NBME 22 Intercostal (NBME Answers)

Retired NBME 22 Answers

nbme22/Block 3/Question#14 (reveal difficulty score)
A 57-year-old woman comes to the physician 2 ...
Intercostal 🔍 / 📺 / 🌳 / 📖
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submitted by ∗ilikecheese(46)

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If you want to think of this simply, the ribs are connected posteriorly to the vertebral column. and the intercostal veins run between them, so they are the closest to the vertebral column.

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umpalumpa Shouldn't it be mammary vein the answer? The breast cancer in question vignette is MEDIAL (medial part of the breast gives blood to mammary veins. The route should be: breast-->mammary veins-->anterior IC veins-->posterioir IC veins-->vertebral venous plexus. Therefore, the most direct pathway is provided by going through the mammary veins. +

chaosawaits @umpalumpa, just look at the picture provided multiple times below for your answer +

chaosawaits @umpalumpa, at closer reading of the question, I see where you're confused being that the breast mass is on the upper inner portion of the breast and not the upper outer. My best educational guess is that blood drainage from the breast is not absolute geographically. Therefore, not all blood from the inner breast goes by the internal thoracic v and not all outer blood drains by the intercostal v. Given the choice between the two veins, the internal thoracic vein is a shorter route. In essence, I think the answer is internal thoracic no matter where the mass is located. +

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submitted by ∗mcl(671)

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Intercostal veins drain into the azygous/hemiazygous veins, which run right next to the vertebral column. Another useful diagram showing left and right intercostal veins.

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+9 upvote downvote
submitted by ∗monoclonal(24)

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http://i.imgur.com/3fZ2AaE.png

This image shows the multiple veins which drain breast tissue. easy visual. (to easy to miss it, but i did)

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yb_26 this one is the best, thank you! +1

canyon_run very nice! +

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submitted by ∗the_enigma28(69)

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UWorld QID: 11747 option A.

"The VVP also communicates with the azygos vein in the chest, which explains in part why breast and lung cancers frequently metastasize to the thoracic spine."

Breast → Intercostal veins → Azygous vein → Vertebral venous plexus (VVP) → Vertebrae

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srmtn https://i.imgur.com/3fZ2AaE.png +

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submitted by ∗d_holles(218)

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Goljan mentioned this (not sure what lecture -- might have been the endo one).

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