331.A mammogram of a woman, age 48, reveals macrocalcification within
the right breast, indicating the need for biopsy. The surgeon visually and man-
ually examines the breast with negative results. The surgeon closely examines
the nipple for indications of ductal carcinoma. At surgery for the biopsy, a
locator needle is inserted into the region of macrocalcification and the posi-
tion confirmed by mammography. The surgeon incises the skin and dissects
a block of tissue. The pathology report indicates ductal carcinoma with
microinvasion necessitating surgery. Both patient and surgeon agree that a
modified radical mastectomy offers the best prognosis in her case. At surgery
for mastectomy, the surgeon carries the dissection along the major pathway
of lymphatic drainage from the mammary gland. The major lymphatic
channels parallel which of the following?
a. Subcutaneous venous networks to the contralateral breast and abdominal wall
b. Tributaries of the axillary vessels to the axillary nodes
c. Tributaries of the intercostal vessels to the parasternal nodes
d. Tributaries of the internal thoracic (mammary) vessels to the parasternal nodes
e. Tributaries of the thoracoacromial vessels to the apical (subscapular) nodes
332.A 48-year-old woman underwent a complete mastectomy, including
removing several axillary lymph nodes. The lymph nodes were all negative
for evidence of metastasis. However, the patient is found to have winging
of the scapula when her flexed arm is pressed against a fixed object. This
indicates injury to which of the following nerves?
a. Axillary
b. Long thoracic
c. Lower subscapular
d. Supraclavicular
e. Thoracodorsal
333.A firefighter, age 34, who is a nonsmoker, complains of bouts of
dizziness at times of intense exertion. His history reveals having been
exposed to intense smoke 6 months ago when his breathing apparatus mal-
functioned during a job. He is scheduled for a pulmonary function test.
During deep inspiration the “pump handle” movement results in?
a. A decrease in the anterior-posterior diameter of the chest
b. No movement at the costovertebral joints
c. An increase in the superior-inferior diameter of the chest
d. A primary change in the anterior-posterior diameter of the chest
e. A primary change in the transverse diameter of the chest
460 Anatomy, Histology, and Cell Biology