients younger than 40 years. Excess synthesis and release of thyroid hormone T3 and T4 result in thyrotoxicosis, Thyrotoxicosis upregulates tissue metabolism and leads to symptoms indicating increased metabolism. Mnemonics Memory Aids Table I Associate the TEAC sound with the vocal cords and you can make a connection.
Opening is protected by a thin moveable fold: the eyelid. Eyelids Two moveable folds of skin that cover the eye anteriorly Protect the eye from injury and excessive light and keep the corneas moist. Eyelids separated by an elliptical opening, the palpebral fissure.
Covered by thin skin externally and palpebral conjunctive internally Palpebral conjunctive continuous with bulbar conjunctive of eyeball Lines of reflection of palpebral conjunctiva onto eyeball are deep recesses: superior and inferior conjunctival fornices Strengthened by plates of dense connective tissue: tarsal plates Tarsal glands embedded in plates Produce a lipid secretion a.
Lubricates edge of eyelids to prevent then from sticking together b. Barrier for lacrimal fluid Medial palpebral ligaments a. Attach tarsal plates to medial margin of orbit b. Orbicularis oculi attaches to this ligament Lateral palpebral ligaments attach tarsal plates to lateral margin of orbit Orbital septum from tarsal plates to margins of orbit, continuous with periosteum of bony orbit Skin around the eyes devoid of hair except for eyelashes Are arranged in double or triple rows on the free edges of the eyelids Ciliary glands associated with eyelashes: sebaceous glands.
Larger orbital b. Smaller palpebral c. Covers posterior five sixths of eyeball b. Visible through conjunctiva is the white of the eye c. Pierced posteriorly by optic nerve Cornea a. Transparent part of fibrous coat b. Transmits light Middle vascular layer Choroid a. Outer pigmented layer b. Inner vascular layer c. Lies between sclera and retina d. Lines most of sclera e. Terminates anteriorly as ciliary body Ciliary body a. Connects choroid with iris b. Contains smooth muscle that alters the shape of lens c.
Folds on internal surface ciliary processes produce aqueous humor and attach to suspensory ligament of lens Iris a. Pigmented diaphragm with central aperture: the pupil b. Contains smooth muscle that alters the size of the pupil to regulate the amount of light entering the eye c. Radial fibers of the dilator pupillae open the pupil d. Circular fibers of the sphincter pupillae close the pupil Inner retinal layer Consists of three parts Optic part 1 a.
Receives light b. Composed of two layers: inner neural layer and outer pigmented layer c. Inner neural layer contains photosensitive cells: rods for black and white and cones for color Ciliary and iridial parts 2 and 3 a. Continuation of pigmented layer plus a layer of supportive cells b.
Cover ciliary body and posterior surface of retina Fundus a. Is posterior part of eye b. Small oval area of retina b. Contains concentration of photoreceptive cones for sharpness of vision c. Contains aqueous humor Posterior chamber a. Between iris pupil anteriorly and lens and ciliary body posteriorly b. Contains aqueous humor Vitreous chamber a.
Between lens and ciliary body anteriorly and retina posteriorly b. Lie in same horizontal plane b. Rotate eyeball laterally and medially, respectively Superior and inferior rectus 2 a. Lie in same vertical plane b. Pull eyeball superiorly and inferiorly, respectively Inferior oblique a. Works with superior rectus b. Pulls eyeball superiorly and laterally Superior oblique a. Works with inferior rectus b. Pulls eyeball inferiorly and laterally Sheathed by reflection of fascial sheath around eyeball Tenon's capsule Medial and lateral check ligaments a.
Triangular expansions of sheath of medial and lateral rectus muscles b. Attached to lacrimal and zygomatic bones c. Limit abduction and adduction Suspensory ligament a. Union of check ligaments with fascia of inferior rectus and inferior oblique muscles b.
Branch of ophthalmic b. Runs within dural sheath of optic nerve c. Emerges at optic disc and branches over retina Posterior ciliary arteries a. Branches of ophthalmic b. Six short to choroid c. Two long to ciliary plexus Anterior ciliary a.
From muscular branches of ophthalmic b. It can be difficult to test each eye muscle individually. Ageneralist, however, can gain a general idea of extraocular muscle or nerve impairment by checking the ability of individual muscles to elevate or depress the globe with the eye abducted or adducted, thereby aligning the globe with the pull line of contraction of the muscle Ask patient to "Follow my finger with just your eyes" and move your finger in the form of the letter H.
Superior rectus is tested by moving your finger superiorly and medially to the eye to counteract the interaction of the inferior oblique a. Inferior rectus is tested by moving your finger inferiorly and medially to the eye to counteract the interaction of the superior oblique b.
The medial and lateral rectus muscles are tested by moving your finder medially and laterally to the eye. The inferior oblique is tested by moving your finger superiorly and laterally to the eye d. The inferior oblique is tested by moving your finger inferiorly and laterally to the eye.
Remember that because all the muscles are involved in the continuous movement of the eye, it is difficult to isolate the action of just one with absolute clinical certainty via this test. Open angle-develops gradually with blocking of canal of Schlemm or obstruction of angle b.
Closed angle-occurs rapidly when iris and lens block passage of aqueous humor through pupil Clinical Points Orbital "blow-out" Fractures Medial and inferior walls of orbit are very thin, so a blow to the eye can fracture the orbit Indirect trauma that displaces walls is called a "blow-out" fracture Fractures of medial wall may involve ethmoid and sphenoid sinuses Fracture of the floor may involved the maxillary sinus Fractures can result in intraorbital bleeding Blood puts pressure on eyeball, causing exophthalmos Blood and orbital structures can herniate into maxillary sinus Clinical Points page 58 page 59 Conjunctivitis Common condition often referred to as "pink eye" An inflammation of the conjunctiva Symptoms include redness, irritation, and watering of the eyes and sometimes discharge and itching Can be triggered by infection a.
Highly contagious b. Caused by bacteria or viruses c. Sexually transmitted diseases STDs , such as gonorrhoea and chlamydia, can cause it d. Viral conjunctivitis is common with several viral infections and can arise as a result of or during a common cold or flu Can be triggered by allergies a. More freqently occurs in children with other allergic conditions, e. Typically affects both eyes at the same time Can be triggered by an external irritant a.
Can be caused by pollutants such as traffic fumes, smoke b. Promontory: round projection overlying basal turn of cochlea b. Fenestra cochlea or round window Anterior wall Separates tympanic cavity from carotid canal Superiorly has opening of auditory tube and canal for tensor tympani Posterior wall Superiorly, aditus opening to mastoid antrum, connecting to mastoid air cells Between posterior wall and aditus, prominence of canal of facial nerve Pyramidal eminence a.
Tiny cone-shaped prominence b. Mucous membrane of tympanic cavity b. Mastoid antrum c. Mastoid air cells d. Spiral canal b. Bony core, the modiolus Canal spirals around modiolus Basal turn forms promontory of medial wall of tympanic cavity At basal turn, bony labyrinth communicates with subarachnoid space above jugular foramen via cochlear aqueduct Vestibule Small oval chamber Contains membranous utricle and saccule Oval window is on lateral wall Continuous with a.
Cochlea anteriorly b. Semicircular canals posteriorly Communicates with posterior cranial fossa via aqueduct of vestibule a. Contains membranous endolymphatic duct Semicircular canals Anterior, posterior, and lateral Set at right angles to each other in three planes Lie posterosuperior to vestibule Each opens into vestibule Swelling at one end of each canal: ampulla Contain membranous semicircular ducts Membranous labyrinth Collection of ducts and sacs Suspended within bony labyrinth Filled with endolymph Vestibular labyrinth Utricle a.
Has specialized area of sensory epithelium: macula b. Hairs respond to tilting of head and linear acceleration and deceleration Saccule a. Communicates with utricle b.
Continuous with cochlear duct c. Contains macula, identical in structure and function to that of utricle Semicircular ducts a. Within semicircular canals b. Each has ampulla at one end c.
Ampullary crest in each ampulla senses movement of endolymph in plane of duct d. Detect rotational tilting movements of head Cochlear labyrinth Spiral ligament suspends cochlear duct from external wall of spiral canal Cochlear duct a.
Triangular in shape b. Filled with endolymph c. Spans spiral canal, dividing it into two channels, each filled with perilymph d. Two channels: scala tympani and scala vestibule, meet at apex of cochlea helicotrema e.
Found on basilar membrane b. Covered by gelatinous tectorial membrane c. Contains hair cells-tips embedded in tectorial membrane d. Drains cerebral veins Confluence of sinuses sagittal sinus 2.
Contains arachnoid villi and granulations for reabsorption CSF Inferior sagittal Lower free margin falx cerebri Joins great cerebral vein sinus forming straight sinus Straight sinus Junction falx cerebri and Formed by union great cerebral vein with inferior sagittal Confluence of sinuses tentorium cerebelli sinus Transverse Lateral margin tentorium 1.
Passes laterally from confluence of sinuses Sigmoid sinus sinus cerebelli 2. Left is usually larger Sigmoid sinus S-shaped course in temporal Continuation transverse sinus Internal jugular vein and occipital bones Cavernous Superior surface of body of 1. Receives superior and inferior ophthalmic and Superior and inferior sinus sphenoid, lateral to sella superficial middle cerebral veins and sphenoparietal petrosal sinuses turcica sinus 2.
CN V has three divisions: V1 and V2 are sensory, and V3 is both motor to skeletal muscle and sensory. The following table summarizes the types of fibers in each cranial nerve and where each passes through the cranium: Cranial nerves emerge through foramina or fissures in the cranium Twelve pairs Numbered in order of origin from the brain and brain stem, rostral to caudal Contain one or more of six different types of fibers Motor fibers to voluntary muscles Somatic motor fibers to striated muscles 1 a.
Orbit b. Tongue c. Carry sensation from viscera b. Thyrohyoid muscle b. Omohyoid b. Sternohyoid c. Usually one-sided and can affect a division of CN V, usually the mandibular, maxillary nerve. Pain can be triggered by touching a sensitive area "trigger point" The cause is not usually known Treatment is directed to controlling the pain.
Ocular Nerve Palsy Alesion of the oculomotor nerve will paralyze all extraocular muscles except the lateral rectus and the superior oblique.
Ascends on pharynx b. Send branches to pharynx, prevertebral muscles, middle ear, and cranial meninges Superior thyroid a. Gives rise to superior laryngeal artery supplying larynx Lingual a. Passes deep to hypoglossal nerve, stylohyoid muscle, and posterior belly of digastric b. Disappears beneath hyoglossus muscle and becomes deep lingual and sublingual arteries Facial a. Branches to tonsil, palate, and submandibular gland b. Hooks around middle of mandible and enters face Occipital a. Passes deep to posterior belly of the digastric b.
Grooves base of skull c. Supplies posterior scalp Posterior auricular a. Passes posteriorly between external acoustic meatus and mastoid process b. Supplies muscles of region, parotid gland, facial nerve, auricle, and scalp Maxillary a. Larger of two terminal branches b. Branches supply external acoustic meatus, tympanic membrane, dura mater and calvaria, mandible, gingivae and teeth, temporal pterygoid, masseter, and buccinator muscles Superficial temporal a. Smaller terminal branch b.
Supplies temporal region of scalp Carotid Branch Course and Structures Supplied Superior thyroid Supplies thyroid gland, larynx, and infrahyoid muscles Ascending pharyngeal Supplies pharyngeal region, middle ear, meninges, and prevertebral muscles Lingual Passes deep to hyoglossus muscle to supply the tongue Facial Courses over the mandible and supplies the face Occipital Supplies SCM and anastomoses with costocervical trunk Posterior auricular Supplies region posterior to ear Maxillary Passes into infratemporal fossa described later Superficial temporal Supplies face, temporalis muscle, and lateral scalp page 79 page 80 Subclavian artery Branch of aortic arch on the left From brachiocephalic trunk on the right Enters neck between anterior and posterior scalene muscles Supplies upper limbs, neck and brain Divided for descriptive purposes into 3 parts, in relation to the anterior scalene muscle First part a.
Medial to the anterior scalene b. Has three branches Second part a. Posterior to the anterior scalene b. Has one branch Third part a. Lateral to anterior scalene b. Has one branch Subclavian Branch Course Part 1 Vertebral Ascends through C6-C1 transverse foramina and enters foramen magnum Internal thoracic Descends parasternally to anastomose with superior epigastric artery Thyrocervical trunk Gives rise to inferior thyroid, transverse cervical, and suprascapular arteries Part 2 Costocervical trunk Gives rise to deep cervical and superior intercostal arteries Part 3 Dorsal scapular Is inconstant; may also arise from transverse cervical artery Venous drainage Superficial veins External jugular vein EJV Drains most of scalp and side of face Formed at angle of mandible by union of retromandibular vein with posterior auricular vein Enters posterior triangle and pierces fascia of its roof Descends to terminate in subclavian vein Receives a.
Transverse cervical vein b. Suprascapular vein c. Muscles that are readily visible are trapezius, latissimus dorsi, and teres major. The patient is placed in the left decubitus position, flexed in the fetal posture with the supracristal line vertical. The secondary curvatures are mainly a result of anterior-posterior differences in IV disc thickness.
The cervical curvature is acquired when the infant begins to lift its head, and the lumbar curvature when the infant begins to walk. Abnormal curvatures: Kyphosis is an increased thoracic curvature, commonly seen in the elderly "Dowager hump".
It is usually caused by osteoporosis, resulting in anterior vertebral erosion or a compression fracture. An excessive lumbar curvature is termed a lordosis and is seen in association with weak trunk muscles, pregnancy, and obesity. Scoliosis is an abnormal lateral curvature of the spine, accompanied by rotation of the vertebrae. Spondylolisthesis: The lumbosacral angle is created between the long axes of the lumbar vertebrae and the sacrum.
It is primarily because of the anterior thickness of the L5 body. As the line of body weight passes anterior to the SI joints, anterior displacement of L5 over S1 may occur spondylolisthesis , applying pressure to the spinal nerves of the cauda equina.
They drain into the valveless vertebral venous plexus. The anesthetic solution spreads superiorly to act on spinal nerves S2-Co. The height to which the anesthetic ascends is affected by the amount of solution injected and the position of the patient. Spinal block: Introduction of an anesthetic directly into the CSF in the subarachnoid space utilizing a lumbar puncture see above. Subsequent leakage of CSF may cause a headache in some individuals.
Radiation to back of the thigh and into the leg sciatica or focal neurology suggests radiculopathy. Back strain: Stretching and microscopic tearing of muscle fibres or ligaments, often because of a sport-related injury. The muscles subsequently go into spasm as a protective response causing pain and interfering with function.
This is a common cause of low back pain. Frequently caused by impacts from the rear in motor vehicle accidents. May cause herniation of the IV disc and subsequent radiculopathy. The thoracic cage protects the contents of the thorax, whereas the muscles assist in breathing. It is important to identify and count ribs as they form key landmarks to the positions of the internal organs.
Midaxillary lines are perpendicular lines through the apex of the axilla on both sides Cephalic vein can be seen in some subjects lying in the deltopectoral groove between the deltoid and pectoralis major muscles.
This is called a median sternotomy. The middle ribs are most commonly fractured, and multiple rib fractures can manifest as a "flail chest," where the injured region of the chest wall moves paradoxically, that is, in on inspiration and out on expiration.
The glands are rudimentary in males and immature females. Size and shape of the adult female breast varies; the size is determined by the amount of fat surrounding the glandular tissue. The base of the breast is fairly consistent extending from the lateral border of the sternum to the midaxillary line and from the 2nd to the 6th ribs. The majority of the breast overlies the deep pectoral fascia of the pectoralis major muscle, with the remainder overlying the fascia of the serratus anterior.
The breast is separated from the pectoralis major muscle by the retromammary space, a potential space filled with loose connective tissue. The breast is firmly attached to the overlying skin by condensation of connective tissue called the suspensory ligaments of Cooper , which help to support the lobules of the breast. Asmall part of the mammary gland may extend toward the axilla, called the axillary tail of Spence.
Structure of the Breast For descriptive purposes, the breast is divided into four quadrants: upper and lower lateral, and upper and lower medial. The most prominent feature of the breast is the nipple.
The nipple is surrounded by the areola, a circular pigmented area of skin. The areola is pink in Caucasians and brown in African and Asian people. The pigmentation of the areola increases during pregnancy. The areola contains sebaceous glands, following a pregnancy these secrete an oily substance to protect the mother's nipple from irritation during nursing. The breast is composed of 15 to 20 lobules of glandular tissue, formed by the septa of the suspensory ligaments.
The mammary glands are modified sweat glands that are formed from the development of milk-secreting alveoli, arranged in clusters. Each lobule is drained by a lactiferous duct Each lactiferous duct opens on the nipple. The breast is also supplied by the branches of the thoracoacromial and lateral thoracic arteries from the axillary artery.
Venous drainage parallels the arterial supply and is mainly to the axillary artery and internal thoracic vein. Lymphatic Drainage of the Breast [Plate , Lymph Vessels and Nodes of Mammary Gland] Lymph from the nipple, areola, and lobules of the mammary glands drains to a subareolar lymphatic plexus. From there, a system of interconnecting lymphatic channels drains lymph to various lymph nodes.
The majority of the lymph, especially from the lateral quadrants of the breast, drains to the pectoral nodes, and from there to the axillary nodes. The remaining amount of lymph, especially from the medial quadrants of the breast, drains into the parasternal lymph nodes along the internal thoracic vessels. Some lymph from the lower quadrants of the breast passes to the inferior phrenic nodes. It is important to note that lymph from the medial quadrants can cross to the opposite breast.
Thus secondary metastases of breast carcinoma can spread to the opposite breast in this way. The palpation should extend into the axilla to palpate the axillary tails.
After palpation of one breast, the other should be palpated in the same way. Examine the skin of the breast for a change in texture or dimpling peau d'orange sign and the nipple for retraction, since these signs may indicate an underlying pathology. Pathology of the Breast Fibroadenoma: benign tumor, usually a solid and solitary mass that moves easily under the skin.
Often painless although sometimes tender on palpation. More common in young women but can occur at any age. Intraductal carcinoma or breast cancer: the commonest type of malignancy in women but can also occur in men. This malignancy presents as a palpable mass that is hard, immobile and sometimes painful. Additional signs can include bloody or watery nipple discharge if the larger ducts are involved. Gynecomastia: enlargement of the breasts in males because of aging, drug treatment, and changes in the metabolism of sex hormones by the liver.
External intercostal muscles: Have fibers that slope down and medially. Extend from the posterior tubercle of the rib to the junction of the rib and its costal cartilage anteriorly. Anteriorly, are replaced by external intercostal membranes that extend from the costochondral junctions to the sternum.
Internal intercostal muscles: Lie internal to the external intercostal muscles Their fibers lie at right angles to those of the external intercostal muscles and run inferiorly and laterally. Anteriorly extend to the lateral border of the sternum. Posteriorly extend only to the angles of the ribs; medial to the angles, are replaced by the internal intercostal membranes. Innermost intercostal muscles Lie deep to the internal intercostal muscles Are separated from the internal intercostals by the intercostal vessels and nerves Occupy the middle parts of the intercostal spaces Connect inner surfaces of adjacent ribs All intercostal muscles are supplied by intercostal nerves corresponding in number to their intercostal space.
Main action of the intercostals is to maintain the space between the ribs during inspiration and expiration. Other muscles of the rib cage Subcostal muscles-internal to the internal intercostals, cross from the angle of one rib to internal surface of the rib 1 to 2 spaces below. Transversus thoracis-4 to 5 slips of muscle that attach to the xiphoid process and inferior sternum and pass superiorly and laterally to attach to the 2nd through 6th costal cartilages.
Muscular branches supply the intercostal, levatores costarum, transversus thoracis, and serratus posterior muscles. The lower five intercostal nerves supply the skin and muscles of the abdominal wall Contain general somatic afferent and efferent fibers, as well as general visceral efferent fibers from the sympathetic trunk via white and grey rami communicantes and general visceral afferent fibers.
Ribs 1 through 7 are vertebrocostal because they attach to the sternum via a costal cartilage. Ribs 8 through 10 are vertebrochondral because their cartilages are joined to the cartilage of the rib above and via that connection to the sternum. Ribs 11 and 12 are free or floating ribs, which do not connect even indirectly with the sternum but which have a costal cartilage on their tips.
First rib is broad and sharply curved and has a tubercle of the attachment of scalene muscles. To avoid damage to the intercostal vein, artery, and nerve that run in the costal groove on the inferior surface of each rib, the needle is inserted well below the rib. The needle also must be placed sufficiently above the rib below to avoid the collateral branches of intercostal nerve and vessels that run along the superior surface of each rib.
They articulate with the C7 vertebra, but do not attach to the sternum. They may fuse with the first rib. If a cervical rib is present, however, it may compress the subclavian artery or inferior trunk of the brachial plexus and cause ischemic pain and numbness in the shoulder and upper limb. This condition is called thoracic outlet syndrome.
Bone Marrow Biopsy and Aspiration. Bone marrow aspiration and biopsy help diagnose many blood disorders and can be used to detect if cancer has spread to the bone marrow.
Bone marrow biopsy: The removal of bone and marrow for examination under the microscope. The sternum is a site of red marrow, even in adulthood, and is a good site for a bone marrow biopsy. Another common site is the posterior iliac crest. Abiopsy is usually conducted before performing a bone marrow aspiration. Bone marrow aspiration: The removal of a small amount of bone marrow fluid through a needle inserted into the bone.
Fluid is examined to determine if there are any problems with the blood cells made in the bone marrow Mnemonics Memory Aids Vertical order of the contents of the neurovascular bundle in the costal groove on the lower border of each rib: VAN Vein, Artery, Nerve.
The pleural cavity contains a thin layer of serous pleural fluid, which lubricates and allows the pleurae to move smoothly over each other during respiration. Surface tension keeps the lung surface in contact with the thoracic wall. The lung expands and fills with air when the thoracic cavity expands. The sternal line of pleural reflection is the sharp line along which the costal pleura becomes the mediastinal pleura The costal line of pleural reflection is the sharp line along which the costal pleura becomes the diaphragmatic pleura The vertebral line of pleural reflection is a smooth reflection of the costal pleura onto the vertebrae posteriorly.
The lines of pleural reflection on the left side can be remembered as The line of pleural reflection on the left descends in the midline of the sternum to the 4th costal cartilage, where it deviates to the left margin of the sternum at the 6th costal cartilage to accommodate the pericardium and the heart cardiac notch.
This line then deviates to cross the 8th rib at the midclavicular line. It crosses the 10th rib at the midaxillary line It then crosses the 12th rib at approximately the neck. On the right side, the line of pleural reflection descends at the midline of the sternum to the xiphoid process, and then deviates The lungs do not fully occupy the pleural cavities during expiration There are peripheral areas where the diaphragmatic and costal pleura come in contact and these are called the costodiaphragmatic recesses.
There are areas posterior to the sternum where the costal and mediastinal pleura come in contact with each other, and these are called costomediastinal recesses. The costomediastinal recess is larger on the left, because of the cardiac notch.
During expiration, the lower limit of the lungs is two costal spaces above the line of pleural reflection: the sixth rib at the midclavicular line, the 8th rib at the midaxillary line, and the 10th rib at the neck. Thus the costodiaphragmatic recess is approximately two costal spaces deep. The horizontal fissure runs from the oblique fissure at the midaxillary line along the 4th rib to its costal cartilage anteriorly.
The anterior margin of the left lung has an indentation-the cardiac notch, which often creates a thin process in the upper lobe called the lingula. Each lung has three surfaces: Costal Mediastinal Diaphragmatic Each lung is connected to the mediastinum by the root of the lung. Lung root contains: Main stem or lobar bronchi Pulmonary vessels and bronchi. Bronchial vessels, lymphatics, and autonomic nerves. The lung root is surrounded by a pleural sleeve, from which extends the pulmonary ligament inferiorly.
The carina is the keel-like ridge between the two openings of the main stem bronchi. The right main stem bronchus divides into upper and lower lobar bronchi before reaching the substance of the right lung. The main bronchi branch to form the bronchial tree. There are three lobar bronchi on the right: upper, middle, and lower There are two lobar bronchi on the left: upper and lower Each lobar bronchus branches into segmental bronchi that supply a bronchopulmonary segment. Each pulmonary artery gives rise to lobar and segmental arteries.
Intrasegmental veins drain to intersegmental veins in the pulmonary septa, which run a separate course from the pulmonary and segmental arteries and which drain to two pulmonary veins for each lung. Unknown 25 de junio de , Medical Students 25 de junio de , Medical Students 22 de julio de , Medical Students 5 de septiembre de , Unknown 28 de julio de , Medical Students 24 de diciembre de , Unknown 22 de agosto de , Gustavo R 20 de enero de , Medical Students 11 de junio de , Unknown 28 de marzo de , Unknown 10 de mayo de , Ana 8 de junio de , Medical Students 20 de mayo de , Unknown 6 de octubre de , Julia 25 de marzo de , Unknown 20 de abril de , Mosquera 18 de junio de , Medical Students 28 de agosto de , Unknown 30 de agosto de , Suscribirse a: Enviar comentarios Atom.
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