Pectoral Region & Axilla

1.Describe the mammary gland under the following headings: extent, deep relations, gross structure, arterial supply and lymphatics

2.A 55-year-old female presented to general surgery outpatient department with pain in left axilla and swelling of left upper limb. On clinical examination the surgeon noted the presence of few enlarged swellings in her left axilla and a swelling in upper lateral quadrant of her left breast. With your knowledge in anatomy, answer the following questions.

• a) Which group of axillary lymph nodes could be enlarged in this patient.
• b) Describe the anatomical groups of axillary lymph nodes and specify their areas of drainage.
• c) Describe the lymphatic drainage of mammary gland
• d) Enumerate the boundaries and contents of axilla

3.A painter experienced difficulty in raising the right arm upwards. The physician asked the patient to press his hands against the wall in front. It was found that the medial border and inferior angle of right scapula became prominent.  Name the muscle tested in this person to detect the injury to which nerve.  What is the name of the deformity.  What is the origin and root value of this nerve. How this nerve gets damaged  What are the attachments and actions of this muscle

4.A 45 years old nulliparous woman reported to the OPD with two small palpable nodules in her left axilla. She was admitted, investigated and taken up for mastectomy (left) in the same week. With your knowledge of anatomy answer the following questions:  What could be the probable diagnosis  What could be the nodule in the axilla and why  Describe the blood supply and lymphatic drainage of the breast  Mention the development and developmental anomalies of the breast

5.A 48 year old woman came to the surgery out-patient department with complaint of a lump in her right breast. On examination, surgeon found that the lump was hard and painless and in the upper outer quadrant of right breast. Axillary lymph nodes on the right side were enlarged and right breast was not mobile. Histopathological examination revealed malignancy of right breast. With your knowledge in anatomy answer the following questions: • What is the normal extent of breast both vertically and horizontally • Name three muscles related to the base of the breast. • What could be the reason for loss of mobility of breast in this condition • Describe the lymphatic drainage of the breast • Describe the arterial supply of the breast (1+1½+1+3½+3=10)

1.Lymphatic drainage of mammary gland

2.Blood supply and lymphatic drainage of the breast

3.Lymphatic drainage of mammary gland and its clinical significance

4.Axillary artery and distribution

5.Serratus anterior

6.Axillary nerve

1.Clavipectoral fascia

2.Trapezius muscle

3.Axillary nerve

1.Parts and branches of axillary artery

2.Name four structures piercing clavi-pectoral fascia

3.Name the muscles supplied by axillary nerve

4.Relations of Ist part of axillary artery

5.Branches of subclavian artery

6.The nerve injury which leads to winging of scapula

7.Pectoralis minor

1.Assertion: In carcinoma of the breast peau d’ orange appearance of skin occurs

• Reason: Blockage of cutaneous lymph vessels occurs in carcinoma of the breast
• a) Both A and R are true and R is the reason for A
• b) Both A and R are true and R is not the reason for A
• c) A is correct but R is incorrect
• d) A is incorrect but R is correct

2.(A): The axillary vein can freely expand during increased venous return

• (R): There is no or very thin axillary sheath around the axillary vein
• a) Both A and R are true, and R is the reason for A
• b) Both A and R are true, and R is not the reason for A
• c) A is correct but R is incorrect
• d) A is incorrect but R is correct