Anatomy - Consequences of chronic cough

Question 1

What is a large pneumothorax?

Answer 1

When there is >2cm gap between lung and parietal pleura. Slide 4

Question 2

What is different from a normal pneumothorax and a tension pneumothorax?

Answer 2

The torn pleura can create a one-way valve that means air enters the pleural cavity during inspiration but not expiration. Slide 6

Question 3

What is the superior mediastinum level with?

Answer 3

The level of the sternal angle and T4. Slide 8

Question 4

What happens when there is a mediastinal shift?

Answer 4

Tracheal deviation and there is SVC compression which reduced venous return to the heart and results in hypotension. Slide 9

Question 5

How can you manage a large pneumothorax?

Answer 5

Needle aspiration or chest drain through the 4th or 5th intercostal space MIDAXILLARY. Slide 10

Question 6

What is the “safe triangle”?

Answer 6

The anterior border of the latissimus dorsi, the posterior border of the pec. major and the axial line superior to the nipple. Slide 10

Question 7

How you manage an emergency tension pneumothorax?

Answer 7

Large gauge cannula into pleural cavity in the 2ND or 3RD intercostal space. Slide 11

Question 8

What are 3 consequences to a chronic cough?

Answer 8

A pneumothorax, tension pneumothorax and a herniae. Slide 12

Question 9

What are two factors in a herniae forming?

Answer 9

Weakness of one structure and increased pressure on one side of that part wall. Slide 12

Question 10

Where do diaphragmatic herniae develop?

Answer 10

Oesophageal hiatus
Aortic hiatus
Caval opening
Attachements to the xiphoid
Posterior attachments. Slide 13

Question 11

What is a paraoesophageal hiatus hernia and a sliding hiatus hernia?

Answer 11

Para = part of stomach passes through the hiatus and becomes parallel to the oesophagus.
Sliding = stomach slides up through the hiatus with the gastro-oesophageal junction. Slide 14

Question 12

What are the inguinal ligaments?

Answer 12

The inferior border of the external oblique aponeuroses. Slide 16

Question 13

Where is the deep ring of the inguinal canal and the superficial?

Answer 13

Deep = midpoint of inguinal ligament

Superficial =V shaped defect of the external oblique aponeuroses superolateral to the pubic tubercle. Slide 17

Question 14

What are the 10 layers in a male’s anterolateral abdominal wall in the inguinal region?

Answer 14

1. Scrotal skin
2. Superficial fascia of the scrotum
3. Deep fascia
4. The inguinal ligament
5. Lower border of the internal oblique
6. lower border of the tansversus abdominis
7. Transversalis fascia
8. Testicular Vein
9. Testicular Artery
10. Parietal peritoneum. Slide19

Question 15

What happens as the testicles descend?

Answer 15

They pass through each layer apart from the transverse abdominis.
It takes with it the blood vessels, vas deferens and a part of the parietal peritoneum. Slide 19

Question 16

What pulls the testicles to descend?

Answer 16

The gubernaculum. Slide 19

Question 17

What are the 3 layers of the spermatic cord from inside to out?

Answer 17

Internal spermatic fascia
Cremasteric fascia
External spermatic fascia. Slide 26

Question 18

What are the two types of inguinal hernia and what are they?

Answer 18

Direct = peritoneum is forced through the wall of the canal and straight out the superficial ring.
Indirect = Peritoneum forced through the deep ring and out through the superficial ring. Slide 35

Question 19

How can you clinically differentiate between the two types of inguinal herniae?

Answer 19

Push the hernia and put a finger on the deep ring with pressure and ask the patient to cough.
Direct = lump with reappear
Indirect = lump will not reappear. Slide 36