Anatomy 2 Flashcards
Sophia, 45, is involved in a high speed car crash.
Upon examination it is observed a section of her chest wall is exhibiting paradoxical movement (as she inhales a section of the rib cage moves inwards)
The crush injury had compressed a phrenic nerve
She has sustained multiple rib fractures
Damage to the intercostal muscles is preventing them from contracting normally
Sophia, 45, is involved in a high speed car crash.
Upon examination it is observed a section of her chest wall is exhibiting paradoxical movement (as she inhales a section of the rib cage moves inwards)
The crush injury had compressed a phrenic nerve
She has sustained multiple rib fractures
Damage to the intercostal muscles is preventing them from contracting normally
*The most common cause for paradoxical breathing noted in the literature is called a flail chest, which consists of a segment of the free-floating chest wall from multiple rib fractures.
*
Anterior intercostal arteries branch from the [] artery which passes down the posterior aspect of the costal cartilages on either side
The [] intercostal arteries are smaller and shorter than the [] intercostal arteries as they only supply the [] third of the chest wall.
Anterior intercostal arteries branch from the internal thoracic artery (internal mammary artery) which passes down the posterior aspect of the costal cartilages on either side
The anterior intercostal arteries are smaller and shorter than the posterior intercostal arteries as they only supply the anterior third of the chest wall.
The intercostal veins drain anteriorly to the [] vein, and drain posteriorly to the [] and [] veins
The intercostal veins drain anteriorly to the internal thoracic vein, and drain posteriorly to the azygos (right) and hemi azygos veins (left).
Label A-C
Label A-C
If passing a needle through the thoracic cage to sample air or fluid in the pleural cavity (pleural tap/aspiration), should you pass the needle immediately above or below the rib?
Above
Below
If passing a needle through the thoracic cage to sample air or fluid in the pleural cavity (pleural tap/aspiration), should you pass the needle immediately above or below the rib?
Above
Below
The primary and larger intercostal neurovascular bundles run immediately below each rib.
Secondary to the rib fractures Sophia has damage to several intercostal arteries.
How would you expect this to present on a Chest X-ray?
Blunted costophrenic angles
Mottled appearance across the lung fields
This would not be identified on a chest X-ray
Secondary to the rib fractures Sophia has damage to several intercostal arteries.
How would you expect this to present on a Chest X-ray?
Blunted costophrenic angles
Mottled appearance across the lung fields
This would not be identified on a chest X-ray
Bleeding from intercostal arteries is significant enough to cause a haemothorax. The blood from these vessels would enter the pleural cavity and tract to the lowest point (the costophrenic recesses). On a chest x-ray this can be seen as blunting of these angles. You cannot distinguish what the fluid is by chest x-ray.
Name the divisions of the pharnyx in order from superior to inferior [3]
Nasopharnyx
Oropharnyx
Laryngopharynx
What structure is found directly posterior to the trachea? [1]
Acceptable responses:Oesophagus, esophagus
Aspirated foreign bodies travel down the trachea and are most likely to end up in which main bronchus due to its wider and more vertical structure?
Acceptable responses: Right, R
Which lung has two lobes and which has three lobes? [2]
The left lung has two lobes while the right lung has three
Which nerve provides motor supply to the diaphragm? [1]
Acceptable responses: Phrenic, phrenic nerve, C3,4,5, phrenic nerve C3.4.5
The diaphragm attaches to the bony skeleton of the thorax are in which three parts? [3]
The sternal part is attached to the posterior aspect of the xiphoid proces
The costal part is attached to internal surfaces of the lower six ribs & costal cartilages.
The lumbar part attaches to the first 3 lumbar vertebrae posteriorly (around the aorta).
The right dome of the diaphragm reaches as high as the upper border of the [] rib, and the left dome reaches the lower border of the [] rib
The right dome of the diaphragm reaches as high as the upper border of the 5th rib, and the left dome reaches the lower border of the 5th rib (NB the height of the nipple is 4th intercostal space so domes of diaphragm just below this level)
The intercostal nerves provide the sensory innervation to the [] pleura, and the [] plura (lining the inner chest wall). Remember general sensory innervation gives well localised sensation of all sensory modalities.
The intercostal nerves provide the sensory innervation to the peripheral diaphragmatic parietal pleura, and the costal parietal plura (lining the inner chest wall). Remember general sensory innervation gives well localised sensation of all sensory modalities.
Which nerve fibres provide stretch and provide poorly localised sensation?
General visceral afferent fibres are also carried from the lungs and visceral pleural. These visceral afferent fibres mainly detect stretch and provide poorly localised sensation.
Name the arterial supply to the parietal pleura [1] and visceral pleura and lungs [1]
Parietal pleura: Anterior and posterior intercostal arteries
Visceral pleura and lung: Bronchial arteries
Name the venous supply to the visceral pleura and lung [1]
These small vessels return blood from the [] to the [] vein on the right, while the left side drains into an [] vein or the [] vein.
Visceral pleura and lung: Bronchial veins.
These small vessels return blood from the lungs to the azygos vein on the right, while the left side drains into an intercostal vein or the accessory hemiazygos vein.
What has happened here?
Pneumothorax
Mass growth
Haemothorax
Malignant effusion
What has happened here?
Pneumothorax
Mass growth
Haemothorax
Malignant effusion
leural effusions are collections of fluid within the pleural space. The term is usually reserved for collections of serous fluid and therefore excludes hemothorax, chylothorax, and pyothorax (empyema). Effusions may cause mass effect on the adjacent lung causing collapse, breathlessness, and respiratory compromise.
Which bone is the upper most skeletal part of the larynx? [1]
Hyoid bone
The skeleton of the larynx is held together by anumber of membranes (which are often named by the structures they connect).
Between the cricoid and thyroid cartilages in the midline lies the [] membrane.
Between the arytenoid and thyroid cartilages lies the []
Above the vocal fold is the [] (sometimes called the false vocal cord).
The [] membrane fills the space between the hyoid bone and the top of the thyroid cartilage.
The skeleton of the larynx is held together by anumber of membranes (which are often named by the structures they connect).
Between the cricoid and thyroid cartilages in the midline lies the cricothyroid membrane.
Between the arytenoid and thyroid cartilages lies the vocal fold
Above the vocal fold is the vestibular fold (sometimes called the false vocal cord).
The thyrohyoid membrane fills the space between the hyoid bone and the top of the thyroid cartilage.
Which of the following are:
Cricothyroid [1]
Posterior crico-arytenoids [1]
Vocalis [1]
Cricothyroid: F & G
Posterior crico-arytenoids: E
Vocalis: B
The larynx is supplied by the left and right [] nerves and the left and right [] nerves, branches of the [] nerve
The larynx is supplied by the left and right superior laryngeal nerves and the left and right recurrent laryngeal nerves, branches of the vagus nerve (CN X).
What is the pathology shown here? [1]
Vocal cord nodules are bilaterally symmetrical benign white masses that form at the midpoint of the vocal folds and are usually due to excess mechanical stress (e.g. singers, teachers, actors)
What is the pathology? [1]
The most important risk factor for laryngeal cancer is smoking. This cancer looks like it might be spreading anteriorly from the cord. If it has grown into the thyroid cartilage, the patient can still be cured but it would require a total laryngectomy!
What is the pathology? [1]
Vocal cord papillomas are small, wart-like growths caused by the human papilloma virus (HPV). They appear more well defined than a carcinoma.
What is the pathology? [1]
Epiglottitis is inflammation of the epiglottis and was historically mostly caused by infection by H. influenzae type b until widespread vaccination. It is clearly potentially life threatening due to airway obstruction.
What is the pathology? [1]
Laryngitis is a common cause of hoarseness. This case looks like a fungal laryngitits which is sometimes related to inhaled corticosteroid use (e.g. asthma inhalers).
What pathology is shown here? [1]
Reinke’s edema is the swelling of the vocal cords due to fluid (edema) collected within the Reinke’s space (between the mucosa and the vocal ligament). It is usually related to smoking, but can be caused by GORD or chronic voice overuse.
Which pathology is shown here?
Pleural effusion
Pulmonary oedema
Cardiomegaly
Heart Valve
Normal CXR
Pleural effusion
Pulmonary oedema
Cardiomegaly
Normal CXR
What is the major pathological finding in this image ?
Pleural effusion
Pulmonary oedema
Cardiomegaly
Heart Valve
Normal CXR
What is the major pathological finding in this image ?
Pleural effusion
Pulmonary oedema
Cardiomegaly
Heart Valve
Normal CXR
There is bilateral patchy opacification of the lung fields, which would be in keeping with pulmonary oedema.
What is the major pathological finding in this image ?
Pleural effusion
Pulmonary oedema
Cardiomegaly
Heart Valve
Normal CXR
What is the major pathological finding in this image ?
Pleural effusion
Pulmonary oedema
Cardiomegaly
Heart Valve
Normal CXR
There is a moderate right-sided pleural effusion. There is a meniscus and opacification clearly visible into the midzone of the right lung.
