Practice Quiz - Pectoral Region & 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
    Axillary
    Subscapular
    Thoracoacromial
    Thoracodorsal
  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:
    axillary
    lateral pectoral
    medial pectoral
    suprascapular
    thoracodorsal
  5. In lymphatic drainage of the breast, the major portion (about 75%) enters eventually into which group of nodes?
    Central axillary
    Deltopectoral
    Lateral axilllary
    Parasternal
    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?
    apical
    central
    lateral
    anterior
    posterior
  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:
    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?
    Levator scapulae
    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?
    Accessory
    Lateral pectoral
    Long thoracic
    Phrenic
    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:
    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?
    Deltoid
    Pectoralis major
    Pectoralis minor
    Serratus anterior
    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?
    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
    Musculophrenic
    Posterior intercostal
    Superior epigastric
    Thoracoacromial
  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
  17. In the process of escaping from T. rex in Jurassic Park the heroine punctures the skin on the medial side of her wrist on a spiny bush. A few days later, due to the toxin, an infection is seen spreading up the medial side of her arm along the large cutaneous vein extending from the dorsum of her hand to the medial side of her arm. The vein involved is the:
    basilic
    brachial
    cephalic
    median cubital
    ulnar
  18. The lateral antebrachial cutaneous nerve comes from the:
    Axillary nerve
    Medial cord nerve
    Musculocutaneous nerve
    Radial nerve
    Ulnar nerve
  19. In withdrawing a blood sample from the median cubital vein the needle passes slightly deep and medial; which nerve might possibly be injured?
    Dorsal ulnar cutaneous
    Lateral antebrachial cutaneous
    Medial antebrachial cutaneous
    Posterior antebrachial cutaneous
    Superficial radial
  20. The vein of choice for withdrawing blood is the:
    Basilic
    Cephalic
    Median antebrachial
    Median cubital

    A man is in an auto accident and sustains several injuries, among them are:
    1. Skin lacerations:
      • on the back of his head in the occipital area,
      • on his chest just above the nipple,
      • on the lateral side of his arm,
      • lateral forearm at midlength,
      • dorsal hand between his thumb and index finger.
    2. Abrasions and contusions (bruises) about his right shoulder
    3. A fractured right radius near its distal end

  21. After X-ray examination, you are called upon to suture his lacerations in the emergency room. Which laceration (from your observations in the gross anatomy lab) would you expect to be the most difficult to suture because of thick skin?
    back of his head in the occipital area
    chest, just above the nipple
    lateral side of arm
    lateral forearm
    dorsal side of hand
  22. While you are stitching up his hand, he notes that you did not have to give him an anesthetic since the area between his thumb and index finger on the dorsal side was already numb. Which nerve must have been injured (most likely by the fracture of his wrist) for this area to be numb?
    lateral antebrachial cutaneous
    medial antebrachial cutaneous
    median
    superficial radial
    superficial ulnar
  23. The injured nerve (from the skin of his hand) contains afferent nerve fibers that travel through which of the following parts of a spinal nerve?
    dorsal primary ramus
    dorsal root
    gray ramus communicans
    posterior cutaneous branch
    ventral root
  24. A sixteen-year-old boy receives a superficial cut on the thumb side of his forearm. The superficial vein most likely affected is the:
    Basilic
    Cephalic
    Median antebrachial
    Median cubital
    Radial
  25. A sixteen-year-old boy received a superficial cut on the ulnar side of his forearm. The superficial vein most likely affected is the:
    Basilic
    Cephalic
    Median antebrachial
    Median cubital
    Radial
  26. During insertion of an IV cannula in the median cubital vein, the patient suddenly lost feeling on the radial side of the forearm. What nerve was injured?
    Lateral antebrachial cutaneous
    Medial antebrachial cutaneous
    Musculocutaneous
    Posterior antebrachial cutaneous
    Superficial radial nerve
  27. After trying to throw a curve ball, a pitcher lost sensation from the tip of the little finger. This indicates injury to which nerve?
    Radial
    Median
    Ulnar
    Musculocutaneous
    Medial antebrachial cutaneous
  28. While having an IV needle inserted into the cephalic vein of the forearm, the patient suddenly screamed in pain and felt tingling in part of the skin of the forearm supplied by the nerve accompanying the vein. What nerve was injured?
    Posterior antebrachial cutaneous
    Lateral antebrachial cutaneous
    Medial antebrachial cutaneous
    Musculocutaneous
    Superficial radial
  29. Because of scarring of a patient's median cubital vein, the technician chooses to insert an infusion needle into her basilic vein at the level of the medial epicondyle. Despite the certainty that the needle does not pass through the deep (investing) fascia, there is still a chance that it might nick or impale which of the following?
    Brachial artery
    Lateral antebrachial cutaneous nerve
    Medial antebrachial cutaneous nerve
    Median nerve
    Radial nerve