15) 67 A 65-year-old patient complains of severe, chronic
pain from the region of her right hip. The patient is
admitted to the hospital and a decision is made to per￾form surgery to avoid prescribing excessive pain medi￾cation. In such a case, which would the surgeon most
likely choose to perform?
⃣ A. Division of the ventral primary rami of nerves
supplying the affected region
⃣ B. Transection of all dorsal primary rami of
nerves from the hip area
⃣ C. Removal of abdominal sympathetic chain gan￾glia on the right side
⃣ D. Transection of the dorsal rootlets of spinal
nerves supplying the right hip
⃣ E. Division of lower lumbar and sacral ventral
rootlets

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
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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?