Nipple location

4th
intercostal
space

Peau dorange 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

Mastectomy
A

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.
B.
C.
D.
E.

Central axillary
Deltopectoral
Lateral axillary
Parasternal
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 nodes
B. Internal thoracic vein
C. Intercostal veins
D. Parasternal lymph nodes
E. 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 thoracic
B. Musculophrenic
C. Posterior intercostal
D. Superior epigastric
E. Thoracoacromial

Pleura
The

pleura is divided
into two major types,
based on location:
1. Parietal pleura
feels pain and touch
2. Visceral pleurainsensitive to pain

Pleural recesses
1.

Costomediastina
l recesses
2.
Costodiaphragm
atic recesses

MCL

Pleural

MAL

VERTERBRAL

Refelction

LUNGS

10

PLEUR
A

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 effusion
Types

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.

Fissures

1.

Oblique fissure
2. Horizontal fissure

Medial surface of the right

lung
1. Heart
2.Inferior

vena

cava
3.Superior vena
cava
4.Azygos vein
5.Esophagus

Left 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.

Trachiobronchial Tree

Trachea
Bronchi

Right and left [primary]

Lobar [secondary] [3 or 2]
Segmental [Tertiary] [10]

Bronchiole

Terminal
Respiratory

Alveoli

Alveolar duct
Alveolar Sac
Alveoli

Bronchopulmonary
segments
A

bronchopulmonar
y 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
line
B. the bottom of interspace 8 in the
midclavicular line
C. the top of interspace 9 in the midaxillary line
D. the bottom of interspace 9 in the midaxillary
line
E. 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 mediastinum
B. Costodiaphragmatic recess
C. Costomediastinal recess
D. Cupola
E. Pulmonary ligament

Which

feature is found only in the

left lung?
A. Cardiac notch
B. Horizontal fissure
C. Oblique fissure
D. Superior lobar bronchus
E. Three lobes

Which

part of the left lung might

partially fill the costomediastinal
recess in full inspiration?
A. Apex
B. Cupola
C. Hilum
D. Lingula
E. Middle lobe

The

oblique fissure of the right

lung separates which structures?
A. Lower lobe from lingula
B. Lower lobe from upper lobe
only
C. Lower lobe from both upper and
middle lobes
D. Lower lobe from middle lobe
only
E. Upper from middle lobe

In

a post-soccer match brawl, a 35-yearold 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. Hilum
B. Inferior lobe
C. Lingula
D. Middle lobe
E. Superior lobe