Document Text Contents
Page 2
Interference with the lymphatic drainage of the breast by invasion of cancer cells can
produce edema, which gives the skin a thickened, finely dimpled appearance that has
been compared to the skin of an orange ("peau d'orange") or to pigskin leather.
Localized depressions of the skin and/or retraction of the nipple results when cancer
invades the suspensory ligaments, glandular tissue, or lactiferous ducts. Elevation of the
entire breast, making the affected nipple higher than its contralateral partner, results
from entry of cancer cells into the retromammary space, the pectoral fascia, and the
interpectoral nodes
A woman was stabbed in the right side of her lower neck. The stab wound was two to
three centimeters superior to the medial third of the clavicle. Shortly after the bleeding
was controlled, the woman began breathing rapidly and was given oxygen by the
paramedics. Physical examination revealed a significant shift of the apex beat of the
heart to the left, and poor breath sounds were heard on the right side of her thorax.
1.3A
What structures were likely injured?
The structures that may have been injured are the right subclavian artery and vein, the
suprapleural membrane, cervical pleura, and the apex of the lung
1.3B
What injuries could cause the shift of the apex beat of the heart to the left side of the
thorax?
Injury to the subclavian vessels and parietal pleura could result in the accumulation of
air and blood in the pleural cavity (pneumothorax and hemothorax). This condition may
in turn result in partial or total collapse of the right lung (atelectasis). Accumulation of
air or blood sufficient to increase the volume of the right pulmonary cavity (tension
pneumo- or hemothorax) causes the soft mediastinum (including the heart) to shift to
the left (mediastinal shift).
1.3C
What procedure would likely be performed to rectify the abnormal position of the heart?
A thoracocentesis followed by insertion of a valved chest tube (drain) would likely be
performed to remove blood from the pleural cavity and allow the lung to inflate.
1.3D
What structures are vulnerable during this procedure?
The intercostal nerve and vessels are vulnerable to injury during thoracocentesis
A 62-year-old man consulted his physician about his difficulty breathing. During the
physical examination, the physician palpated the man's trachea in the jugular notch.
During cardiac systole, he felt the trachea move abnormally. Radiographic studies
revealed an aneurysm of the arch of the aorta.
1.4A
What is an aneurysm of the arch of the aorta?
An aneurysm of the arch of the aorta is a dilation of the wall of the arch, usually due to
an acquired or congenital weakness of the wall of the vessel
1.4B
Why is this abnormality common in older people?
Page 56
Undoubtedly, the tendon of the semitendinosus was cut.
5.5B
How is this tendon related to others?
The semitendinosus tendon lies superficial to the tendon of the semimembranosus, and
in this area passes superficial to the medial head of the gastrocnemius and posterior to
the medial femoral condyle.
5.5C
How can the muscle to which this tendon belongs be tested during a physical
examination?
To test the muscle during a physical examination (but not in the presence of trauma),
the person is asked to flex his knee against the resistance of your hand while he is lying
prone. If the muscle is normal, the tendon can be palpated proximal to the knee on the
medial side.
5.6A
A young woman injured her ankle during a basketball game. She said, I turned my ankle
in but it's only a slight sprain! An examination by the trainer indicated that she had a
severely sprained ankle. What ankle ligament did she most likely tear?
The most commonly injured ligament of the ankle of the entire body, in fact is the
anterior talofibular ligament.
5.6B
What other ligaments may have been torn?
In severe sprains, the calcaneofibular and posterior talofibular ligaments may also be
torn.
5.6C
What bone might she have fractured?
An avulsion fracture of the distal fibula is often associated with a severe ankle sprain.
5.7A
A woman spoke to her primary care physician about pain in her feet. She was also
concerned about the uneven wearing of the soles of her shoes. The physician examined
the woman's feet while she was standing. He observed that her longitudinal arch was
flatter than normal. What do you think the physician's diagnosis will be?
This person has flat feet (pes planus).
5.7B
What pattern of excessive shoe wear is most likely to occur in this syndrome?
People with flat-feet wear down the soles of their shoes on the medial side, extending
to the tip of the shoe.
5.7C
What is/are possible cause(s) of this condition in adults?
Flatfeet are flexible (flat when weight bearing, but normal in appearance when not
bearing weight) or rigid (feet are flat even when not bearing weight). The more common
flexible flat-feet result from loose or degenerated intrinsic ligaments (inadequate
passive arch support). Rigid flat-feet with a history that goes back to childhood are likely
Interference with the lymphatic drainage of the breast by invasion of cancer cells can
produce edema, which gives the skin a thickened, finely dimpled appearance that has
been compared to the skin of an orange ("peau d'orange") or to pigskin leather.
Localized depressions of the skin and/or retraction of the nipple results when cancer
invades the suspensory ligaments, glandular tissue, or lactiferous ducts. Elevation of the
entire breast, making the affected nipple higher than its contralateral partner, results
from entry of cancer cells into the retromammary space, the pectoral fascia, and the
interpectoral nodes
A woman was stabbed in the right side of her lower neck. The stab wound was two to
three centimeters superior to the medial third of the clavicle. Shortly after the bleeding
was controlled, the woman began breathing rapidly and was given oxygen by the
paramedics. Physical examination revealed a significant shift of the apex beat of the
heart to the left, and poor breath sounds were heard on the right side of her thorax.
1.3A
What structures were likely injured?
The structures that may have been injured are the right subclavian artery and vein, the
suprapleural membrane, cervical pleura, and the apex of the lung
1.3B
What injuries could cause the shift of the apex beat of the heart to the left side of the
thorax?
Injury to the subclavian vessels and parietal pleura could result in the accumulation of
air and blood in the pleural cavity (pneumothorax and hemothorax). This condition may
in turn result in partial or total collapse of the right lung (atelectasis). Accumulation of
air or blood sufficient to increase the volume of the right pulmonary cavity (tension
pneumo- or hemothorax) causes the soft mediastinum (including the heart) to shift to
the left (mediastinal shift).
1.3C
What procedure would likely be performed to rectify the abnormal position of the heart?
A thoracocentesis followed by insertion of a valved chest tube (drain) would likely be
performed to remove blood from the pleural cavity and allow the lung to inflate.
1.3D
What structures are vulnerable during this procedure?
The intercostal nerve and vessels are vulnerable to injury during thoracocentesis
A 62-year-old man consulted his physician about his difficulty breathing. During the
physical examination, the physician palpated the man's trachea in the jugular notch.
During cardiac systole, he felt the trachea move abnormally. Radiographic studies
revealed an aneurysm of the arch of the aorta.
1.4A
What is an aneurysm of the arch of the aorta?
An aneurysm of the arch of the aorta is a dilation of the wall of the arch, usually due to
an acquired or congenital weakness of the wall of the vessel
1.4B
Why is this abnormality common in older people?
Page 56
Undoubtedly, the tendon of the semitendinosus was cut.
5.5B
How is this tendon related to others?
The semitendinosus tendon lies superficial to the tendon of the semimembranosus, and
in this area passes superficial to the medial head of the gastrocnemius and posterior to
the medial femoral condyle.
5.5C
How can the muscle to which this tendon belongs be tested during a physical
examination?
To test the muscle during a physical examination (but not in the presence of trauma),
the person is asked to flex his knee against the resistance of your hand while he is lying
prone. If the muscle is normal, the tendon can be palpated proximal to the knee on the
medial side.
5.6A
A young woman injured her ankle during a basketball game. She said, I turned my ankle
in but it's only a slight sprain! An examination by the trainer indicated that she had a
severely sprained ankle. What ankle ligament did she most likely tear?
The most commonly injured ligament of the ankle of the entire body, in fact is the
anterior talofibular ligament.
5.6B
What other ligaments may have been torn?
In severe sprains, the calcaneofibular and posterior talofibular ligaments may also be
torn.
5.6C
What bone might she have fractured?
An avulsion fracture of the distal fibula is often associated with a severe ankle sprain.
5.7A
A woman spoke to her primary care physician about pain in her feet. She was also
concerned about the uneven wearing of the soles of her shoes. The physician examined
the woman's feet while she was standing. He observed that her longitudinal arch was
flatter than normal. What do you think the physician's diagnosis will be?
This person has flat feet (pes planus).
5.7B
What pattern of excessive shoe wear is most likely to occur in this syndrome?
People with flat-feet wear down the soles of their shoes on the medial side, extending
to the tip of the shoe.
5.7C
What is/are possible cause(s) of this condition in adults?
Flatfeet are flexible (flat when weight bearing, but normal in appearance when not
bearing weight) or rigid (feet are flat even when not bearing weight). The more common
flexible flat-feet result from loose or degenerated intrinsic ligaments (inadequate
passive arch support). Rigid flat-feet with a history that goes back to childhood are likely
