The lower border of the lung is usually located two intercostal spaces above the respective pleural border. Thoracentesis, therefore, should be performed between 5- and 7- ribs along the midclavicular line, the 7 and 9 ribs along the midaxillary line, and 9 and 11 ribs along the paravertebral line. If the needle is inserted higher, there is a risk of lung injury. Insertion of the needle below the 9 rib at the middle axillary line on the right may cause liver injury (Choice B).

(Choice A) The lower border of the right lung is located two intercostal spaces

above the pleural border. The lung is not likely to be injured by insertion of a needle
into the 10* intercostal space at the midaxillary line as described.

(Choices C and D) The intercostal vein, artery, and nerve lie in the subcostal groove on the lower border of the rib. Thoracentesis should be performed along the upper border of the rib to prevent injury to these structures.

(Choice E) Hepatic veins are not likely to be injured during thoracocentesis.

Educational tip:

Thoracocentesis should be performed above the 7- rib in midclavicular line, the 9 rib along midaxillary line and the 11 rib along posterior scapular line. Insertion of a needle lower than these points increases the risk of penetrating abdominal structures, and insertion of the needle on the inferior margin of the rib risks striking the subcostal neurovascular bundle.

A 23-year-old woman is brought to the emergency department unconscious after a motor vehicle accident. The patient was texting on her cell phone and was not wearing a seatbelt during the incident. She has no known medical problems and takes no medications. Her temperature is 36.7 C (98 F), blood pressure is 155/90 mm Hg, pulse is 62/min, and respirations are 10/min. A linear skull fracture at the junction of the frontal, parietal, temporal, and sphenoid bones is seen on head CT scan.
#nextpattern #intregrated
#newpattern

The following statements concerning the trachea are true except:
a) It lies anterior to the esophagus in the superior mediastinum
b) In deep inspiration the carina may descend as far as the level of the sixth thoracic vertebra
c)The left principal bronchus is wider than the right principal bronchus
d) The arch of the aorta lies on its anterior and left sides in the superior mediastinum
e) The sensory innervation of the mucous membrane lining the trachea is derived from branches of the vagi, ad the recurrent laryngeal nerves

comment below

The answer is D: Epidermis, dermis, superfi cial fascia, deep
fascia, epimysium. The epidermis is the superfi cial cellular
layer of the skin. The dermis is the deeper, dense connective
tissue layer of the skin. The superfi cial fascia (subcutaneous
tissue) is the fatty loose connective tissue layer that underlies
the skin. The deep fascia is the relatively dense, fat-free connective tissue layer that lies deep to the skin and superficial fascia. The epimysium is a deep extension of the deep fascia that tightly invests the surface of individual muscles. Choice A (Epidermis, dermis, superfi cial fascia, epimysium, deep fascia) is incorrect. In this sequence, the epimysium incorrectly overlies the deep fascia. Choice B (Dermis, epidermis, superfi cial
fascia, deep fascia, epimysium) is incorrect. Here, the dermis is
incorrectly superfi cial to the epidermis. Choice C (Dermis, epidermis, superfi cial fascia, epimysium, deep fascia) is incorrect. Again, the dermis is incorrectly listed as the most superficial layer. Also, the epimysium incorrectly overlies the deep fascia. Choice E (Epidermis, superfi cial fascia, dermis, deep fascia, epimysium) is incorrect. In this sequence, the superfi cial fascia is incorrectly interposed between the epidermis and the
dermis.

2) The caecum is found to be placed below the stomach and in
midline. Which of the following abnormalities would have
taken place in the rotation of gut?

In mixed rotation the intestine doesn’t rotate as it re-enters the abdomen after physiological hernia leading to caecum located just
inferior to the pylorus of the stomach in the midline.

Brown Sequard syndrome presents with contralateral loss of crude touch sensations, since anterior spinothalamic tract carrying
these sensations, crosses the midline and runs on the opposite half of spinal cord.

4) During a thyroid operation, a nerve coursing along with the superior thyroid artery is injured. What can be the possible consequence(s)?

4) The nerve coursing along with the superior thyroid artery is external laryngeal nerve (branch of superior laryngeal nerve, vagus)
which supplies cricothyroid muscle.
• All the muscles of larynx are supplied by recurrent laryngeal nerve except the cricothyroid muscle.
• Sensory supply to laryngeal mucosa above vocal cords is by internal laryngeal nerve and below the vocal cords by recurrent
laryngeal nerve

5)The anterior abdominal wall of a 21-year-old woman impacts the steering wheel during a head-on car collision. The blunt trauma resulted in a lacerated pancreas with
digestive enzyme spilling anterior. Which of the following locations would initially receive the contents of the lacerated
pancreas?

The answer is D: Omental bursa. The omental bursa (or
lesser peritoneal sac) is an isolated part of the peritoneal
cavity, which lies posterior to the stomach and anterior to
the pancreas. Because of its location, the omental bursa
would receive digestive enzymes emanating from the lacerated section of the anterior pancreas. The only connection
between the omental bursa and the remaining aspects of the
peritoneal cavity is through the epiploic (omental) foramen.
Choice A (Supracolic part of greater peritoneal sac) is
incorrect. The supracolic part of greater peritoneal sac is
located above the transverse mesocolon. Digestive enzymes
emanating from a lacerated pancreas would only reach this
space if the fl uids traveled through the epiploic foramen.
Remember, these fluids initially spill into the omental bursa. Choice B (Infracolic part of greater peritoneal sac) is incorrect. The infracolic part of greater peritoneal sac is
located below the transverse mesocolon. Digestive enzymes
emanating from a lacerated pancreas could only reach this
space if the fluids traveled inferiorly via the right paracolic
gutter to reach this lower aspect of the peritoneal cavity.
However, these pancreatic enzymes would initially spill into the omental bursa. Choice C (Subhepatic space) is incorrect. The subhepatic space is a recess in the supracolic part of the greater peritoneal sac located between the visceral surface of the liver and the transverse colon. Digestive enzymes emanating from the anterior pancreas initially
spill into the omental bursa. Choice E (Subphrenic space)
is incorrect. The subphrenic space is a recess located in the
anterior part of the liver and the diaphragm. Therefore, it is
a component of the supracolic part of the greater peritoneal
sac. Due to the superior location of the damaged organ, the
subphrenic space is not a likely location to fi nd the emitted
pancreatic enzymes.

6) All of the following pairs for Brodmann area are correct
EXCEPT:
a. Superior temporal gyrus: Auditory cortex (41,42)
b. Superior temporal gyrus: Wernicke’s sensory speech area (22)
c. Inferior frontal gyrus: Broca’s motor speech area (44)
d. Superior frontal gyrus: Frontal eye field (8)