anatomy tutoring

Nipple location

4th intercostal

space

Peau d’orange sign Leathery thickening of the skin Often dimpled and has prominent

pores That gives the skin the

appearance of orange peel The dimples and the pores results

from shortening of the suspensory ligament Because of cancerous invasion

MastectomyA simple mastectomy in which

the pectoral muscles are left intact. The axillary lymph nodes, fat, and fascia are removed.

Radical mastectomy is designed to remove the primary tumor and the lymph vessels and nodes that drain the area.

Breast Quadrants

Lymphatic drainage of breast

Some lymph from lower quadrants→ inferior phrenic nodes

Lymph from medial quadrants can cross to opposite breast via parasternal nodes◦Secondary metastases of breast carcinoma can spread to opposite breast in this way

In lymphatic drainage of the breast, the major portion (about 75%) enters eventually into which group of nodes? 

A. Central axillaryB. DeltopectoralC. Lateral axillary D. ParasternalE. Subscapular

Breast cancer cells can spread directly to the cranial cavity and brain via the vertebral venous plexus. Through which route can they reach this plexus?

A. Axillary lymph nodesB. Internal thoracic veinC. Intercostal veinsD. Parasternal lymph nodesE. Thoracoacromial artery

While observing a mastectomy on a 60-year-old female patient, a medical student was asked by the surgeon to help tie off the arteries that supply the medial side of the breast. The artery that gives origin to these small branches is the:

A. Internal thoracicB. MusculophrenicC. Posterior intercostalD. Superior epigastricE. Thoracoacromial

The pleura is divided into two major types, based on location:

1. Parietal pleura – feels pain and touch

2. Visceral pleura- insensitive to pain

Pleura

1. Costomediastinal recesses

2. Costodiaphragmatic recesses

Pleural recesses

Pleural Refelction

MCL MAL VERTERBRAL

LUNGS 6 8 10

PLEURA

8 10 12

Pleural Effusion

◦Good place to remove fluid from the pleural cavity is from mid clavicular or mid auxillary line.

◦Insert needle below rib 6 and above rib 7 for mid clavicular area

Pleural effusionTypes

◦Serous fluid (hydrothorax) ◦Blood (hemothorax) ◦Chyle (chylothorax) ◦Pus (pyothorax or empyema)

Pneumothorax, Hydrothorax, and Hemothorax

Right lung The right lung has

three lobes and two fissures.

Fissures1. Oblique fissure2. Horizontal fissure

1. Heart 2.Inferior vena

cava 3.Superior vena

cava 4.Azygos vein 5.Esophagus

Medial surface of the right lung

The left lung is smaller than the right lung and has two lobes separated by an oblique fissure.

On the anterior surface of the lower part of the superior lobe a tongue-like extension (the lingula of left lung) projects over the heart bulge.

Left lung

Trachiobronchial Tree

TracheaBronchi

◦ Right and left [primary]◦ Lobar [secondary] [3 or 2]◦ Segmental [Tertiary] [10]

Bronchiole◦ Terminal◦ Respiratory

Alveoli◦ Alveolar duct◦ Alveolar Sac◦ Alveoli

Bronchopulmonary segments

A bronchopulmonary segment is the area of lung supplied by a segmental bronchus and its accompanying pulmonary artery branch.

You are called to perform thoracentesis (remove fluid from the pleural cavity). If you are to avoid injuring lung or neurovascular elements, where would you insert the aspiration needle?

A. the top of interspace 8 in the midclavicular lineB. the bottom of interspace 8 in the midclavicular

lineC. the top of interspace 9 in the midaxillary lineD. the bottom of interspace 9 in the midaxillary

lineE. the top of interspace 11 in the scapular line

The pleural space into which lung tissue just above the cardiac notch would tend to expand during deep inspiration is the:

A. Anterior mediastinumB. Costodiaphragmatic recessC. Costomediastinal recessD. CupolaE. Pulmonary ligament

Which feature is found only in the left lung?

A. Cardiac notchB. Horizontal fissureC. Oblique fissureD. Superior lobar bronchusE. Three lobes

Which part of the left lung might partially fill the costomediastinal recess in full inspiration?

A. ApexB. CupolaC. HilumD. LingulaE. Middle lobe

The oblique fissure of the right lung separates which structures?

A. Lower lobe from lingulaB. Lower lobe from upper lobe

onlyC. Lower lobe from both upper and

middle lobesD. Lower lobe from middle lobe

onlyE. Upper from middle lobe

In a post-soccer match brawl, a 35-year-old man was stabbed in the back with a knife that just nicked his left lung halfway between its apex and diaphragmatic surface. Which part of the lung was most likely injured?

A. HilumB. Inferior lobeC. LingulaD. Middle lobeE. Superior lobe