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Andrea > 29/09/20 > Flashcards

29/09/20 Flashcards

1
Q

What is the Mach effect?

A

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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2
Q

Where is the apical zone of lung?

A

Above the clavicle

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3
Q

Where is the upper zone of lung?

A

Below the clavicles and above the lung hilum/cardiac shadow

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4
Q

Where is the middle zone of lung?

A

Level with the lung hilum

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5
Q

Where is the lower zone of lung?

A

Below the lung hilum, including costodiaphragmatic recess

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6
Q

What is the surface anatomy for the lung pleura?

A

6th CC
8th rib MCL
10th rib MAL

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7
Q

What are the common causes of pleural effusion?

A

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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8
Q

What would you see on a COPD x-ray?

A
  • Ribs are more flat
  • Diaphragm is more flat
  • Hyperinflation of lungs
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9
Q

What are the functions of the nasal cavity?

A
  • 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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10
Q

What type of epithelium lines the nasal vestibule region?

A

Lined with hair-bearing skin.

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11
Q

What are the vessels found in the anterior nasal septum?

A

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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12
Q

What is the sensory innervation of the paranasal sinuses?

A

CN Va (except maxillary sinus which is CN Vb)

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13
Q

What does the frontal sinus drain via?

A

Frontal sinus drains via the frontonasal duct into the middle meatus​

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14
Q

What separates the ethmoid air cells from the orbit?

A

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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15
Q

What are the 6 walls of the middle ear?

A 
Superior (tegmental)
Posterior (mastoid)
Medial (labyrinthine)
Inferior (jugular vein)
Anterior (carotid)
Lateral (membranous)
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16
Q

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

A

Lined with respiratory mucosa​
​
Opening surrounded by tubal tonsil tissue​

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17
Q

Which pharyngeal arches are associated with ear formation?

A

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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18
Q

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

A

Treacher-Collins syndrome

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19
Q

What tuning fork do hearing tests use?

A

256 Hz

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20
Q

What is a positive and negative Rinne’s test?

A

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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21
Q

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

A

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

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22
Q

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

A

CN IX

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23
Q

Where is a Zenker (pharyngeal) diverticulum found?

A

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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24
Q

Where is piriform fossa found?

A

Recess between larynx and lateral thyroid cartilage

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25
Q

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

A

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

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26
Q

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

A

Away from weak side, towards strong side.

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27
Q

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

A

MOTOR LOSS​

Patient has sensation but unilateral/no contraction

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28
Q

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

A

SENSORY LOSS​

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

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29
Q

What are the different types of lymphoid tissue?

A

Pharyngeal (adenoid), tubal, palatine, lingual

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30
Q

What is the posterior boundary of the superior thoracic aperture?

A

T1

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31
Q

At what vertebral level is the jugular/sternal notch?

A

T2

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32
Q

At what vertebral level is the sternal angle?

A

T4/5

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33
Q

At what level is the xiphoid process?

A

T9/T10

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34
Q

Which vertebral body do ribs articulate with?

A

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

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35
Q

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

A

Synovial joints sit between the rib & vertebrae​

Allows for movement!

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36
Q

Which ribs are the vertebrosternal ribs?

A

Ribs 1-7

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37
Q

Which ribs are the vertebrocostal ribs?

A

Ribs 8-10

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38
Q

Which ribs are the floating ribs?

A

Ribs 11 and 12

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39
Q

Which muscle is used for inspiration?

A

External intercostal

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40
Q

Which muscle is used for expiration?

A

Internal intercostal

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41
Q

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

A

4th ICS

Between the mid-axillary line and the anterior axillary fold

42
Q

Where can pleuritic pain refer to?

A

A dermatome

43
Q

Where do posterior intercostal arteries arise from?

A

Descending aorta

44
Q

Where do anterior intercostal arteries arise from?

A

Internal thoracic and musculophrenic

45
Q

Where does the diaphragm attach?

A

Costal margin and ribs 10, 11, 12

Diaphragmatic crura attach to lumbar vertebrae

46
Q

What can unilateral damage to the phrenic nerve cause?

A

Hemidiaphragmatic palsy

47
Q

Where does gallbladder inflammation refer to?

A

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

48
Q

What are the different congenital diaphragmatic hernias?

A

Posterolaterally (Bochdalek) or Retrosternally (Morgagni)​

49
Q

In embryology, when do the respiratory diverticula appear?

A

Week 4

50
Q

How do the lungs develop?

A

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

51
Q

When does the septum between the trachea and oesophagus form?

A

Weeks 4 and 5

52
Q

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

A

Week 16

53
Q

When do respiratory epithelia begin developing?

A

Week 26

54
Q

When does full lung maturation happen?

A

7-10 years

55
Q

What is the pulmonary ligament?

A

Fold of parietal pleura

56
Q

Where do the right and left RLNs recur?

A

Right RLN recurs at right lung apex under right subclavian artery

Left RLN recurs at lung hilum/aortic arch

57
Q

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

A

Hemi-paralysis of vocal cords, hoarse voice

58
Q

What holds the pleural layer close together?

A

Surface tension

59
Q

What are the different surfaces of the parietal pleura?

A
  • Costal
  • Mediastinal
  • Cervical
  • Diaphragm
60
Q

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

A 
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

61
Q

What is the surface anatomy of the oblique fissure?

A

T3 Spinous Process to 6th cc anteriorly

62
Q

What is the surface anatomy of the horizontal fissure?

A

4th cc horizontally back to oblique fissure​

63
Q

What is the surface anatomy of the tracheal bifurcation?

A

at sternal plane or just below T4/T5​

64
Q

What is the posterior surface marking of the lung?

A

10th rib PVL

65
Q

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

A

12th rib PVL

66
Q

Where do you auscultate the middle lobe of the lung?

A

laterally along axillary lines​

67
Q

What vertebral level is the lung hilum?

A

T5/6

68
Q

What is the lymphatic drainage of the lung?

A

Hilar bronchopulmonary nodes

  • -> Tracheobronchial nodes
  • -> Paratracheal nodes
  • -> Bronchomediastinal duct
  • -> Right lymphatic duct/subclavian vein OR Thoracic duct/left subclavian vein
69
Q

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

A

ELN innervates Cricothyroid

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

70
Q

How far inferiorly does the posterior mediastinum extend?

A

To T12 vertebrae (diaphragm)

71
Q

Are the veins anterior or posterior to the arteries?

A

Veins are anterior

72
Q

Where are the brachiocephalic veins formed?

A

Sternoclavicular joints

73
Q

Where is the SVC formed?

A

SVC forms behind 1st R CC

74
Q

What things are found in the posterior mediastinum?

A

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

75
Q

What does the fibrous pericardium bind to?

A

Fibrous pericardium binds to the central diaphragmatic tendon

76
Q

What innervates the fibrous pericardium?

A

Phrenic nerve

77
Q

What causes the transverse pericardial sinus?

A

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

78
Q

What causes the oblique pericardial sinus?

A

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

79
Q

When do the papillary muscles contract?

A

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​

80
Q

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

A

Late systolic murmur

81
Q

What is the most frequent valve abnormality?

A

Aortic stenosis

Often the result of degenerative calcification

82
Q

What things cause right sided valve disease?

A

Infection, rheumatic fever, infective endocarditis

- causes splinter haemorrhages

83
Q

What are the surface anatomy markings for the heart edges?

A

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

84
Q

What are the auscultation points for the valves?

A

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

85
Q

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

A

Left ventricle is 3x thicker than the right ventricle

86
Q

Which parts of the sympathetic chain innervate the heart?

A

T1-T4

87
Q

What are the non-cyanotic congenital defects?

A
  • Atrial septal defects
  • Ventricular septal defects
  • Patent ductus arteriosus
88
Q

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

A

Week 3

89
Q

When does cardiogenic mesoderm develop?

A

Day 18 (week 3)

90
Q

When does the heart start beating?

A

Day 22-23

91
Q

When does blood flow start?

A

Week 4

92
Q

What forms blood vessels?

A

Angioblastic cell clusters

Angioblastic cords canalise to form two heart tubes; these fuse then expand​

93
Q

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

A

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

94
Q

In what direction would the heart fold in dextrocardia?

A

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

95
Q

What does the sinus venosus eventually become?

A

The smooth part of the right atrium

96
Q

What forms the smooth part of the left atrium?

A

Pulmonary veins get absorbed

97
Q

When does atrial septation occur?

A

Weeks 4 and 5

98
Q

When does ventricular septation occur?

A

Weeks 5-7

99
Q

Where do most ventricular septal defects occur?

A

In the membranous part

100
Q

How much does the aorticopulmonary septum rotate?

A

180 degrees

101
Q

What causes a common/persistent truncus arteriosus?

A

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

102
Q

What are the four things in Tetralogy of Fallot?

A

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

Andrea (10 decks)

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