Common Emergency Drugs in Casualty Wards. Anemia: The Clinical Approach you never knew. You can download or read online the Robbins Basic Pathology 9th Edition book by links given below. You can mail us if you need latest editions of the book such as 10th, 11th or 12th edition of Robbins Basic Pathology. If the links are not working, do let us know using the comments section, we will readily update it. If you are unable to locate the links, please refresh the page.

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Plea send me an e-copy of the latest edition 10th of Robins Pathology on my e-mail …. You may send an email to arshadullahbangash gmail. Comments I want step up to medicine 5th edition PDF. Your email address will not be published. Scoliosis is an abnormal lateral curvature of the spine, accompanied by rotation of the vertebrae. Spondylolisthesis: The lumbosacral angle is created between the long axes of the lumbar vertebrae and the sacrum. It is primarily because of the anterior thickness of the L5 body.

As the line of body weight passes anterior to the SI joints, anterior displacement of L5 over S1 may occur spondylolisthesis , applying pressure to the spinal nerves of the cauda equina. They drain into the valveless vertebral venous plexus. The anesthetic solution spreads superiorly to act on spinal nerves S2-Co.

The height to which the anesthetic ascends is affected by the amount of solution injected and the position of the patient. Spinal block: Introduction of an anesthetic directly into the CSF in the subarachnoid space utilizing a lumbar puncture see above. Subsequent leakage of CSF may cause a headache in some individuals. Radiation to back of the thigh and into the leg sciatica or focal neurology suggests radiculopathy. Back strain: Stretching and microscopic tearing of muscle fibres or ligaments, often because of a sport-related injury.

The muscles subsequently go into spasm as a protective response causing pain and interfering with function. This is a common cause of low back pain. Frequently caused by impacts from the rear in motor vehicle accidents. May cause herniation of the IV disc and subsequent radiculopathy. The thoracic cage protects the contents of the thorax, whereas the muscles assist in breathing. It is important to identify and count ribs as they form key landmarks to the positions of the internal organs.

Midaxillary lines are perpendicular lines through the apex of the axilla on both sides Cephalic vein can be seen in some subjects lying in the deltopectoral groove between the deltoid and pectoralis major muscles. This is called a median sternotomy. The middle ribs are most commonly fractured, and multiple rib fractures can manifest as a "flail chest," where the injured region of the chest wall moves paradoxically, that is, in on inspiration and out on expiration.

The glands are rudimentary in males and immature females. Size and shape of the adult female breast varies; the size is determined by the amount of fat surrounding the glandular tissue.

The base of the breast is fairly consistent extending from the lateral border of the sternum to the midaxillary line and from the 2nd to the 6th ribs. The majority of the breast overlies the deep pectoral fascia of the pectoralis major muscle, with the remainder overlying the fascia of the serratus anterior. The breast is separated from the pectoralis major muscle by the retromammary space, a potential space filled with loose connective tissue.

The breast is firmly attached to the overlying skin by condensation of connective tissue called the suspensory ligaments of Cooper , which help to support the lobules of the breast. Asmall part of the mammary gland may extend toward the axilla, called the axillary tail of Spence. Structure of the Breast For descriptive purposes, the breast is divided into four quadrants: upper and lower lateral, and upper and lower medial.

The most prominent feature of the breast is the nipple. The nipple is surrounded by the areola, a circular pigmented area of skin. The areola is pink in Caucasians and brown in African and Asian people. The pigmentation of the areola increases during pregnancy. The areola contains sebaceous glands, following a pregnancy these secrete an oily substance to protect the mother's nipple from irritation during nursing.

The breast is composed of 15 to 20 lobules of glandular tissue, formed by the septa of the suspensory ligaments. The mammary glands are modified sweat glands that are formed from the development of milk-secreting alveoli, arranged in clusters. Each lobule is drained by a lactiferous duct Each lactiferous duct opens on the nipple.

The breast is also supplied by the branches of the thoracoacromial and lateral thoracic arteries from the axillary artery. Venous drainage parallels the arterial supply and is mainly to the axillary artery and internal thoracic vein. Lymphatic Drainage of the Breast [Plate , Lymph Vessels and Nodes of Mammary Gland] Lymph from the nipple, areola, and lobules of the mammary glands drains to a subareolar lymphatic plexus.

From there, a system of interconnecting lymphatic channels drains lymph to various lymph nodes. The majority of the lymph, especially from the lateral quadrants of the breast, drains to the pectoral nodes, and from there to the axillary nodes. The remaining amount of lymph, especially from the medial quadrants of the breast, drains into the parasternal lymph nodes along the internal thoracic vessels. Some lymph from the lower quadrants of the breast passes to the inferior phrenic nodes.

It is important to note that lymph from the medial quadrants can cross to the opposite breast. Thus secondary metastases of breast carcinoma can spread to the opposite breast in this way.

The palpation should extend into the axilla to palpate the axillary tails. After palpation of one breast, the other should be palpated in the same way. Examine the skin of the breast for a change in texture or dimpling peau d'orange sign and the nipple for retraction, since these signs may indicate an underlying pathology.

Pathology of the Breast Fibroadenoma: benign tumor, usually a solid and solitary mass that moves easily under the skin. Often painless although sometimes tender on palpation. More common in young women but can occur at any age.

Intraductal carcinoma or breast cancer: the commonest type of malignancy in women but can also occur in men. This malignancy presents as a palpable mass that is hard, immobile and sometimes painful. Additional signs can include bloody or watery nipple discharge if the larger ducts are involved. Gynecomastia: enlargement of the breasts in males because of aging, drug treatment, and changes in the metabolism of sex hormones by the liver.

External intercostal muscles: Have fibers that slope down and medially. Extend from the posterior tubercle of the rib to the junction of the rib and its costal cartilage anteriorly. Anteriorly, are replaced by external intercostal membranes that extend from the costochondral junctions to the sternum. Internal intercostal muscles: Lie internal to the external intercostal muscles Their fibers lie at right angles to those of the external intercostal muscles and run inferiorly and laterally.

Anteriorly extend to the lateral border of the sternum. Posteriorly extend only to the angles of the ribs; medial to the angles, are replaced by the internal intercostal membranes. Innermost intercostal muscles Lie deep to the internal intercostal muscles Are separated from the internal intercostals by the intercostal vessels and nerves Occupy the middle parts of the intercostal spaces Connect inner surfaces of adjacent ribs All intercostal muscles are supplied by intercostal nerves corresponding in number to their intercostal space.

Main action of the intercostals is to maintain the space between the ribs during inspiration and expiration. Other muscles of the rib cage Subcostal muscles-internal to the internal intercostals, cross from the angle of one rib to internal surface of the rib 1 to 2 spaces below.

Transversus thoracis-4 to 5 slips of muscle that attach to the xiphoid process and inferior sternum and pass superiorly and laterally to attach to the 2nd through 6th costal cartilages. Muscular branches supply the intercostal, levatores costarum, transversus thoracis, and serratus posterior muscles. The lower five intercostal nerves supply the skin and muscles of the abdominal wall Contain general somatic afferent and efferent fibers, as well as general visceral efferent fibers from the sympathetic trunk via white and grey rami communicantes and general visceral afferent fibers.

Ribs 1 through 7 are vertebrocostal because they attach to the sternum via a costal cartilage. Ribs 8 through 10 are vertebrochondral because their cartilages are joined to the cartilage of the rib above and via that connection to the sternum.

Ribs 11 and 12 are free or floating ribs, which do not connect even indirectly with the sternum but which have a costal cartilage on their tips. First rib is broad and sharply curved and has a tubercle of the attachment of scalene muscles. To avoid damage to the intercostal vein, artery, and nerve that run in the costal groove on the inferior surface of each rib, the needle is inserted well below the rib. The needle also must be placed sufficiently above the rib below to avoid the collateral branches of intercostal nerve and vessels that run along the superior surface of each rib.

They articulate with the C7 vertebra, but do not attach to the sternum. They may fuse with the first rib. If a cervical rib is present, however, it may compress the subclavian artery or inferior trunk of the brachial plexus and cause ischemic pain and numbness in the shoulder and upper limb.

This condition is called thoracic outlet syndrome. Bone Marrow Biopsy and Aspiration. Bone marrow aspiration and biopsy help diagnose many blood disorders and can be used to detect if cancer has spread to the bone marrow. Bone marrow biopsy: The removal of bone and marrow for examination under the microscope. The sternum is a site of red marrow, even in adulthood, and is a good site for a bone marrow biopsy. Another common site is the posterior iliac crest.

Abiopsy is usually conducted before performing a bone marrow aspiration. Bone marrow aspiration: The removal of a small amount of bone marrow fluid through a needle inserted into the bone. Fluid is examined to determine if there are any problems with the blood cells made in the bone marrow Mnemonics Memory Aids Vertical order of the contents of the neurovascular bundle in the costal groove on the lower border of each rib: VAN Vein, Artery, Nerve.

The pleural cavity contains a thin layer of serous pleural fluid, which lubricates and allows the pleurae to move smoothly over each other during respiration. Surface tension keeps the lung surface in contact with the thoracic wall. The lung expands and fills with air when the thoracic cavity expands. The sternal line of pleural reflection is the sharp line along which the costal pleura becomes the mediastinal pleura The costal line of pleural reflection is the sharp line along which the costal pleura becomes the diaphragmatic pleura The vertebral line of pleural reflection is a smooth reflection of the costal pleura onto the vertebrae posteriorly.

The lines of pleural reflection on the left side can be remembered as The line of pleural reflection on the left descends in the midline of the sternum to the 4th costal cartilage, where it deviates to the left margin of the sternum at the 6th costal cartilage to accommodate the pericardium and the heart cardiac notch.

This line then deviates to cross the 8th rib at the midclavicular line. It crosses the 10th rib at the midaxillary line It then crosses the 12th rib at approximately the neck. On the right side, the line of pleural reflection descends at the midline of the sternum to the xiphoid process, and then deviates The lungs do not fully occupy the pleural cavities during expiration There are peripheral areas where the diaphragmatic and costal pleura come in contact and these are called the costodiaphragmatic recesses.

There are areas posterior to the sternum where the costal and mediastinal pleura come in contact with each other, and these are called costomediastinal recesses. The costomediastinal recess is larger on the left, because of the cardiac notch. During expiration, the lower limit of the lungs is two costal spaces above the line of pleural reflection: the sixth rib at the midclavicular line, the 8th rib at the midaxillary line, and the 10th rib at the neck.

Thus the costodiaphragmatic recess is approximately two costal spaces deep. The horizontal fissure runs from the oblique fissure at the midaxillary line along the 4th rib to its costal cartilage anteriorly. The anterior margin of the left lung has an indentation-the cardiac notch, which often creates a thin process in the upper lobe called the lingula. Each lung has three surfaces: Costal Mediastinal Diaphragmatic Each lung is connected to the mediastinum by the root of the lung.

Lung root contains: Main stem or lobar bronchi Pulmonary vessels and bronchi. Bronchial vessels, lymphatics, and autonomic nerves. The lung root is surrounded by a pleural sleeve, from which extends the pulmonary ligament inferiorly. The carina is the keel-like ridge between the two openings of the main stem bronchi. The right main stem bronchus divides into upper and lower lobar bronchi before reaching the substance of the right lung.

The main bronchi branch to form the bronchial tree. There are three lobar bronchi on the right: upper, middle, and lower There are two lobar bronchi on the left: upper and lower Each lobar bronchus branches into segmental bronchi that supply a bronchopulmonary segment. Each pulmonary artery gives rise to lobar and segmental arteries.

Intrasegmental veins drain to intersegmental veins in the pulmonary septa, which run a separate course from the pulmonary and segmental arteries and which drain to two pulmonary veins for each lung. Pulmonary veins carry oxygenated blood to the left atrium of the heart. Bronchial arteries from the thoracic aorta carry oxygenated blood to the tissue of the lungs, traveling along the posterior surface of the bronchi. The left bronchial arteries come from the thoracic aorta; the single right bronchial artery may also arise from the superior posterior intercostal or a left superior bronchial artery.

The bronchial arteries anastomose with branches of the pulmonary arteries. Pulmonary veins drain the blood to the lungs supplied by the bronchial veins and empty into the azygos and accessory hemiazygos veins. The lungs have a rich, freely connecting network of lymphatic vessels.

Lymph from the lungs drains to Pulmonary lymph nodes along the lobar bronchi Bronchopulmonary lymph nodes along the main stem bronchi Superior and inferior tracheobronchial lymph nodes superior and inferior to the bifurcation of the trachea Innervation of the lungs Innervation is via the pulmonary plexuses located anterior and posterior to the lung roots. The plexuses contain postganglionic sympathetic fibers from the sympathetic trunks that innervate the smooth muscle of the bronchial tree, pulmonary vessels, and glands of the bronchial tree.

Sympathetic fibers are bronchodilators, vasoconstrictors, and inhibit glandular secretion. The plexuses contain preganglionic parasympathetic fibers from the vagus nerve CN X , small parasympathetic ganglia, and postganglionic parasympathetic nerves that innervate the smooth muscle of the bronchial tree, pulmonary vessels, and glands of the bronchial tree.

Parasympathetic fibers are bronchoconstrictors, vasodilators, and secretomotor to the glands. Pneumonia: a bacterial or viral infection of the lung that can lead to widespread systemic infection and lung collapse. Pneumonia is frequently confined to a single lobe of one lung and is called lobar pneumonia.

It can be clearly seen circumscribed to one lobe in a chest radiograph. The entry of air into a pleural cavity because of a penetrating wound or a fractured rib is called a pneumothorax and results in partial or total collapse of the lung. The escape of fluid into the pleural cavity pleural effusion is called hydrothorax; if the fluid is blood, the condition is known as a hemothorax, and if it is chyle from the thoracic duct, it is called a chylothorax.

Inflammation of the pleurae is called pleuritis or pleurisy; resulting friction between the two pleurae pleural rub is very painful and can be heard with a stethoscope.

The inflamed pleurae may adhere to each other pleural adhesion Squamous cell or oat cell carcinoma is a common cancer of the lung, usually caused by smoking, that may be indicated by a persistent cough or spitting of blood hemoptysis.

The fibrous outer layer of the pericardium the fibrous pericardium consists of dense connective tissue. The fibrous pericardium is attached to the central tendon of the diaphragm by the pericardiacophrenic ligament.

It blends with the tunica adventitia of the vessels entering and leaving the heart. It has ligamentous attachments to the sternum It is thus affected by movements of the heart, the great vessels, the sternum, and the diaphragm. Skin Lesions Melanoma Surgical Intensive Care Pediatric Surgery Plastic Surgery Hand Surgery Otolaryngology: Head and Neck Surgery Thoracic Surgery Cardiovascular Surgery Transplant Surgery Orthopaedic Surgery Neurosurgery Urology Ophthalmology Figure Credits Index Click it to start your free download now.

Tuesday, November 23, All Things Medicine. The study of neuroanatomy is described best by this snell book and its 8th edition proves the amount of importance it has for students. Download it now along with the gross anatomy snell. Other family members and associates include Paul Splittgerber and Kelly Splittgerber. Splittgerber is an amazing anatomist. A great resource for learning anatomy!