PHUS Note

rib two is atypical because it has an extra tuberosity on the shaft of
the rib
the superior surface:

o
slightly concave
more of an external angulation than first rib
unlike first rib, tubercle and angle are separate
has tuberosity for the attachment of serratus anterior at

the lateral margin in the posterior third of the shaft
posterior to serratus anterior tubercle are attachment

points for, sequentially:
scalenus posterior
serratus posterior superior
levator costae
along the medial aspect from the tubercle anteriorly,

there is the point of attachment for the intercostal
muscles
\
The breast skin is innervated by the:
anterior branches of the 1st to 6th intercostal nerves for

medial breast skin
lateral branches of the 2nd to 7th intercostal nerves for lateral

breast skin
4th intercostal nerve, both anterior and lateral branches for

the nipple areola complex with contributions from the 3rd and
5th intercostal nerves
These same cutaneous nerves supply sensory fibres and

sympathetic fibres to the mammary gland. However, the secretory
functions of the breast are largely controlled by hormones from the
ovaries and pituitary.
The highest intercostal artery (supreme intercostal artery or

superior intercostal artery) is an artery in the human body that
usually gives rise to the first and second posterior intercostal
arteries, which supply blood to their corresponding intercostal
space. It usually arises from the costocervical trunk, which is a
branch of the subclavian artery. Some anatomists may contend that
there is no supreme intercostal artery, only a supreme intercostal
vein
The supreme intercostal vein (highest intercostal vein) is a paired
vein that drains the first intercostal space on its corresponding side.
It usually drains into the brachiocephalic vein.[1] It can also drain into
the superior intercostal vein, or the vertebral vein of its
corresponding side
The superior intercostal veins are two veins that drain the 2nd, 3rd,
and 4th intercostal spaces, one vein for each side of the body.
The left superior intercostal vein passes posteriorly above the aortic
arch, it crosses deep to the phrenic nerve and the
pericardiacophrenic vessels and then superficial to the vagus nerve.
The superior thoracic artery (highest thoracic artery) is a small
artery located near the armpit in humans. It normally arising from
the first division of the axillary artery, but may arise from the
thoracoacromial artery, itself a branch of the second division of the
axillary artery. It supplies branches to the first and second
intercostal spaces as well as to the superior portion of serratus
anterior.
IVC is at the Middle mediastinum
The phrenic nerve originates mainly from the 4th cervical nerve, but
also receives contributions from the 5th and 3rd cervical nerves (C3C5) in humans.
The phrenic nerves contain motor, sensory, and sympathetic nerve

fibers. These nerves provide the only motor supply to the diaphragm
as well as sensation to the central tendon. In the thorax, each
phrenic nerve supplies the mediastinal pleura and pericardium.
coronary sulcus,
a surface groove encircling the heart that separates the atria from
the ventricles. It contains the right coronary artery, the small
cardiac vein, the coronary sinus, and the circumflex branch of the
left coronary artery.
The smallest cardiac veins or Thebesian veins or veins of Thebesius

are minute valveless veins in the walls of all four heart chambers
and they are often confused with the distinct set of arterial
connections, the "vessels of Wearn".[1] They are most abundant in
the right atrium and least in the left ventricle. They drain the
myocardium[2] and pass through the endocardial layer to empty
mostly into the right atrium, but a few empty into the ventricles. The
openings of the chambers are called the foramina venarum
minimarum
The Oblique Vein of the Left Atrium (oblique vein of Marshall) is a
small vessel which descends obliquely on the back of the left atrium
and ends in the coronary sinus near its left extremity;
The right marginal vein is a small vein that drains blood from the
heart. It passes along the inferior margin of the heart and joins the
small cardiac vein (sometimes known as the right coronary vein) in
the coronary sulcus, or opens directly into the right atrium.
The superficial part of the cardiac plexus gives branches
(a) to the deep part of the plexus;
(b) to the anterior coronary plexus; and
(c) to the left anterior pulmonary plexus.
Superficial part
The superficial part of the cardiac plexus lies beneath the arch of
the aorta, in front of the right pulmonary artery.
It is formed by the superior cardiac branch of the left sympathetic
trunk and the lower superior cervical cardiac branch of the left
vagus nerve.
A small ganglion, the cardiac ganglion of Wrisberg, is occasionally
found connected with these nerves at their point of junction.
This ganglion, when present, is situated immediately beneath the
arch of the aorta, on the right side of the ligamentum arteriosum.
The superficial part of the cardiac plexus gives branches
(a) to the deep part of the plexus;
(b) to the anterior coronary plexus; and
(c) to the left anterior pulmonary plexus.
Deep part
The deep part of the cardiac plexus is situated in front of the
bifurcation of the trachea, above the point of division of the
pulmonary artery, and behind the aortic arch.
It is formed by the cardiac nerves derived from the cervical ganglia
of the sympathetic trunk, and the cardiac branches of the vagus and
recurrent laryngeal nerves.
The only cardiac nerves which do not enter into the formation of the
deep part of the cardiac plexus are the superior cardiac nerve of the
left sympathetic trunk, and the lower of the two superior cervical
cardiac branches from the left vagus nerve, which pass to the
superficial part of the plexus.
Right half
The branches from the right half of the deep part of the cardiac
plexus pass, some in front of, and others behind, the right
pulmonary artery; the former, the more numerous, transmit a few
filaments to the anterior pulmonary plexus, and are then continued
onward to form part of the anterior coronary plexus; those behind
the pulmonary artery distribute a few filaments to the right atrium,
and are then continued onward to form part of the posterior
coronary plexus.
Left half
The left half of the deep part of the plexus is connected with the
superficial part of the cardiac plexus, and gives filaments to the left
atrium, and to the anterior pulmonary plexus, and is then continued
to form the greater part of the posterior coronary plexus.
An infundibulum (Latin for funnel; plural, infundibula) is a funnelshaped cavity or organ.
pericardial artery
one of several small vessels branching from the thoracic aorta,
supplying the dorsal surface of the pericardium.
mesopneumonium
1. The reflection of pleura surrounding the root of the lung (including
the pulmonary ligament inferiorly) as parietal pleura becomes
continuous with the visceral pleura of the lung.
The Levatores costarum, twelve in number on either side, are small

tendinous and fleshy bundles, which arise from the ends of the
transverse processes of the seventh cervical and upper eleven
thoracic vertebrae
They pass obliquely downward and laterally, like the fibers of the
Intercostales externi, and each is inserted into the outer surface of
the rib immediately below the vertebra from which it takes origin,
between the tubercle and the angle (Levatores costarum breves).
Each of the four lower muscles divides into two fasciculi, one of
which is inserted as above described; the other passes down to the
second rib below its origin (Levatores costarum longi).
Their role in normal inspiration, if any, is uncertain. They may play a
role in vertebral movement and/or proprioception.
How many presynaptic sympathetic fibres do we have?

The cross over of hemiazygous to the right-anterior or posterior to
the thoracic duct?

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rib two is atypical because it has an extra tuberosity on the shaft of

the superior surface:

more of an external angulation than first rib

unlike first rib, tubercle and angle are separate

has tuberosity for the attachment of serratus anterior at

posterior to serratus anterior tubercle are attachment

serratus posterior superior

along the medial aspect from the tubercle anteriorly,

anterior branches of the 1st to 6th intercostal nerves for

lateral branches of the 2nd to 7th intercostal nerves for lateral

4th intercostal nerve, both anterior and lateral branches for

These same cutaneous nerves supply sensory fibres and

The highest intercostal artery (supreme intercostal artery or

IVC is at the Middle mediastinum

The phrenic nerves contain motor, sensory, and sympathetic nerve

The smallest cardiac veins or Thebesian veins or veins of Thebesius

The superficial part of the cardiac plexus gives branches

(a) to the deep part of the plexus;

(b) to the anterior coronary plexus; and

(c) to the left anterior pulmonary plexus.

(a) to the deep part of the plexus;

(b) to the anterior coronary plexus; and

(c) to the left anterior pulmonary plexus.

An infundibulum (Latin for funnel; plural, infundibula) is a funnelshaped cavity or organ.

The Levatores costarum, twelve in number on either side, are small

How many presynaptic sympathetic fibres do we have?

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