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MBBS1 Thorax > Gus's Rugby Injury > Flashcards

Gus's Rugby Injury Flashcards

1
Q

Describe the course of the right phrenic nerve from origin to diaphragm

A

It passes in front of right scalenus anterior muscle, then to the side of the superior vena cava and over the right border of the heart. It pierces the diaphragm beside the IVC in the tendinous portion.

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2
Q

Name a tributary of the superior vena cava.

A

The azygos vein

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3
Q

Why might hypoxia occur 12-24 hours after a haemorrhage?

A

Reduced haemocrit due to internal transfusion but since CO, blood volume and pressure are normal there is no detection of this by baroreceptors

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4
Q

Describe the course of the left phrenic nerve from origin to diaphragm

A

It passes over the left scalenus anterior muscle then passes to the side of the aorta and pulmonary trunk and over the left border of the heart. It pierces the diaphragm in the muscular portion of the left dome.

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5
Q

What lies in the posterior mediastinum?

A

Oesophagus and vagus nerves, azygos system of veins, the descending thoracic aorta and sympathetic chain

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6
Q

Where do the superficial lymphatics drain to?

A

The axillary lymph nodes

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7
Q

Why does diastolic blood pressure rise in isometric exercise but not in dynamic exercise?

A

Because of the compression of blood vessels in the contracting muscle raising TPR

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8
Q

Which vein drains the lower left side of the thoracic cage?

A

Hemiazygos vein

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9
Q

What damage caused by haemorrhage may be irreversible?

A

Damage to myocardium leads to ischemia, ischemic gut from reduced splanichic circulation may become leaky and lead to escape of toxic gut bacteria. Renal failure from under perfusion, ARDS from lung under perfusion

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10
Q

What factor is missing in haemophilia A?

A

FVIII

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11
Q

Where do the posterior deep lymph heads of the chest wall drain to?

A

The thoracic duct or right lymphatic duct

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12
Q

What would a graph of work and O2 consumption look like and why?

A

Linear up until a set point which is maximum work output as VO2 max has been reached

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13
Q

What is vitamin K required for in coagulation pathways?

A

y-carboxylation of prothrombin and factors VII, IX, X during synthesis in the liver

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14
Q

What is O2 consumption at rest and during exercise?

A

At rest: 250ml/min

Exercise: 2500ml/min

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15
Q

How will SV change with venous pooling?

A

Decreases SV by 40%

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16
Q

What may cause vitamin K deficiency?

A

Haemolytic disease of the newborn, bile duct obstruction, coeliac disease and Crohn’s disease

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17
Q

Where are the sympathetic chains in the back of the thoracic inlet?

A

At the back in the posterior mediastinum

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18
Q

Where in the brain are the phrenic nerves under control from?

A

Hind brain (lower pons and medulla)

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19
Q

Where does the trachea bifurcate?

A

The plane of the sternal angle

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20
Q

Where do pre ganglionic sympathetic nerves originate?

A

The lateral horn of spinal levels T1-L2 inclusively

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21
Q

How is lymphatic drainage of the chest wall divided?

A

Into superfical and deep

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22
Q

How long does it take for haemoglobin levels in blood to return to normal following blood loss of 20-30%?

A

5-6 weeks

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23
Q

What % blood loss can lead to irreversible damage or death in an healthy individual?

A

Above 30-50%

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24
Q

What is dynamic contraction?

A

Muscles shorten in rhythmic contraction and relaxation

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25
Q

When is the thymus gland most essential?

A

In neonates and grows until age 1 and prevents immune disorders in childhood. Begins to regress after puberty and is small and fat ridden in adults.

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26
Q

What is the pressure in a venule?

A

12.18 mmHg

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27
Q

Where do the anterior deep lymph heads of the chest wall drain to?

A

The bronchomediastinal lymph trunk

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28
Q

Why should jugular cannulation be done with the head down?

A

Jugular vein pressure is usually 0 so this prevents the possibility of an air embolus entering during inspiration

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29
Q

What kind of genetic disease is haemophilia?

A

X-linked, recessive

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30
Q

Why does vascular smooth muscle vasodilate in exercise?

A

Decreased PO2 and pH, increased PCO2, local metabolites, sympathetic stimulation of B2 receptors, nitric oxide

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31
Q

How are arterial and venous O2 content affected by exercise intensity?

A

Arterial blood content will not change and venous will decrease with increased exercise intensity.

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32
Q

What lies in the middle mediastinum?

A

Heart and pericardium

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33
Q

What do sympathetic efferent do in the thorax?

A

Stimulation of SAN and cardiac muscle increasing heart rate and strength of contraction. Increases smooth muscle tone in blood vessels of lungs causing vasoconstriction

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34
Q

How do you work out ventilation and alveolar ventilation?

A

Ventilation = tidal volume x respiratory frequency

Alveolar ventilation= (tidal volume - dead space volume) x respiratory frequency

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35
Q

What is the pressure in a vein?

A

10 mmHg

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36
Q

What is the main factor in determining VO2 max?

A

CO

37
Q

How will limb and splanchnic flow change with venous pooling?

A

Decreases limb and splanchnic flow by 25%

38
Q

How does the increase in heart rate in isometric exercise compare to that of dynamic exercise?

A

Heart rate increases steadily with length of contraction but not as steep and high as in dynamic excercise

39
Q

How does training improve ability to exercise?

A

The anaerobic threshold is higher, more O2 is offloaded to tissues so Hb effectively more efficient, lungs have better perfusion as more capillaries so need to ventilate less, heart can pump higher SV with each pump

40
Q

How will PvO2 change as VO2 max is reached?

A

Venous O2 pressure will decrease sharply to begin with then decrease at a slower rate as exercise intensity increases

41
Q

Where does the azygos vein receive blood from?

A

The right side of the posterior chest wall with the exception of the first posterior intercostal vein which drains to the right brachiocephalic vein

42
Q

How will TPR change with venous pooling?

A

Increases TPR by 25%

43
Q

Where do phrenic nerves pass through in the thoracic inlet?

A

In front of the subclavian artery

44
Q

What are the most common causes of severe internal bleeding?

A

Ruptured ectopic pregnancy, ruptured spleen, aortic aneurysm, fracture, bleeding peptic ulcer

45
Q

Where do the upper spaces of the thoracic cage drain to?

A

The left brachiocephalic vein

46
Q

What drains the anterior chest wall?

A

The internal thoracic veins

47
Q

What lies in the anterior mediastinum?

A

Internal thoracic vessels, lymphatics and part of the thymus gland

48
Q

How do valves help reduce venous pressure in legs?

A

Aid venous return by aiding skeletal muscle pumping and preventing back flow of blood due to gravity

49
Q

How will PvCO2 change as VO2 max is reached?

A

CO2 pressure will rise sharply to begin with then rise at a slower rate as exercise intensity increases

50
Q

How will PaCO2 and PaO2 change as VO2 max is reached?

A

Remain constant

51
Q

What is reverse stress compensation?

A

Compensatory mechanism for reduced blood volume whereby veins shrink around reduced blood volume, maintaining venous pressure and venous return despite reduced CO and blood volume

52
Q

What is isometric contraction?

A

Contraction with no muscle shortening, sustained contraction.

53
Q

What does the brachiocephalic artery divide into?

A

Right common carotid and right subclavian arteries

54
Q

Describe the course of the oesophagus

A

It lies behind the trachea in the superior mediastinum and, leaving the trachea behind, it courses downwards and to the left entering the inferior mediastinum behind the left atrium of the heart. It passes through the left muscular portion of the diaphragm.

55
Q

What are the subdivisions of the mediastinum?

A

Superior and inferior mediastinum bounded by an imaginary line drawn from the sternal angle. The inferior mediastinum can be further divided into anterior middle and posterior

56
Q

What are the three usual branches of the aorta?

A

The brachiocephalic artery, the left common carotid (to left side of face and neck) and the left subclavian (to left upper limb)

57
Q

How do you calculate O2 consumption?

A

CO x (arterial- mixed venous blood O2 content)

58
Q

What is progressive shock?

A

Initial recovery in terms of BP and CO but ultimately leads to death if untreated by transfusion

59
Q

What is an internal transfusion?

A

Restoration of blood volume by fluid movement from interstitum to blood caused by fall in BP/ hydrostatic pressure difference. Associated with haemodilution

60
Q

What is the superior vena cava formed of?

A

Union of right and left brachiocephalic veins

61
Q

What forms the brachiocephalic veins?

A

The internal jugular vein from head and neck and the subclavian vein from upper limb

62
Q

What do sympathetic afferents in the thorax do?

A

Signal pain from viscera to spinal nerves C7-T4

63
Q

What % blood loss will elicit shock in an healthy individual?

A

20% and above

64
Q

How can we calculate the blood pressure in the feet or the head of a person with normal BP?

A

Distance from heart x 0.77 and then add for feet or subtract for head this value from BP

65
Q

Where can the oesophagus be constricted?

A

By the cricoid cartilage of the larynx, the arch of the aorta, by the left main bronchus, by the left atrium of the heart and by entry through the diaphragm

66
Q

Which nerves are motor control for diaphragm?

A

Phrenic nerves

67
Q

Where do phrenic nerves lie in the chest?

A

In front of lung root

68
Q

What does stimulation of the vagus nerve do in the thorax?

A

Increases respiratory tract mucus secretion, causes bronchoconstriction, motor supply to smooth muscle in lower oesophagus and causes myocytes to slow rate of depolarisation

69
Q

What are the main factors affecting maximum and resting heart rates?

A

Maximum: age, younger people have a higher maximum heart rate
Resting: physical fitness, fitter people have a lower resting heart rate

70
Q

How is CO increased in exercise?

A

By consistent rise in heart rate and more modest increase in stroke volume due to increased filling pressure of the heart and increased contractility

71
Q

What is the vasovagal response?

A

The overwhelmingly parasympathetic response on the vascular system experienced in fainting (vasodilation and vagally mediated bradycardia)

72
Q

Which kind of shock gets better without treatment?

A

Non progressive

73
Q

What bounds the mediastinum?

A

The mediastinum is the space between the lungs and is bounded in front by the sternum and behind by the vertebral column

74
Q

How will CO change with venous pooling?

A

Decreases CO by 25%

75
Q

What increases the reticulocyte count?

A

Erythropoietin released by kidneys

76
Q

How will pH change as VO2 max is reached?

A

Decrease slowly, may be fairly constant to begin with due to buffering

77
Q

Where are the baroreceptors and where do they send afferent signals to?

A

Carotid sinus and aortic arch, responses sent to nucleus tractus solaris via glossopharyngeal and vagus nerves respectively

78
Q

What is oligaria?

A

Low urine output caused by sudden decrease in blood volume

79
Q

Where are cervical post ganglionic neurones mainly clustered?

A

Into three ganglia, superior (C1-C4), middle (C5, C6) and inferior (C7-T1)

80
Q

Does most of the blood reside in the arterial or venous system at rest?

A

60% in venous, 40% in arterial

81
Q

What lies in the superior mediastinum?

A

The remnants of the thymus gland, the great veins (brachiocephalic and SVC) the arch of the aorta and its branches (brachiocephalic trunk, left common carotid and left subclavian), the lower part of the trachea and the oesophagus. All these structures lie behind the manubrium to some extent so are well protected

82
Q

What factor is missing in haemophilia B (Christmas disease)?

A

FIX

83
Q

What are the symptoms of severe internal blood loss?

A

Grey, cold skin, shallow, rapid breathing, quick pulse, intense thirst, nausea, reduced urine output, low BP, anxiety, confusion, aggression, decreased coagulation time

84
Q

How will CVP change with venous pooling?

A

Decreases CVP

85
Q

Where does the aorta arch?

A

At the sternal angle, lying in the superior mediastinum, arching backwards and to the left lying behind the left main bronchus

86
Q

Where do the azygos vein and the superior vena cava join?

A

By the arch of the azygos at the plane of the sternal angle

87
Q

How can circulatory shock be defined?

A

Not only low blood pressure but inadequacy of blood flow

88
Q

What is venous pooling?

A

When standing still for too long there is reduced skeletal pumping so decreased venous return,

MBBS1 Thorax (6 decks)

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