Practice Quiz - Pectoral Region, Posterior Shoulder & Breast

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  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:
    branches of the cephalic vein
    branches of the lateral thoracic vein
    branches of the thoracoacromial veins
    lymphatic vessels draining into the axilla
    branches of the intercostal veins
  2. The clavipectoral fascia is penetrated by which artery?
    Anterior circumflex humeral
  3. 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:
    lateral pectoral
    medial pectoral
  5. In lymphatic drainage of the breast, the major portion (about 75%) enters eventually into which group of nodes?
    Central axillary
    Lateral axilllary
  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?
  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 fat-filled space full of vessels and nerves.

    The muscle running downward and medially from the coracoid process which was partially severed was the:
    Pectoralis minor
    Long head of the biceps
  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?
    Levator scapulae
    Pectoralis major
    Rhomboideus major
    Serratus anterior
  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?
    Lateral pectoral
    Long thoracic
  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:
    Abdominal wall
    Anterior mediastinum
    Axillary lymph nodes
    Opposite breast
    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?
    Pectoralis major
    Pectoralis minor
    Serratus anterior
  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?
    Axillary lymph nodes
    Internal thoracic vein
    Intercostal veins
    Parasternal lymph nodes
    Thoracoacromial artery
  13. Upon finding a malignant tumor in the medial portion of the breast of a 40-year-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?
    Central only
    Parasternal only
    Parasternal and apical
    Parasternal and lateral
    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?
    Abduction and extension
    Abduction and lateral rotation
    Adduction and flexion
    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:
    Internal thoracic
    Posterior intercostal
    Superior epigastric
  16. In the axilla the pectoralis minor is a landmark, being closely related to all of the following structures except:
    cephalic vein
    cords of the brachial plexus
    lateral thoracic artery
    medial pectoral nerve
    second part of the axillary artery