for 2nd course students!!! MCQ & cases �� ï&iques

For 2nd course students!!! MCQ & cases �� ï&iques

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During one of your third-year rotations you observe a resident on your service perform a thoracocentesis to obtain a sample of pleural fluid. The resident inserts the needle near the lower border of the eighth rib at the right anterior axillary line and withdraws a few milliliters of fluid. The next day, during your rounds, the patient complains of tingling and numbness of the skin of his chest from the level of the eighth rib down toward the umbilicus on the right side. Questions to consider: 1. Why is the needle inserted in the eighth interspace? 2. How would you explain the presence of the parasthesia? 3. What specific structure was likely damaged by the needle, and how does this explain the distribution of the parasthesia? 4. What other structures are associated with the damaged structure and how are they arranged? Between what two muscle layers are these structures found? 5. Where should the resident have inserted the needle to avoid damaging these structures? References: - Gray’s Anatomy  - D.Chaurasia’s  Human Anatomy. Regional and Applied,  Dissection  а nd Clinical.  - Frank H. Netter, M.D. Atlas of Human Anatomy.  - Prives M. G.  Human Anatomy
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1.1. The second costal cartilage can be located by palpating the: A). costal margin B). sternal angle C). sternal notch D). sternoclavicular joint E). xiphoid process 1.2. The thoracic wall is innervated by: A). Dorsal primary rami B). Intercostal nerves C). Lateral pectoral nerves D). Medial pectoral nerves E). Thoracodorsal nerves 1.3. You are caring for a 68-year-old male who has copious amounts of fluid in the left pleural cavity due to acute pleurisy. When you examine him as he sits up in bed (trunk upright), where would the fluid tend to accumulate? A). costodiaphragmatic recess B). costomediastinal recess C). cupola D). hilar reflection E). middle Mediastinum 1.4. When inserting a chest tube, intercostal vessels and nerves are avoided by placing the tube immediately: A). above the margin of a rib B). below the margin of a rib 1.5. The first rib articulates with the sternum in close proximity to the: A). Nipple B). Root of the lung C). Sternal angle D). Sternoclavicular joint E). Xiphoid process 1.6. The portion of the parietal pleura that extends above the first rib is called the : A). costodiaphragmatic recess B). costomediastinal recess C). costocervical recess D). cupola E). endothoracic fascia 1.7. You are attending an operation to remove a thymic tumor from the superior mediastinum. The surgeon asks, "What important nerve lying on and partly curving posteriorly around the arch of the aorta should we be careful of as we remove this mass?" You quickly answer, "The _____
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A). left phrenic B). left sympathetic trunk C). left vagus D). right phrenic E). right sympathetic trunk 1.8. A needle inserted into the 9th intercostal space along the midaxillary line would enter which space? A).
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This note was uploaded on 11/29/2011 for the course RWR fref taught by Professor Erf during the Spring '11 term at Audencia Nantes Ecole de Management.

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For 2nd course students!!! MCQ & cases �� ï&iques

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