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Medicine > Case 6 > Flashcards

Case 6 Flashcards

1
Q

Describe the anatomy of the chest wall in Figure 1

A

(Left down, then right down)

  • Manubrium
  • Superior Vena Cava
  • Right main bronchus (Bronchus bifurcation)
  • Horizontal fissure (on lobe of lung)
  • Right atrium
  • Oblique fissure (on lobe of lung)
  • Inferior Vena Cava
  • Diaphragm Liver
  • Aortic Arch
  • Pulmonary trunk
  • Left main bronchus
  • Left Atrium
  • Left Ventricle
  • Oblique fissure (on lobe)
  • Diaphragm
  • Left costophrenic nerve

Middle:
-Gastric bubble

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2
Q

From right to left, name the vessels which branch off the aortic arch (Figure 2)

A
  • Brachiocephalic artery (branches off into right common carotid artery and right subclavian artery)
  • Left common carotid artery
  • Left subclavian artery
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3
Q

What are the types of ribs in our body?

A
  • True: 1st 7 ribs, these attach/articulate directly to the sternum
  • False: ribs 8-10, articulate to sternum via costal cartilage (not directly)
  • Floating: posterior to thoracic walls/cage, doesn’t attach to sternum at all.
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4
Q

What level is the sternal angle at?

A

T4

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5
Q

What level is the suprasternal notch at?

A

T2

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6
Q

What are sternocostal joints?

A

Bond between sternum/sternal body and cartilage of rib

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7
Q

What are costochondrial joints?

A

Bond between ribs and cartilage

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8
Q

What are interchondrial joints?

A

Bond between false rib and true rib

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9
Q

What is a cartilagenous joint?

A

All cartilage, allows more movement than fibrous joint, but not more than synovial joints

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10
Q

What is a synovial joint?

A

When bones join together

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11
Q

Name the bony parts of the chest wall (figure 3)

A
  • Manubrium
  • Sternal body
  • Xiphoid process
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12
Q

What is the joint between the Manubrium and the sternal body called?

A

Manubrial joint

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13
Q

What is the Xiphersternal joint?

A

Joint between Xiphoid process and sternal body

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14
Q

What is synchodrosis?

A

Joint between bones bound by layer of cartilage - almost immovable

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15
Q

Give the definition of health promotion (WHO, 1946)

A

Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmary

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16
Q

Give the Downie, Tanahill and Tanahill definition for health promotion

A

Health promotion compromises efforts to enhance positive and reduce risk of ill-health, through the overlapping spheres of health education, prevention and health protection.

17
Q

What is Primary Prevention?

A

Concerned with preventing the onset of disease, aims to reduce the incidence. It involves the interventions that are applied before there is any evidence of disease or injury.

18
Q

What is Secondary Prevention?

A

Concerned with detecting a disease in its earliest stages, before symptoms appear, and intervening to slow or stop its progression to catch it early.
Distinguish people who are healthy on the surface, but may have risk factors which will lead to illness later.

19
Q

What is Tertiary Prevention?

A

Refers to intervention designed to arrest the progress of an established disease and to control its negative consequences to avoid need for hospital.
Use of clinical treatment and rehabilitation e.g. speech therapy, physiotherapy

20
Q

What is Primary prevention for COPD?

this is population/community level

A
  • Detect the risk factors
  • Screen high risk populations
  • Health education (smoking cessation, wood cooking, air pollution, exposure)
21
Q

What is Secondary prevention for COPD?

this is community health centre level

A
  • Avoid exacerbations among known patients
  • Screening e.g. FEV1 test
  • Pneumococcal bird flu virus
  • Smoking cessation
  • Physical activity
22
Q

What are the steps in Tertiary prevention of COPD?

patient is hospitalised at this point

A

-Person suspected to have COPD
-Confirm and record diagnosis
-Managing exacerbation of COPD (tertiary prevention)
-Review response to treatment
-If stable, discharge the patient and make sure they’re managing their stable COPD (through tertiary prevention and rehabilitation)
OR
-If not stable, go back to managing exacerbation of COPD step until it is stable

23
Q

What is exacerbating COPD?

A

‘Flare up’ of COPD, worsening
(also known as worsening of chronic bronchitis)
Sudden worsening of COPD symptoms (SOB, quantity and colour of phlegm)
Triggered by infection from bacteria/viruses/environment pollutants
Can last for several days

24
Q

What are signs of COPD in a patient?

A

-Smoker/ex smoker
-Coughing
-Productive cough
-Out of breath
-Over 35
3 and over = could be COPD

25
Q

What are the five steps in the Health Impact Pyramid?

A
  1. Counselling and Education
  2. Medical care
  3. Preventive Medicine
  4. Making healthy decisions the default
  5. Socioeconomic factors
26
Q

What’s the most effective way of stopping/preventing COPD?

*Give examples

A

Changing lifestyle behaviours

*stop smoking, exercise, healthy diet, avoid close contact to those with respiratory infections

27
Q

What does the Health Act 2006 say about smoking?

A

Introduced smoke-free premises, no smoking signs, and warning signs on cigarette packs.

28
Q

What is an example of a counselling and education step to prevent COPD?

A

Tobacco warnings to promote quitting smoking

29
Q

What medical care is available to prevent COPD?

A

Inhalers
Medication, pharmacological (Roflumilast, Macrolides)
Surgery (Lung volume reduction surgery = LVRS)
Non-pharmacological methods (rehabilitation, though this is expensive and patients don’t always follow through)

30
Q

What is an example of preventative medicine to prevent COPD?

A

Smoking cessation interventions

31
Q

Where has ‘making healthy decisions the default’ helped prevent COPD?

A

The Health Act 2006 proposed new rules about smoking - by making these the law, people have to comply

32
Q

How can socioeconomic factors be changed to reduce COPD?

A

Reduce the poverty/health inequalities

That has a big impact on people

33
Q

What are the positive aspects/results of smoke free legislation (law of no smoking/smoking banned in some areas)?

A
  • Evidence shows reduction in acute coronary heart disease/events
  • Effect also increases over time after implementation
  • Has effected passive smoking
34
Q

What are the negative aspects/results of smoke free legislation (law of no smoking/smoking banned in some areas)?

A

-Unsure about effect on active smoking (need more evidence)

35
Q

What makes an effective smoking cessation intervention?

A
  • Advice from doctors
  • Structured intervention from nurses
  • Individual and group counselling
  • Nicotine replacement therapy
36
Q

What is a QALY?

A

Quality Adjusted Life Year

37
Q

What services contribute to a QALY and what are there costs?

A
  • Advice from GP to stop smoking = £180
  • Pacemakers implant for heart block = £700
  • Heart valve surgery for aortic stenosis = £900
  • Coronary graft (for artery) for angina = £1040
  • Heart transplant = £8000

Medicine (11 decks)

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