QUIZ

1. A woman with breast cancer subsequently develops metastases in her vertebral column. The most direct route for spread of the tumor to the vertebral column was via: A. branches of the cephalic vein B. branches of the lateral thoracic vein C. branches of the thoracoacromial veins D. lymphatic vessels draining into the axilla E. branches of the intercostal veins

2. A. B. C. D. E.

The clavipectoral fascia is penetrated by which artery? Anterior circumflex humeral Axillary Subscapular Thoracoacromial Thoracodorsal

3. A. B. C. D. E.

Mastitis is a condition which involves: A type of leukemia Inflammation of the breast Infection of lymph nodes Mast cells Tumors of glandular tissue

4. In the process of doing an axillary lymph node dissection in a 50 year-old patient, the surgery resident cleans the space between the pectoralis major and minor muscles, in an attempt to remove all of the lateral pectoral lymph nodes. Upon recovery it is noted that the patient's lower pectoralis major is paralyzed. The nerve most likely injured is the: A. axillary B. lateral pectoral C. medial pectoral D. suprascapular E. thoracodorsal

5. In lymphatic drainage of the breast, the major portion (about 75%) enters eventually into which group of nodes? A. Central axillary B. Deltopectoral C. Lateral axilllary D. Parasternal E. Subscapular

6. The prognosis in breast cancer is poorer as more proximal lymph nodes are found to have cancerous cells in them. Spread of cancer to which of the following axillary nodes would indicate the worst prognosis? A. apical B. central C. lateral D. pectoral E. subscapular

7. You are in the emergency room when a patient is brought in, the loser in a street fight. He has received a stab wound about 1.5 cm long in the right side of the chest about 1.5 cm below and 1 cm medial to the coracoid process of the scapula. He has lost a lot of bright red blood from a large (~1.2 cm in diameter) severed artery found deep at this location. Intravenous fluids are immediately administered and a surgeon is called in to repair the artery. He begins by making an incision through the skin and subcutaneous tissue just below the clavicle, then cuts the clavicular head of the pectoralis major muscle and retracts it downward to obtain sufficient exposure of the area. He next encounters a partially severed muscle running downward and medially from the coracoid process. He divides the remaining fibers of the muscle and has you retract it downward. This exposes a bloody fatfilled space full of vessels and nerves. The muscle running downward and medially from the coracoid process which was partially severed was the: A. B. C. D. E. Coracobrachialis Pectoralis minor Long head of the biceps Subclavius Subscapularis

8. Postoperative examination revealed that the medial border and inferior angle of the left scapula became unusually prominent (projected posteriorly) when the arm was carried forward in the sagittal plane, especially if the patient pushed with outstretched arm against heavy resistance (e.g., a wall). What muscle must have been denervated during the axillary dissection? A. Levator scapulae

B. C. D. E.

Pectoralis major Rhomboideus major Serratus anterior Subscapularis

9. During a motorcycle accident, an 18-year-old male landed on the right lateral side of his rib cage with his right upper limb abducted. In the hospital he was found to have "winging" of the right scapula. Which nerve was likely damaged in the accident? A. Accessory B. Lateral pectoral C. Long thoracic D. Phrenic E. Vagus

10. During the planning of therapeutic intervention for a 54-year-old female patient with cancer of the right breast, a 3rd year medical student would need to first consider where most of the cancer cells would metastasize, which would be: A. Abdominal wall B. Anterior mediastinum C. Axillary lymph nodes D. Opposite breast E. Parasternal lymph nodes

11. After a jarring blow to the left anterior shoulder region, a young field hockey player was told by an examining physician that she had a muscle tear that resulted directly from the superolateral distraction of a fractured coracoid process. Which muscle was torn? A. Deltoid B. Pectoralis major C. Pectoralis minor D. Serratus anterior E. Subclavius 12. 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

13. Upon finding a malignant tumor in the medial portion of the breast of a 40year-old female, the surgeon began to search for the lymph nodes that would be the first ones reached by metastatic spread of cancer cells from this site. Which group(s) would have to be examined to determine whether metastasis had occurred? A. Central only B. Parasternal only C. Parasternal and apical D. Parasternal and lateral E. Parasternal and pectoral

14. After being thrown from a motorcycle moving at high speed, a 16-year-old female was found to have a paralyzed right pectoralis major muscle. Which set of movements at the shoulder joint would be found greatly weakened? A. Abduction and extension B. Abduction and lateral rotation C. Adduction and flexion D. Lateral rotation and extension

15. 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

16. In the axilla the pectoralis minor is a landmark, being closely related to all of the following structures except: A. cephalic vein B. cords of the brachial plexus C. lateral thoracic artery D. medial pectoral nerve E. second part of the axillary artery

17. The nerve which passes through the quadrangular space of the posterior shoulder innervates which muscle? A. Deltoid B. Infraspinatus C. Subscapularis D. Supraspinatus E. Teres major 18. In a diving accident that severed the spinal cord below the sixth cervical vertebra, which muscle would be affected? A. Deltoid B. Infraspinatus C. Latissimus dorsi D. Levator scapulae E. Trapezius 19..A man suffers a penetrating wound through the anterior axillary fold, with resulting damage to one of the main terminal branches of the brachial plexus. Among the effects is a significant weakening of flexion of the elbow. One or more other effects to be expected is (are): A. Loss of cutaneous sensation on the tips of several fingers B. Only loss of cutaneous sensation on the anterolateral surface of the forearm C. Only weakening of flexion at the shoulder D. Weakening of flexion at the shoulder and loss of cutaneous sensation on the anterolateral surface of the arm E. Weakening of flexion at the shoulder and loss of cutaneous sensation on the anterolateral surface of the forearm

20. The cords of the brachial plexus are: A. above the clavicle, medial to the scalenus anticus (anterior scalene). B. above the clavicle, behind the scalenus anticus (anterior scalene). C. at or below the clavicle, closely related to the axillary artery. D. at or below the clavicle, closely related to the axillary vein.