Thorax Revision Flashcards
Identify the structure indicated by the arrow.
Anterior interventricular artery
Otherwise known as the left anterior descending artery
The structure indicated by the arrow is a direct branch from which artery?
Left coronary artery
Identify the chamber of the heart indicated by the arrow.
Right atrium
Which of the following conditions would cause a deviation of the trachea to the left side of the midsternal line?
* Left pleural effusion
* Right pneumonectomy
* Right upper lobe collapse
* Left lower lobe fibrosis
* Left sided tension pneumothorax
Left lower lobe fibrosis
Fibrosed lung tissue undergoes contraction and drags the major bronchi and the trachea towards the side of the diseased lung.
Which is the best auscultation site for the middle lobe of the lung in a female patient?
* Right supraclavicular fossa just above the medial third of the clavicle.
* Right 5th intercostal space at the midclavicular line.
* Right 2nd intercostal space at the midclavicular line.
* Right midaxillary line just below the axilla.
* Right 7th intercostal space in the mid axillary line.
Right midaxillary line just below the axilla
You are asked to choose a site for placing a chest drain into a patient with a massive pleural effusion in the left pleural cavity. Where would you place the drain?
* Midclavicular line in the left 5th intercostal space
* Midaxillary line in the left 5th intercostal space
* Midaxillary line in the left 2nd intercostal space
* 5th intercostal space behind the left posterior axillary line
Midaxillary line in the left 5th intercostal space
This is the best position for large amounts of fluid and it is within the triangle of safety.
When you auscultate a healthy adult patient with no lung disease, where would you hear bronchial breathing sounds on their anterior chest wall?
* Above the medial third of the clavicle.
* Over the body of the sternum below the level of 2nd intercostal space.
* Just below the axilla
* Over the manubrium of the sternum.
* Anywhere along the anterior costal margin.
Over the manubrium of the sternum
Just behind the manubrium the trachea bifurcates into right and left bronchi.
You were assessing the vocal resonance of a patient by auscultating over different areas of the anterior chest wall whilst the patient was repeating the words ninety-nine. There was increased vocal resonance over the right upper lobe compared to the rest of the lung. What would cause this?
* Bronchial obstruction
* Consolidation of the right upper lobe.
* Chronic Obstructive Pulmonary Disease (COPD)
* Pneumothorax
* Pleural effusion
Consolidation of the right upper lobe
Consolidation of tissue increases the sound conduction.
Where would you palpate for the apex beat of the heart in a healthy adult?
* 3rd left intercostal space at the mid-clavicular line
* 4th left intercostal space at the mid-axillary line
* 5th left intercostal space at the mid-clavicular line
* 5th left intercostal space at the sternal border
5th left intercostal space at the mid-clavicular line
Where would you auscultate for the tricuspid valve?
* 2nd left intercostal space near the sternal border
* 2nd right intercostal space near the sternal border
* 5th left intercostal space near the sternal border
* 5th left intercostal space at the mid-clavicular line
* 5th left intercostal space at the mid axillary line
5th left intercostal space near the sternal border
Which of the following arterial pulses you would use to assess the character and volume?
* Radial
* Popliteal
* Carotid
* Dorsalis pedis
* Ulnar
Carotid
During a cardiovascular examination you were able palpate parasternal heaves along the left sternal border. What cardiac condition might cause palpable heaves?
* Incompetent AV valves
* Cardiomegaly
* Pericardial effusion
* AV bloc
* Fibrillation of heart
Cardiomegaly
In a postero-anterior (PA) radiograph of the chest what two structures of the heart occupy most of the right border of the cardiovascular silhouette?
* Superior vena cava and right brachiocephalic trunk
* Superior vena cava and right atrium
* Right atrium and right ventricle
* Left atrium and right atrium
* Aortic knuckle and ascending aorta
Superior vena cava and right atrium
Identify the structure indicated by the arrow (please state side).
Left common carotid artery
This is the left common carotid artery which is the second branch from the arch of the aorta.
The part of the fibrous pericardium indicated by the arrow attaches to which part of the diaphragm?
Central tendon
The fibrous pericardium attaches the heart to the central tendon of the diaphragm
The arrow indicated by the arrow is the right coronary artery. ”Right dominance” is referring to which artery which arises from the right coronary artery in approximately 80% of people?
- Posterior interventricular artery
- Right marginal artery
- Left coronary artery
- Left circumflex artery
- Anterior interventricular artery
Posterior interventricular artery
Left or right dominance refers to whether the posterior interventricular artery arises from the left or right coronary artery.
Anatomy Thorax 3 5/5
The 73-year-old man is a retired police officer. Current smoker with a history of medication-controlled diabetes.
He has reported chest pain on exertion that is relieved with rest over the last couple of months. On this occasion the chest pain is central, crushing and radiates to his jaw and his left arm. There appears to be no haemodynamic instability at present, the patient is apyrexial but appears to be plethoric.
On examination, his HR is 70 BPM and regular. There is no pain elicited on palpation of the thorax and has good air entry bilaterally throughout all zones. No murmurs are heard on auscultation. His BP is similar in both arms.
The ECG shows STEMI.
How would a STEMI appear on an ECG?
- STEMI= St segment elevation myocardial infarction, most serious form of MI causing extensive damage to the heart, caused by complete blockage of a coronary artery.
- Myocardial cell death occurs because of a prolonged mismatch between perfusion and demand of the myocardium. Predominantly by complete atherothrombotic occlusion of a coronary artery.
Anatomy Thorax 3 5/5
Where is the origin of the left coronary artery?
Left coronary sinus of the ascending aorta
Anatomy Thorax 3 5/5
Where is the origin of the right coronary artery?
Right coronary sinus of the ascending aorta
Anatomy Thorax 3 5/5
Coronary arteries are supplied with oxygenated blood in what phase
- Systole
- Diastole
Diastole
Anatomy Thorax 3 5/5
The 73-year-old man is a retired police officer. Current smoker with a history of medication-controlled diabetes.
He has reported chest pain on exertion that is relieved with rest over the last couple of months. On this occasion the chest pain is central, crushing and radiates to his jaw and his left arm. There appears to be no haemodynamic instability at present, the patient is apyrexial but appears to be plethoric.
On examination, his HR is 70 BPM and regular. There is no pain elicited on palpation of the thorax and has good air entry bilaterally throughout all zones. No murmurs are heard on auscultation. His BP is similar in both arms.
The ECG shows STEMI.
Why the jaw and arm pain?
- STEMI= St segment elevation myocardial infarction, most serious form of MI causing extensive damage to the heart, caused by complete blockage of a coronary artery.
- Myocardial cell death occurs because of a prolonged mismatch between perfusion and demand of the myocardium. Predominantly by complete atherothrombotic occlusion of a coronary artery.
- The visceral afferents (visceral sensory) from the heart travel via the roots of T1-T4 spinal nerves into the spinal cord. The CNS refers this pain to the sensory dermatomes of T1-T4 nerves.
- It is believed this information travels up/down the spinal cord in some people hence the jaw pain (C2/C3).
Anatomy Thorax 3 5/5
She reports a slow but definite decline in her exercise tolerance and an associated increase in breathlessness. Notes some bilateral leg swelling and sleeps with three pillows at night (Paroxysmal nocturnal dyspnea).
On Examination:
* The patient is saturating 96% on room air.
* No crackles heard during resp examination.
* Heart sounds I + II (lub + dub) present.
* An ejection systolic murmur is noted 2nd rib space right side, which radiates to the right carotid artery.
* You also note she has a raised JVP and pitting oedema to her knee.
What is your lead diagnosis?
Bilateral leg swelling: Indicate right heart failure
Paroxysmal nocturnal dyspnea: Indicate left heart failure
Aortic stenosis
Aortic Stenosis:
Thickening and narrowing of the aortic valve. The valve does not open properly meaning that the areas of the body perfused receive reduced blood flow. The left ventricle has to work much harder to eject blood causing hypertrophy.
