Anatomy of the Breast

Question 1

What ribs does the bed of the breast extend between?

Answer 1

rib 2-6 (lateral border of the sternum to mid auxiliary line)

Question 2

What is the role of the retromammary space and where is it?

Answer 2

allows breast to move

found between the fascia and breast

Question 3

What do you have around the breast?

Answer 3

lactating lobules - more closer to pregnancy
non lactating lobules
lactating ducts

Question 4

What would be suggested if the breast is fixed to any underlying tissue?

Answer 4

invasive tumour through the fascia

Question 5

How is an invasive tumour through the fascia tested for?

Answer 5

patient puts hands on hips and contracts pec muscles

Question 6

What does >75% of lymphatic drainage from the breast go to?

Answer 6

ipsilateral axillary lymph nodes -> supraclavicular lymph nodes

Question 7

Where does lymph from the internal breast quadrant go to?

Answer 7

parasternal lymph nodes

Question 8

Where does lymph from the lower inner breast quadrant go to?

Answer 8

abdominal lymph nodes

Question 9

Where does lymph from the upper limb go to?

Answer 9

auxillary lymph nodes

Question 10

What is lymphodema?

Answer 10

swelling that occurs due to damage or removal of lymph nodes

Question 11

What does the axilla contain?

Answer 11

brachial plexus branches
axillary artery, vein and lymph nodes
fat

Question 12

How is pain from the superior aspect of the pelvic organs and those touching the perineum transported?

Answer 12

visceral afferents alongside sympathetic fibres

T11-L2

Question 13

How is pain from the superior aspect of the pelvic organs and perineum percieved?

Answer 13

suprapubic

Question 14

How is pain from the inferior aspect of the pelvic organs and those not touching the perineum transported?

Answer 14

visceral afferents alongside parasympathetic fibres

S2,3,4

Question 15

How is pain from the inferior aspect of the pelvic organs and those not touching the perineum percieved?

Answer 15

S2,3,4 dermatome - perineum

Question 16

How is pain from the structures that are in the pelvis eg cervix and superior vagina ABOVE the levator ani transported?

Answer 16

visceral afferents alongside parasympathetics

S2,3,4

Question 17

How is pain from the structures that are in the perineum eg inferior vagina, perineal muscles and skin BELOW the levator ani transported?

Answer 17

somatic sensory from the pudendual nerve

Question 18

Which spinal levels is a spinal anaesthetic inserted to?

Answer 18

L3/L4

Question 19

What does a spinal anaesthetic aneasthetise?

Answer 19

from waiste down - intra and sub peritoneal plus somatic areas

Question 20

What is the furthest point that a spinal anaesthetic goes into?

Answer 20

spinal cord

Question 21

What is the mode of action of a spinal anaesthetic?

Answer 21

blockade of sympathetic tone to all arterioles in the lower limb causing - vasodilation

Question 22

What is a side effect of spinal anaesthetic?

Answer 22

hypotension

Question 23

How do you know if spinal anaesthetic is working?

Answer 23

skin of the lower limbs look flushed
warm lower limbs
reduced sweating

Question 24

What does an epidural anaesthetise?

Answer 24

sub peritoneal plus somatic areas innervated by the pudendual nerve

Question 25

Which spinal level is used for an epidural?

Answer 25

L3/L4

Question 26

Which is the furthest point that an epidural goes into?

Answer 26

epidural space

Question 27

What is the action of a pudendual nerve block?

Answer 27

anaesthetises areas innervated by the pudendual nerve

Question 28

What is used as a landmark for a pudendual nerve block?

Answer 28

ischial spines - 4 and 8 o’clock positions

Question 29

What is the route of the pudendual nerve?

Answer 29

exits via the greater sciatic foramen, passes the posterior sacrospinous ligament then reenters via the lesser sciatic foramen
travels in the pudendual canal within the obturator fascia

Question 30

When is a pudendual nerve block given?

Answer 30

during labour/forceps delivery
painful delivery
episotomy needed
perineal suturing post delivery

Question 31

What is an episiotomy? What type is usually done?

Answer 31

posterolateral inscison done to prevent tearing into the anus
usually medial lateral done