Anatomy Tutoring

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Quick revision of the Respiratory Anatomy

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Nipple location

4th intercostal space

Peau dorange signLeathery thickening of the skinOften dimpled and has prominent poresThat gives the skin the appearance of orange peelThe 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 nodesSecondary 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?

Central axillaryDeltopectoralLateral axillary ParasternalSubscapular

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? Axillary lymph nodes Internal thoracic vein Intercostal veins Parasternal lymph nodes 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: Internal thoracic Musculophrenic Posterior intercostal Superior epigastric 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


1. Costomediastinal recesses 2. Costodiaphragmatic recesses Pleural recesses

Pleural Refelction



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 effusionTypesSerous 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 TracheaBronchiRight and left [primary]Lobar [secondary] [3 or 2]Segmental [Tertiary] [10]

BronchioleTerminalRespiratoryAlveoliAlveolar ductAlveolar SacAlveoli


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? the top of interspace 8 in the midclavicular line the bottom of interspace 8 in the midclavicular line the top of interspace 9 in the midaxillary line the bottom of interspace 9 in the midaxillary line 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: Anterior mediastinum Costodiaphragmatic recess Costomediastinal recess Cupola Pulmonary ligament

Which feature is found only in the left lung? Cardiac notch Horizontal fissure Oblique fissure Superior lobar bronchus Three lobes

Which part of the left lung might partially fill the costomediastinal recess in full inspiration? Apex Cupola Hilum Lingula Middle lobe

The oblique fissure of the right lung separates which structures? Lower lobe from lingula Lower lobe from upper lobe only Lower lobe from both upper and middle lobes Lower lobe from middle lobe only 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? Hilum Inferior lobe Lingula Middle lobe Superior lobe