29/09/20 Flashcards by Andrea Agnel

What is the Mach effect?

Can create the illusion of shadows. The edges of darker objects located adjacent to lighter ones to appear lighter (and vice versa).

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Where is the apical zone of lung?

Above the clavicle

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Where is the upper zone of lung?

Below the clavicles and above the lung hilum/cardiac shadow

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Where is the middle zone of lung?

Level with the lung hilum

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Where is the lower zone of lung?

Below the lung hilum, including costodiaphragmatic recess

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What is the surface anatomy for the lung pleura?

6th CC
8th rib MCL
10th rib MAL

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What are the common causes of pleural effusion?

1) Congestive heart failure (transudate)
2) Pneumonia (exudate)
3) Cancer (exudate)
4) Pulmonary embolus (exudate)
5) Viral disease (exudate)
6) Coronary artery bypass surgery (exudate)
7) Cirrhosis with ascites (transudate)

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What would you see on a COPD x-ray?

Ribs are more flat
Diaphragm is more flat
Hyperinflation of lungs

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What are the functions of the nasal cavity?

Warms, humidifies and filters incoming air
Highly vascular mucosal tissue covers the bony concha projections.
Due to their shape, the bony concha create turbulent air flow
Produces resonance in voice

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What type of epithelium lines the nasal vestibule region?

Lined with hair-bearing skin.

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What are the vessels found in the anterior nasal septum?

External carotid artery –> maxillary artery –> sphenopalatine artery –> Little’s area or Kiesselbach’s plexus

Internal carotid artery –> anterior and posterior ethmoid artery

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What is the sensory innervation of the paranasal sinuses?

CN Va (except maxillary sinus which is CN Vb)

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What does the frontal sinus drain via?

Frontal sinus drains via the frontonasal duct into the middle meatus

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What separates the ethmoid air cells from the orbit?

Ethmoid air cells separated from orbit by only a thin plate of bone - lamina papyracea.
Infection can spread to orbit and cause peri-orbital cellulitis.

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What are the 6 walls of the middle ear?

Superior (tegmental)
Posterior (mastoid)
Medial (labyrinthine)
Inferior (jugular vein)
Anterior (carotid)
Lateral (membranous)

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What type of epithelium is the Eustachian tube lined with? And what surrounds the opening?

Lined with respiratory mucosa

Opening surrounded by tubal tonsil tissue

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Which pharyngeal arches are associated with ear formation?

1st Arch – Malleus & Incus
CN V

2nd Arch – Stapes
CN VII

Ectoderm (of 1st cleft) & Endoderm (of 1st Pouch) –> Tympanic membrane (with a bit of mesoderm sandwiched in-between)

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Which syndrome is associated with a defect with pharyngeal arch 1?

Treacher-Collins syndrome

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What tuning fork do hearing tests use?

256 Hz

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What is a positive and negative Rinne’s test?

Normal finding: Air conduction should be better than bone conduction, so air conduction should persist twice as long as bone, this is a “positive test.”

Abnormal: Bone conduction is better than air conduction, this suggests conductive hearing loss and is referred to as “negative test.”

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With the Weber’s test, with which type of deafness in which ear are sounds louder?

Normally there is no lateralisation
Conduction deafness: Sound loudest in affected ear
Sensorineural deafness: Sound loudest in normal ear

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What innervates the middle ear and middle ear side of tympanic membrane?

CN IX

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Where is a Zenker (pharyngeal) diverticulum found?

posteriorly herniated pharyngeal lining at the “weak spot” (where the inferior constrictor meets the cricopharyngeus). Can be in front of oesophagus and cause halitosis.

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Where is piriform fossa found?

Recess between larynx and lateral thyroid cartilage

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What do the palatoglossus and palatopharyngeus muscles do and which are more medial/lateral?

When these contract, they ELEVATE the pharynx – helping to cover the bolus of food Palatoglossal are more lateral and palatopharyngeal are more medial.

Which side will the uvula move to if there is a CN X lesion?

Away from weak side, towards strong side.

What sort of gag reflex will you see with a CN X lesion?

MOTOR LOSS | Patient has sensation but unilateral/no contraction

What sort of gag reflex will you see with a CN IX lesion?

SENSORY LOSS | Patient has NO gag reflex when touching side with sensory loss, full gag when touching innervated side

What are the different types of lymphoid tissue?

Pharyngeal (adenoid), tubal, palatine, lingual

What is the posterior boundary of the superior thoracic aperture?

At what vertebral level is the jugular/sternal notch?

At what vertebral level is the sternal angle?

T4/5

At what level is the xiphoid process?

T9/T10

Which vertebral body do ribs articulate with?

Their own vertebra and the the vertebral body above. Eg. Rib 5 with articulate with T5 and T4.

What type of joint is found between the rib and vertebra?

Synovial joints sit between the rib & vertebrae | Allows for movement!

Which ribs are the vertebrosternal ribs?

Ribs 1-7

Which ribs are the vertebrocostal ribs?

Ribs 8-10

Which ribs are the floating ribs?

Ribs 11 and 12

Which muscle is used for inspiration?

External intercostal

Which muscle is used for expiration?

Internal intercostal

Where is the Revised Triangle of Safety for thoracostomy (chest drain) insertion?

4th ICS | Between the mid-axillary line and the anterior axillary fold

Where can pleuritic pain refer to?

A dermatome

Where do posterior intercostal arteries arise from?

Descending aorta

Where do anterior intercostal arteries arise from?

Internal thoracic and musculophrenic

Where does the diaphragm attach?

Costal margin and ribs 10, 11, 12 | Diaphragmatic crura attach to lumbar vertebrae

What can unilateral damage to the phrenic nerve cause?

Hemidiaphragmatic palsy

Where does gallbladder inflammation refer to?

Shoulder pain (phrenic n.) or regional pain in the R hypochondrium (intercostal n.)

What are the different congenital diaphragmatic hernias?

Posterolaterally (Bochdalek) or Retrosternally (Morgagni)

In embryology, when do the respiratory diverticula appear?

Week 4

How do the lungs develop?

Diverticulum --> lung/bronchial buds --> buds grow into splanchno-pleuric mesoderm (Week 5)

When does the septum between the trachea and oesophagus form?

Weeks 4 and 5

When have all major lung parts developed except those for gas exchange?

Week 16

When do respiratory epithelia begin developing?

Week 26

When does full lung maturation happen?

7-10 years

What is the pulmonary ligament?

Fold of parietal pleura

Where do the right and left RLNs recur?

Right RLN recurs at right lung apex under right subclavian artery Left RLN recurs at lung hilum/aortic arch

What might happen in a patient with an aortic arch aneurysm?

Hemi-paralysis of vocal cords, hoarse voice

What holds the pleural layer close together?

Surface tension

What are the different surfaces of the parietal pleura?

- Costal - Mediastinal - Cervical - Diaphragm

What would you see on an X-ray of tension pneumothorax? And how would you treat?

``` Mediastinal shift Tracheal deviation Diaphragmatic depression Unilateral hyperinflation Increased intercostal space size Hyper-resonant ``` Needle decompression --> wide bore needle stuck into the 2 intercostal space at the midclavicular line

What is the surface anatomy of the oblique fissure?

T3 Spinous Process to 6th cc anteriorly

What is the surface anatomy of the horizontal fissure?

4th cc horizontally back to oblique fissure

What is the surface anatomy of the tracheal bifurcation?

at sternal plane or just below T4/T5

What is the posterior surface marking of the lung?

10th rib PVL

What is the posterior surface marking of the pleura and lung at end tidal inspiration?

12th rib PVL

Where do you auscultate the middle lobe of the lung?

laterally along axillary lines

What vertebral level is the lung hilum?

T5/6

What is the lymphatic drainage of the lung?

Hilar bronchopulmonary nodes - -> Tracheobronchial nodes - -> Paratracheal nodes - -> Bronchomediastinal duct - -> Right lymphatic duct/subclavian vein OR Thoracic duct/left subclavian vein

What can happen to patient's voice if there is damage to the External Laryngeal Nerve?

ELN innervates Cricothyroid | If this muscle fails, patient may have monotone voice (damage to external laryngeal nerve)

How far inferiorly does the posterior mediastinum extend?

To T12 vertebrae (diaphragm)

Are the veins anterior or posterior to the arteries?

Veins are anterior

Where are the brachiocephalic veins formed?

Sternoclavicular joints

Where is the SVC formed?

SVC forms behind 1st R CC

What things are found in the posterior mediastinum?

oesphagus and vagal plexus, descending aorta, thoracic duct, sympathetic chain and azygous system

What does the fibrous pericardium bind to?

Fibrous pericardium binds to the central diaphragmatic tendon

What innervates the fibrous pericardium?

Phrenic nerve

What causes the transverse pericardial sinus?

Folding of heart tube creates a passageway (transverse pericardial sinus) between arterial outflows & venous input

What causes the oblique pericardial sinus?

Reflection of serous layer creates blind ended oblique pericardial sinus posterior to heart

When do the papillary muscles contract?

Papillary muscles are extensions of ventricular wall DO NOT CONTRACT to open valves – valves open passively They DO CONTRACT to prevent cusps from being blown back into Atria during ventricular systole

What type of murmur do you get with mitral valve prolapse?

Late systolic murmur

What is the most frequent valve abnormality?

Aortic stenosis | Often the result of degenerative calcification

What things cause right sided valve disease?

Infection, rheumatic fever, infective endocarditis | - causes splinter haemorrhages

What are the surface anatomy markings for the heart edges?

3rd R CC 2nd L CC 6th R CC 5th L ICS

What are the auscultation points for the valves?

A - 2nd R ICS P - 2nd L ICS T - 4th/5th L ICS M - 5th L ICS MCL

How much thicker is the left ventricular wall than the right ventricular wall?

Left ventricle is 3x thicker than the right ventricle

Which parts of the sympathetic chain innervate the heart?

T1-T4

What are the non-cyanotic congenital defects?

- Atrial septal defects - Ventricular septal defects - Patent ductus arteriosus

In embryology/placenta, when is blood present in the foetal vessels?

Week 3

When does cardiogenic mesoderm develop?

Day 18 (week 3)

When does the heart start beating?

Day 22-23

When does blood flow start?

Week 4

What forms blood vessels?

Angioblastic cell clusters | Angioblastic cords canalise to form two heart tubes; these fuse then expand

In what direction do the parts of the heart move in heart folding?

During folding the bulbus cordis normally moves to the right and the ventricle to the left

In what direction would the heart fold in dextrocardia?

Folding of the bulbus cordis to the left and ventricle to the right results in dextrocardia

What does the sinus venosus eventually become?

The smooth part of the right atrium

What forms the smooth part of the left atrium?

Pulmonary veins get absorbed

When does atrial septation occur?

Weeks 4 and 5

When does ventricular septation occur?

Weeks 5-7

Where do most ventricular septal defects occur?

In the membranous part

How much does the aorticopulmonary septum rotate?

180 degrees

What causes a common/persistent truncus arteriosus?

Failure of bulbar ridge formation in common arterial outflow Creates a common arterial outflow VSD with an overriding truncus arteriosus This is a cyanotic condition

What are the four things in Tetralogy of Fallot?

1) Pulmonary stenosis 2) RV Hypertrophy 3) Over-riding aorta 4) Ventricular septal defect

29/09/20 Flashcards

(102 cards)