at 1 - Anatomy in Clinical Practice

Question 1

What occurs at the level of the angle of Louis?

Answer 1

IVD of T4/T5
RATPLANT
Rib (2nd)
Arch of aorta
Trachea (bifurcation)
Pulmonary trunk (bifurcation)
Left recurrent laryngeal nerve (under aorta) and ligamentum arteriosum 
Azygous vein into SVC
Nerves - cardiac plexus
Thoracic duct into left subclavian vein

Question 2

What forms the costal margin?

Answer 2

The 7th, 8th, 9th and 10th costal cartilages

Question 3

What is used to help remember the surfaces markings of the pleura and lungs?

Answer 3

2 - 2cm above clavicle
2 - run together for 2cm in midline
4 - diverge at 4th costal cartilage, notching on left
6 - descends down to 6th costal cartilage
8 - crosses MCL at 8th costal cartilage
10 - crosses MAL at 10th costal cartilage
12 - crosses 12th rib at the back

The markings of the lung at the back are 2cm higher than the pleura

Question 4

When the pleura extend beyond the lung there is a recess.

What are the names of these two recesses?

Answer 4

costodiaphragmatic recess

costomediastinal recess

Question 5

What are the simple surface projections of the right heart border and the apex?

Answer 5

3rd to 6th ribs on right of sternum

apex in the 5th intercostal space, in the MCL

Question 6

Draw the surface markings of the horizontal and oblique fissures

Answer 6

..

Question 7

Where do you listen to each of the lobes of the lung?

Answer 7

RUL - anteriorly just under clavicle
RML - right axilla
RLL - posteriorly 
LUL - upper front
LLL - lower back

Question 8

What is stridor?

Answer 8

inspiratory noise seen on inspiration

upper airway obstruction

Question 9

Do you get stridor with obstructive sleep apnea?

Answer 9

No, as you get stridor with the upper airway is permanently obstructed.
OSA is intermittent

Question 10

What is obstructive sleep apnoea?

Answer 10

tongue and fatty tissues of neck are causing soft palate to fall backwards and obstructs his upper airway

Question 11

Why does OSA occur in cycles throughout the night?

Answer 11

Sleep cycles between NREM and REM sleep
In REM sleep muscle tone is decreased and sympathetic nervous system activity is increased.
Lose muscle tone, tongue and soft palate collapses.
Happens to most people in REM sleep, serious if occurs in all stages of sleep

Question 12

What chest wall and abdominal movement is common in OSA?

Answer 12

‘seesaw’ movement

chest wall and abdomen moving paradoxically

Question 13

How many breath holds/hour to diagnose severe OSA?

Answer 13

> 30
15-30 is moderate
length of breath hold doesn’t matter

Question 14

Why is OSA a problem?

Answer 14

tiredness
many fluctuations in saturations and HR
risk factor for cardiovascular disease because of stress on heart

Question 15

What are some clinical features of OSA?

Answer 15

associated with obesity of craniofacial abnormalities
daytime tiredness
snoring
morning headaches (due to increased CO2)
'choking' episodes overnight

Question 16

What conditions can lead to increased risk of OSA

Answer 16

microglossia in downs syndrome and acromegaly
enlarged adenoids in children
micrognathia in treacher-collins syndrome

Question 17

What conditions cause breathing problems associated with the chest wall

Answer 17

ankylosing spondylitis - stiffening of back restriction of chest expansion
motor neurone disease - problems with muscles of respiration

Question 18

Clinical features of pneumothorax?

Answer 18

pleuritic chest pain
dyspnoea
diminished expansion
hyper-resonant chest 
absent breath sounds (blanket of air between skin and lungs)

Question 19

How do you manage a small pneumothorax?

Answer 19

aspiration

needle in 2nd intercostal space

Question 20

Where do you insert a chest drain?

Answer 20

Above the rib as neurovascular bundle lies just below the rib