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NBME 22 Answers

nbme22/Block 3/Question#14

A 57-year-old woman comes to the physician 2 weeks ...

Intercostal

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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.





 +5  upvote downvote
submitted by mcl(218),

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.





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)

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




 +0  upvote downvote
submitted by pitaziki(0),

Why is it that the intercostal vein provides the most direct pathway for metastatic breast cancer cells to spread to vertebral column? I thought it was internal thoracic (mammary) and I couldn’t find much searching online, besides wikipedia saying that internal thoracic vein drains the breast.

gainsgutsglory  Intercostal vein → Azygos → Batson vertebral plexus → infection of inner vertebral body +2  
realmedicmd  The internal thoracic drains into the subclavian, intercostal drains into the azygos system which is a more direct path to the vertebral drainage. +  




 +0  upvote downvote
submitted by d_holles(38),

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