anatomy

Question 1

thoracic wall (bone)

Answer 1

thoracic vertebrae (t5-t8)
related to desending thoracic aorta
aorta contacts at t6 level

ribs
sternum

Question 2

thoracic wall (muscles)

Answer 2

diaphgram

intercoastals

Question 3

what will happen in case of an Aneurysm of the decending Thoracic aorta?

Answer 3

erode of t5-t6 vertebrae due to pressure atropy

intervertibular disc will remain unharmed as it it avascular structure.

Question 4

In case of Sarcoma in thoracic cavity what will get affected?

Answer 4

only vertebral body not the discs

sarcoma metastasize through blood and discs are avascular

Question 5

will tubercolosis affect vertebral disks?

Answer 5

yes. although Primary tuberculosis only affects four organs (lung,skin,tonsils and intestine)
but when you are immunocompromised the TB is reactivated and then can affect any other organ such as the Vertebrae

first it affects the body of the vertebrae and then extends to the disc forming a COLD absess.

Question 6

ribs are the weakest at the________

Answer 6

Coastal angle

Question 7

most commonly fractured rib?

Answer 7

middle ribs

Question 8

Least commonly fractured ribs

Answer 8

first two ( protected by clavicle)
last two (floating)

Question 9

what is pluritic chest pain?

Answer 9

Chest pain related to breathing. not present when breathing stopped voluntarily (pain when lung or pleura is moving)

Question 10

flail chest (stove in chest)

Answer 10

A segment of a rib cage breaks and gets detached from the thoracic wall.

Question 11

what type of movement in seen in flail chest?

Answer 11

Paradoxical Movement (on inhalation affected part will move inward and outward during exhalation) (opposite as in normal breathing.

Question 12

what is cervical rib?

Answer 12

an extra rib formed growing from the base of the neck just above the collarbone. You can have a cervical rib on the right, left, or on both sides. It may be a fully formed bony rib or just a thin strand of tissue fibres.

Question 13

what is thoracic outlet syndrome? usually occuring due to extra rib formation such as cervical rib

Answer 13

Thoracic outlet syndrome (TOS) is a term used to describe a group of disorders that occur when there is compression, injury, or irritation of the nerves and/or blood vessels (arteries and veins) in the lower neck and upper chest area.

Question 14

what is Coarctation of aorta?

Answer 14

in some kids there is abnormal marrowing of aorta so blood flow to the lower organs is compromised

narrowing=increase pressure=open of some anastamoses that should be closed opens

often can cause indentation/notching in the ribs as the blood flow and pressure becomes high in the intercoastal arteries

Question 15

Why Sternum Fracture is a disaster waiting to happen? (sternum is one of the hardest bone to break)

Answer 15

it can cause

1) Traumatic rupture of the Aorta (the aorta is the weakest at the junction of the aortic arch and the decending part)
2) Cardiac contusion
3) pulmonary contusion

Question 16

is it possible to live without a diaphgram?

Answer 16

yes. but cannot do vigorous task as only intercoastal muscles wil be helping with the respiration

Question 17

What if half of the diaphgram is Paralysed?

Answer 17

other half have a completely diffrent nerve supply so it will work.

Question 18

What does external intercoastal muscles do?

Answer 18

Expand chest outwards during inhalation to fill air in. same way vice versa the internal intercoastal muscles pull the chest inwards during expiratiok to move the air out

Question 19

Before the lung? Tracheo bronchial tree
Between the lungs? Mediastinum
around? pleura

Answer 19

:)

Question 20

Wuperior and inf mediastenum?

Answer 20

angle of lewis of sternum

Question 21

what divides inf. med. into anterior, middle and post region?

Answer 21

Heart

Question 22

what happens in lung contusion?

Answer 22

involving injury to the alveolar capillaries, without any tear or cut in the lung tissue. This results in accumulation of blood and other fluids within the lung tissue. The excess fluid interferes with gas exchange leading to hypoxia.

we give diuretics in this case.

Question 23

what can pneumomediastinum leads to? (air in the mediastinum)

Answer 23

pneumothorax
pneumopericardium (air in layer of heart)
pneumoperitoneum( air in pleura of lung)

Question 24

what is Beck’s triad? (pericardial Tamponade)

Answer 24

Pericardial Tamponade is a condition in which fluid is filed between the pleura/pericardium of the heart that causes pressure on the heart muscles
the high pressure prevents the heart to dilate fully thus reducing the blood flow to the body as a whole

Beck triad is a collection of three clinical signs associated with pericardial tamponade which is due to an excessive accumulation of fluid within the pericardial sac. The three signs are:

1) low blood pressure (weak pulse or narrow pulse pressure)
2) muffled heart sounds
3) raised jugular venous pressure.

Question 25

What is Tension Pneumothorax?

Answer 25

When there’s damage to the pleura, either due to lung disease or trauma to the chest wall, air from the outside or from the lungs can flow freely into the pleural space, but cannot leave. The accumulated air in the pleural space puts positive pressure on the lung and prevents it from expanding properly, which causes respiratory distress. As the air continues to accumulate, the trachea and other structures of the chest can be pushed away from the pneumothorax, leading to increased difficulty breathing. Additionally, the increased pressure inside the chest can compress the heart and lead to a collapse of the blood vessels that drain to the heart, in turn decreasing venous return and cardiac output. If left untreated, tension pneumothorax can rapidly progress to cardiovascular collapse, which ultimately leads to cardiac arrest.

Question 26

what is tracheal shift towards Normal side.

Answer 26

Okay so lets say in case of tension pneumothorax the air is filled in the pleura of left lung so pressure inside becomes positice. this furthur will push the organs including the trachea towards the right side (the unaffected or the normal suide) this shift is known as shift to normal side

Question 27

what is shift to the affected side and where is it seen?

Answer 27

seen in pulmonary Fibrosis. affected side fibsosis=lung shrinks=space between the visceral and parietal pleura=space increase=negative pressure formed=pull stuff=pull organ toward affected side.

Question 28

what is tracheal tugging?

Answer 28

it is a slight downward movement of trche with each inspration.

causes–

Question 29

what is a carina

Answer 29

the ridge between two main bronchus division of lung. basically angle. if it widens it means there is a tumor that is growing in the LN between the carina or lymphadenitis infection (again increase in size of the LN)

Question 30

if a child inhales a peanut , in which bronchus will it go?

Answer 30

most likely in the right as it is more vertically located. more downward slope
left is a little more horizontal

this will cause obstrutive atelectasis of lung once it passes the carina.

in the carina=cough
passes from carina to the lung (usually right lung)= no cough but a disaster waiting to happen]

if peanut is inhaled when child id in upright position= most likely to go in lower lobe
while supine= superior segment of rght lower lobe
while lying on his right side=right upper/middle lobe
(just see the gravity)

Question 31

If there is a problem with respiratory muscles what will be afected and what kind of disease will occur?

Answer 31

the Inspiration will get affected as its an active process that requires muscle (expiration is passive)

inspiration damage=air cannot get in= Restrictive lung diseases

JOint diseases= Breathing problems occurs normally
costovertebral,costochondral and sternocoastal joints help in breathing)

Question 32

What happens if a Segmental Bronchus is obstructed by something?

Answer 32

the collapse or atelectasis of that segment only (each lung segment is its own entitiy not depending n the other segments) called segmental obstructive atelectasis.

Question 33

what happens if a segmental bronchus is affected by cancer/tubercolosis?

Answer 33

it will spreas to other segments and then to the whole lobe of the lung.

Question 34

can visceral pleura sense pain?

Answer 34

no. visceral pleura in insensitive to pain but sensitive to distension. only parietal pleura can detect pain.
also the apex of the lung is located above the clavicle so in case og injury to the base of neck or near clavicle this pleura is affected and should be checked.

Question 35

Diffrence between pleurisy(Inflammation od the sac surrounding the lungs) and pericarditiis (inflammation of the pericardium surrounding heart)

Answer 35

pain
1) in pleurisy the pain is pleuritic in nature (with breath) and stops when not breathing. sharp and stabbing pain. usually anywhere in the chest
radiates to apex (phrenic nerves) or intercoastal nerves

in pericarditis the pain doesnt stop with stopping breathing. often it can increase while inhaling but doesnt go away completely
it increases when lying backwards,doing heavy excersise, and improves while sitting in a good posture or leaning forward.
sharp pain present in cntre or left
radiates to the back

2) friction rub sound in pleurisy is biphasic (inhalation and exhalation)
pericarditis is triphasic (systole, early and late diastole)

Question 36

extra pleural notes

Answer 36

water in pleura =hydrothorax (usually a transudate) reasons can be CHF, Nephrotic sundrome or cirrhosis

pus in pleura= pyothorax (usually an exudate due to increase permeability of vessel wall)
pleural empyema

Question 37

How to manage tension pneumothorax?

Answer 37

1) needle decompression (thoracentesis) 2nd and 3rd rib , mid axillary line
2) thoracostomy tube 5th ic space at the anterior axillary line

Question 38

at what point will you insert the needle if you want to take the sample of the pleural fluid in case of pneumothorax?

Answer 38

7th IC space on the posterior side. dont go very deep as it can injure the diaphrgm liver or spleen

Question 39

where do Lymph nodes from the right lung drain?

Answer 39

Right Tracheo-Bronchial Lymoh Nodes (present at carina )

Question 40

where do Lymph nodes from the left lung drain?

Answer 40

Left Tracheo-Bronchial L.N.

exception= the inferior lobe of left lung drains its L.N. into Right Tracheo Br. nodes

Question 41

What if there is a painless Left Tracheobronchial Lymphadenopathy?

Answer 41

Cancer of left lung

Question 42

What if there is a painless Right Tracheobronchial Lymphadenopathy?

Answer 42

Cancer of right lung OR the cancer of lower lobe of left lung

Question 43

What is virchows node?

Answer 43

it is the left supraclavicular lymph node.

drains the contents of the abdominal cavity :)

Question 44

AN Enlarged , Hard and painless virchoes node indicates what?

Answer 44

Carcinome (lymph lover) within the abdominal cavity.
Gastric cancer, Pancreatic cancer, Ovarian cancer, testicular, Breast.

this is called as troiesiers,s sign

Question 45

AN Enlarged , Hard and painfull virchoes node indicates what?

Answer 45

Infection (infection is painfull, cancer is painless) such as tubercolosis, sarcoidosis and toxoplasmosis :)

Question 46

what if you find an enlarged Virchows node and an enlarged sister mary joseph node? (at umblical)

Answer 46

indiacte abdominal malignancy

Question 47

any malignancy in the right upper quadrant area will drain to?

Answer 47

right thoracic duct (righnt supraclavicular Lymph node)

Question 48

any malignancy in the left upper and lower quadrant , as well as right lower quadrant area will drain to?

Answer 48

left thoracic duct ( virvhows node/ left supraclavicular node)