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Questions and Answers
What is the common site of fracture in a flail chest?
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 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 reason for the paradoxical movement of the paralyzed dome of the diaphragm on X-ray?
What is the weakest part of the ribs?
What is the weakest part of the ribs?
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Where do approximately 60% of breast cancer cases occur?
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?
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?
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?
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?
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?
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.
