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Flashcards in *Anatomy 3 Deck (47):

What lobe of what lung do foreign bodies tend to be inhaled into in the upright patient?

The inferior lobe of the right lung (right bronchus has a larger diameter, more vertical orientation and a shorter length)


What is the name of the internal aspect of the tracheal birfurcation?



What is a pneumothorax?

The presence of air in the pleural cavity causing the lung to collapse


What are 3 types of pneumothoraxes with explanation?

Spontaneous = no apparent cause (in an otherwise healthy person)
Traumatic = result of an injury
Tension = breach in the lung surface acts as a one way valve allowing air to move into the pleural cavity during inhalation but preventing it from moving out during exhalation


What is a bulla?

A thin-walled air-filled space within the lung, arising congenitally or in emphysema


What size is a small pneumothorax?

Less than 2cm


What happens when a small amount of air enters the pleural cavity (either due to a penetrating injury to the parietal pleura or due to rupture of the visceral pleura) leading to the lung collapsing?

The vacuum is lost and the elastic lung tissue recoils towards the lung root (if only a small pneumothorax there will only be a


Examination findings when a pneumothorax is present? (3)

Reduced ipsilateral chest expansion and breath sounds
Hyper-resonance on percussion


What are the 2 features of a pneumothorax on a chest x-ray?

Absent lung markings peripherally and lung edge invisible


What does the build up of air in the pleural cavity eventually lead to in a tension pneumothorax?

Pleural cavity applies pressure (tension) to the mediastinal structures eventually causing mediastinal shift compressing the heart and left lung


What happens to the trachea in a tension pneumothorax?

Tracheal deviation away from he side of a unilateral tension pneumothorax


Why does a tension pneumothorax lead to hypotension?

SVC compression reduces venous return to the heart leading to hypotension


What is the treatment of a large pneumothorax?

Needle aspiration (thoracentesis)
sitting of a chest drain


Why is the a chest drain inserted in the 4th or 5th intercostal space midaxillary line?

This is the "safe traingle" - anterior border of latissimus dorsi and the posterior border of the pectoralis major


When carrying out thoracentesis, where should you aim to place the needle?

Just above the rib below in order to keep away from the NVB


Emergency management of a tension pneumothorax?

Insert a large gauge cannula (grey/orange) into the pleural cavity via the 2nd or 3rd intercostal space in the midclavicular line on the side of the tension pneumothorax


What is the most likely consequence of a chronic cough?



What are the 2 factors usually required for the development of a hernia?

Weakness of one structure (usually a part of the body wall)
Increased pressure on one side of the part of the wall (e.g. chronic cough)


What are 4 examples of the body wall which have a normal anatomical weakness?

Inguinal canal
Femoral canal


Apart from normal anatomical weakness, what other 2 factors can cause weakness of a structure?

Congenital abnormalities e.g. congenital diaphragmatic weakness
Surgical scars = incisional hernias


What are 3 normal anatomical weaknesses in the diaphragm? (common arrestor hernia)

Attachements to xiphoid process
Oesophageal hiatus
At posterior attachments


2 type of hiatus hernia?

Paraoesophageal hiatus hernia (herniated part of stomach passes through hiatus to become parallel to the oesophagus int he chest)
Sliding hiatus hernia (herniated part of stomach slides through hiatus into chest with gastro-oesophageal junction


Where in the inguinal canal do inguinal herniae tend to form?

In the medial half of the inguinal region


When is the inguinal canal formed?

During embryology due to the passage of the testes or the round ligament of the uterus into the perinuem


What does the inguinal canal contain in the adult?

The spermatic cord or the round ligament of the uterus


What can add increased pressure in the inguinal canal (intra-abdominal) leading to the formation of an inguinal hernia?

Chronic cough
Chronic constipation
Occupational lifting of heavy weights
Athletic effort


Where is the inguinal (groin) region?

The region between the anterior superior iliac spine and the pubic tubercle


Where do the inguinal ligaments attach between?

The ASIS and the pubic tubercle


What does the medial halves of the inguinal ligaments form in terms of the inguinal canals?

Forms the floors of the inguinal canals


How are the inguinal ligaments related to the external oblique aponeuroses?

Inguinal ligaments are the inferior borders of the external oblique aponeuroses


What are the inguinal canals?

approx. 4 cm long passageways through the anterior abdominal wall in the inguinal regions


What are the entrance and exit to the inguinal canals called?

Entrance = deep in (superior to the midpoint of the inguinal ligament)
Exit = Superficial ring ("V" shaped defect in the external oblique aponeurosis that lies superolateral to the pubic tubercle)


What causes the weakness in inguinal hernia?

The presence of the inguinal canal in the inguinal part of the anterolateral abdominal wall


What are the layers of the anterolateral abdominal wall of the inguinal canal in men?

Scrotal skin
Superficial fascia of the scrotum
Deep fascia
Inguinal ligament
Lower border of internal oblique
Lower border of transverses abdomens
Transversalis fascia
Testicular vein (tributary of IVC or left renal vein)
Testicular artery (branch of AA)
(the vas deference is attached inferiorly in the pelvis in the region of the developing prostate gland)


What is the name of the out pouching of parietal peritoneum that forms as the testicle begins to descend?

Processus vaginalis


What is the name of the covering transversals fascia that covers the testicle as it descends through the transversalis fascia?

Internal spermatic fascia


What is the name of the covering of skeletal muscle fibres from the internal oblique that cover the testicle as it descends?

Cremasteric fascia


What is the name of the covering of external oblique aponeurosis that covers the testicle as it descends?

External spermatic fascia


What is the name of the remains of the processes vaginalis?

Tunica vaginalis


What forms the deep ring of the inguinal canal?

Where the testis pushed into the transversalis fascia


What passes through the inguinal canal with the testis?

The spermatic cord


What is the spermatic cord

The 3 layers of "coverings" gained as the testis passes through the inguinal canal and the structures contain within (vas deferent, testicular artery and pampiniform plexus)


What passes through the inguinal canals and females?
Where do these go to?
What are these?

Round ligaments of the uterus
Labium majus
Fibrous embryological remnants in the adult female


2 types of inguinal hernia?

Direct inguinal hernia
An indirect inguinal hernia


How is a direct inguinal hernia formed?

A "finger" of peritoneum is forced through the posterior wall of the inguinal canal and directly out of the superficial ring into the scrotum


How is an indirect inguinal hernia formed?

A "finger" of peritoneum is first forced through the deep ring into the inguinal canal and then out of the superficial ring into the scrotum


How can you clinically differentiate between a direct and indirect hernia? (not a perfect test)

Reduce the hernia
Occlude the deep ring with fingertip pressure
Ask the patient to cough
If it is a direct hernia, the lump will reappear whereas if it is an indirect hernia the lump will not appear