Clinical tips

Question 1

Why is the transverse pericardial sinus an important surgical landmark?

Answer 1

After opening pericardial sac, a finger can be placed in the transverse sinus- allows ligature or surgical clamp to be placed around the vessels anterior to the transverse sinus before inserting the tubes of the heart bypass machine

Question 2

What is an anatomic anastomosis?

Answer 2

cross-connection between adjacent channels, tubes, fibres, or other parts of a network/ physical connection

Question 3

What is a non-functional anastomosis?

Answer 3

Not a physiological anastomosis

Found at apex of heart- branches of the anterior and posterior interventricular arteries

Question 4

What does a non-functional anastomosis mean clinically concerning the coronary arteries?

Answer 4

Anastomose via physical connection but this is inadequate to provide collateral perfusion in the event of a coronary artery occlusion

Question 5

What happens to the apex beat in patients with heart disease?

Answer 5

Left ventricle is often enlarges so apex beat displaced laterally

Question 6

What is the common approach to radiographs of the thorax?

Answer 6

Posterior to anterior

Question 7

Describe angiograms

Answer 7

• Identify site of bleeding or to visualise constricted/narrowed or blocked vessels
• The site of catheter injection and contrast agent injections is most commonly the femoral artery, depending on the patient’s presentation

Question 8

How is lymphatic drainage important clinically?

Answer 8

• Route of lymphatic drainage from a region= considering metastatic cancers
• Lymph from breast tissue drains to axillary lymph nodes
• Mastectomy operation common to remove axillary lymph nodes along with breast tissue

Question 9

Describe the Allen’s Test to assess blood supply to the hand

Answer 9

-Clench fist hard and, using your other hand, palpate your radial and ulnar arteries
-Put pressure on them to restrict blood flow to the hand
-Open you palm whilst maintaining compression on the vessels: observe your palm remains blanched
-Now release pressure on one of the arteries and observe the direction in which blood flow returns to the hand
-Now repeat, but release pressure on the other artery and note any changes in the direction of flushing
=The palm should flush at an equal rate for both arteries to demonstrate the collateral supply achieved by these 2 arteries
=Test should be performed before performing arterial gas sampling as the difference in the rate of blood return may suggest an inadequate supply from one of the arteries

Question 10

Which pulses should you palpate first?

Answer 10

• Start most distally
• If you can find the most distal pulse, you would expect the more proximal pulses to also be identifiable as the blood must have passed these en route to the more distal location
• Quick and simple way of assessing the level of arterial occlusion
• Compare left and right