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Undocumented thoughts about Week 4 lab objectives

9/21/99 W. Crone (303 FTZ, 629-7439, cronewil@hvcc.edu, www.hvcc.edu/academ/faculty/crone/index.html)

Included on this sheet are some thoughts to help you be oriented with the different lab objectives. Feel free to expand and elaborate for your own purposes--I'm not intending this to be exhaustive!

NB: for muscles: O-origin, I-insertion, N-enervation, A-action

Remove mammary gland in one piece with skin; ICS #2 below rib #2

MCL-midclavicular line, ISC 5, apex of heart, mitral valve. Pectoralis major fan shaped

deltopectoral triangle, cephalic vein goes deep and goes into axillary vein

want to detach pectoral muscle from origin, flip out laterally. Underneath, pect minor, smaller--around 3 slips of origin of that

thoracic vertebrae, facets where ribs make contact, slant of ribs

thoracic inlet, where constricted

R clavicle, superior and inferior view.

supine: face up (L. bend backward); prone face down (L. bend forward)

 

  1. rib, head, neck: 3 contact points, T5, T4, transverse T5; all synovial joints, articular cartilage, etc.
  2. tubercle, body, angle: ribs 1-7 true, 8-10 false, 11-12 floating, angle pt of greatest curvature and hence most likely to break there
  3. costal groove: show separate rib piece, VAN (sup. to inf.) : nerve not totally covered by rib
  4. costal cartilage: to offer resiliency to chest wall; inflammed in costochondritis
  5. sternum, manubrium: Rib 1 underneath the clavicle at the manubrium. Rib 2 junction at the sternal angle
  6. body, xiphoid process: body a possible marrow source; process a target to place your hand superiorly for CPR
  7. jugular notch (suprasternal): easily found landmark
  8. sternal angle: bifurcation of trachea at this level ; 2nd rib joins in here
  9. clavicle: first bone to ossify; most commonly broken; lung apex projects 2-4 cm above
  10. acromion: off of spine, articulates with clavicle, prominence of shoulder, proximal point at which clinicians measure the length of the upper limb (trap/delt)
  11. coracoid process (scapula): superior to glenoid cavity, ant. lat. (pect. minor)
  12. auscultation points of heart: pulmonic L parasternal 2-5 (2-3 L intercostal); tricuspid lower L sternal border; mitral--around cardiac apex ICS 5, 8-10 cm L of midsternal line; aortic R 2nd ICS, parasternal. These are wide apart, and blood carries the sound in the direction of the flow. (aortic and mitral are deep, so listen to where blood nearer chest wall)
  13. breast, nipple, aerola: areola, pigmented region around nipple
  14. suspensory (Cooper's) ligaments of breast: reach from deep fascia to dermis, defining the lobes (and shaping the breast)
  15. lactiferous duct: drainage for each lobule (about 14-20) of breast
  16. retromammary space: potential space of loose CT; so that breast has some movement over pectoral mm.
  17. lateral cutaneous branch of T2, intercostobrachial n.*: looks like white threads in fat; often involved in cardiac referred pain
  18. serratus anterior m: draws scapula forward, winging if abduction when paralyzed
  19. pectoralis major m: medial rotate, adduct, flex humerus
  20. deltopectoral triangle: boundary between pectoralis major and deltoid-superficial in fat is the cephalic vein
  21. cephalic v: same one as ant. lat surface of armà axillary v.
  22. pectoralis minor m: helps to stabilize clavicle when reaching for items
  23. external intercostal m.: fibers in same direction as external oblique m. of abdomen; help to elevate ribs in inspiration
  24. internal intercostal m (Remove chest plate following instructor's cutting diagram: more like internal oblique mm., also assist with inspiration
  25. internal thoracic a: supply breast, turns into superior epigastric a to rectus sheath
  26. intercostal space contents:* ext/int/VAN runs here; the innermost intercostals are the transversus equivalent.
  27. superior thoracic aperature (thoracic inlet): bony opening of thorax by the neck
  28. inferior thoracic aperature (thoracic outlet): bony opening of the thorax by the diaphragm
  29. pleural sacs (cavities): lung is surrounded by a pleural sac, pleural cavity a closed, potential space containing pleural fluid
  30. mediastinum: space between lungs and pleurae, with heart, great vessels, esophagus, ANS, thymus, etc.
  31. lung: fills pleural cavity
  32. visceral pleura:closely adherant to all of the lung, continuous with parietal pleura at root of lung
  33. root (lung): where structures enter and leave, e.g., pulmonary a, v, and bronchi
  34. parietal pleura: adherant to thoracic wall (separable by thin layer of endothoracic fascia), diaphragm, and pericardium
  35. costodiaphragmatic recess: not occupied in quiet respiration parts, potential spaces for fluid accumulation, e.g., hemothorax
  36. oblique fissures: separates inf/sup lobes of L lung, and inf lobe of R lung from middle, sup lobes
  37. horizontal fissure: separates superior and middle lobe in R lung
  38. lobes of lung: surrounded by visceral pleura, a sub lung with a secondary bronchus (tertiary bronchi have bronchopulmonary segments not separated by the folds of visceral pleura)

 

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Please send comments and questions to: cronewil@hvcc.edu

 

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This page updated on October 8, 1999