Questions and Answers
What is the common site of fracture in a flail chest?
What is the cause of paralysis of one half of the diaphragm?
What is the reason for the paradoxical movement of the paralyzed dome of the diaphragm on X-ray?
What is the weakest part of the ribs?
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Where do approximately 60% of breast cancer cases occur?
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What is the main cause of the peau d'orange appearance in breast cancer?
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What is the name of the tumor that occurs in the ovary due to cancer cells migrating from the breast?
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What is the name of the nerve that may be damaged during mastectomy, resulting in a skin deficit of the medial arm?
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What is the mnemonic used to remember the common features of DiGeorge syndrome?
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What is the complication that may occur a few weeks after radical mastectomy, due to lesioning of the long thoracic nerve?
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Study Notes
Cervical Rib
- May have a blind tip or be connected to the 1st rib by fibrous band, cartilage, or bone
- Compresses the lower trunk of the brachial plexus and subclavian artery
- Compression produces:
- Pain along the medial side of the forearm and hand
- Disturbance in the circulation of the upper limb
- May cause Thoracic Outlet Syndrome
Diaphragm
- Paralysis can occur due to injury to the phrenic nerve
- Paralysis of one half does not affect the other half due to separate nerve supply
- On X-ray, the paralyzed dome shows paradoxical movement:
- Instead of descending on inspiration, it is pushed superiorly by abdominal viscera
- Descends during expiration due to positive pressure in the lungs
Hiccups
- Occur due to involuntary spasmodic contractions of the diaphragm accompanied by the closure of the glottis
- Normally occur after eating or drinking due to gastric irritation
- Pathological causes include:
- Diaphragmatic irritation
- Phrenic nerve irritation
- Hysteria
- Uremia
Flail Chest
- Occurs due to severe blunt trauma (e.g., serious fall, car accident)
- Portion of rib cage is separated from rest of chest wall (multiple rib fractures)
- Injured region of the chest wall moves paradoxically:
- Inward during inspiration
- Outward during expiration
- Common site of fracture: Middle ribs
- Weakest part of ribs: Just anterior to the angle
- Condition is painful and may cause difficulty in ventilation, leading to reduced oxygenation
Breast Cancer
- One of the most common cancers in females
- Arises from epithelial cells of lactiferous ducts
- More frequently seen in postmenopausal females due to lack of estrogen hormones
- Clinically presents as:
- Painless hard lump
- Breast becomes fixed and immobile due to infiltration of suspensory ligaments
- Skin retraction due to infiltration of suspensory ligaments
- Retraction of nipple due to infiltration and fibrosis of lactiferous ducts
- Prominent or "puffy" skin (peau d'orange appearance)
- Obstruction of superficial lymph vessels by cancer cells may produce edema of the skin
Krukenberg's Tumor
- Lymph vessels from the inferomedial quadrant of the breast communicate with the sub-peritoneal lymph plexus
- Cancer cells migrate trans-coelomically and deposit on the ovary, producing a secondary tumor in the ovary called Krukenberg's tumor
Mastectomy
- Radical mastectomy involves removing the whole breast, pectoral muscles, fat, fascia, and as many lymph nodes as possible in the axilla and pectoral region
- Risks during radical mastectomy:
- Lesioning of the long thoracic nerve during ligation of the lateral thoracic artery
- Damage to the intercostobrachial nerve (lateral cutaneous branch of the second intercostal nerve), resulting in skin deficit of the medial arm
Mediastinum
- Superior and Inferior
DiGeorge Syndrome
- Genetic syndrome caused by deletion of part of chromosome 22
- Clinical findings vary greatly between individuals
- Common features can be memorized using the mnemonic 'CATCH':
- Congenital heart defects
- Abnormal facies
- Thymic aplasia
- Cleft palate
- Hypoparathyroidism
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Description
This quiz covers the anatomy of the cervical rib, its compression effects on the brachial plexus and subclavian artery, and resulting symptoms such as pain, circulation disturbances, and paralysis.
