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MRCS Other > Doctors academy - Thorax COPY > Flashcards

Doctors academy - Thorax COPY Flashcards

1
Q

What is the blood supply to the oesophagus?

A

Upper 1/3 - Inferior thyroid
Middle 1/3 - Descending thoracic aorta
Lower 1/3 - Left gastric

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2
Q

What is the venous drainage of the oesophagus?

A

Upper 1/3 - Inferior thyroid
Middle 1/3 - Azygous
Lower 1/3 - Left gastric

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3
Q

What is the lymphatic drainage of the oesophagus?

A

Upper 1/3 - Deep Cervical
Middle 1/3 - Para trachial
Lower 1/3 - caeliac

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4
Q

What surgical treatment can be done for oesophageal cancer

A

Proximal 1/3 - McKewan Procedure
Middle and Distal - Ivor Lewis

All generally have neoadjuvant chemotherapy

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5
Q

What histological changes occur in barrats oesophagus?

A
  1. There is metaplasia from squamous to columnar
  2. There would then be dysplasia of these cells for them to become cancerous
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6
Q

There are two types of metaplasia in barrats oesophagus, what surveillance is required for each?

A
  1. Gastric metaplasia - surveillance every 3-5 years
  2. Intestine metaplasia - surveillance every 2-3 years
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7
Q

what structure would be damaged 1cm lateral and 1cm deep to the sternum?

A

the internal mammary artery

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8
Q

what is the blood supply and venous drainage of the anterior and posterior chest wall?

A

Anteriorally: Internal mammary arteries and internal mammary veins

posteriorly: decending thoracic aorta and azygous vein (accessory hemi azygous and hemiazygous drain the left side and then drain in to azygous)

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9
Q

where are the intercostal neurovascular bundles found?

A

they are found blow the corresponding rib between the internal intercostal and the innermost intercostal muscles

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10
Q

what are the boarders of the safe triangle for chest drain insertion

A

Roof: Base of the axilla
Floor: 6th Intercostal Space
Lateral: Lateral edge of lat dorsi
Medial: lateral edge of pec major

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11
Q

What layers do you pass through when inserting a chest drain

A

skin
subcutaneous fat / fascia
external intercostal
internal intercostal
innermost intercostal
endothoracic fascia
pariatal pleura of the lung

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12
Q

what are the treatment options for achalasia?

A

either botox or hellers myotomy

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13
Q

what disease is associated with achalasia

A

chagas disease

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14
Q

what are the treatment options for oesophageal spasms/ dysmotility?

A

Nitrates
Calcium Channel blockers
phosphodiesterase inhibitors

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15
Q

what are the features of plummer Vincent syndrome?

A
  • iron deficient anemia
  • post cricoid web
  • macroglositis / angular stomatas
  • beefy red tongue
  • chelitis
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16
Q

What is the inferior most structure in both lung hilum

A

the pulmonary veins

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17
Q

what is the posterior most structure in both lung hilum

A

the bronchus

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18
Q

what is the position of structures in the right lung hilum

A

Anterior - Pulmonary artery
Inferior - Pulmonary vein
Posterior - Bronchus

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19
Q

What is the position of structures in the left lung hilum

A

Anterior (and inferior) - pulmonary Veins
Superior - Pulmonary artery
Posterior - Bronchus

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20
Q

where do the phrenic and vagus nerves lie in the lung hilum

A

phrenic nerve runs in front of the hilum
vagus nerve runs behind the hilum

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21
Q

What are the 4 different types of lung cancer

A
  • Small Cell
  • Large cell
  • Adeno carcinoma
  • Squamous cell carcinoma
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22
Q

what is the most common type of lung cancer in adults and children

A

Adults - adenocarcinoma
Children - bronchiocarcinoma

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23
Q

where are the 4 different lung cancers found within the lung?

A

Adnocarcinma - Peripheral (Away from centre)
Large cell - Peripheral
SCC - Central
Small Cell - Central

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24
Q

what histological features are seen in small cell lung cancer

A

Salt and pepper appearance of nuclei
nuclear chromatin
scanty cytoplasm
round cells

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25
Q

which lung cancer is associated with paraneoplastic syndrome?

A

Small cell lung cancer - It is associated with SIADH and carcinoid syndrome

26
Q

what is pancost syndrome and what are some of the common presenting symptoms?

A

Pancosts tumours are at the apex of the lungs, they cause compression of surrounding structures.

Symptoms:

  1. Compression of sympathetic nerves = horners syndrome (miosis, ptosis and anhydrosis)
  2. Compression of branchial plexus trunks, particularly ulnar nerve - weakness and atrophy of muscles of the hand
  3. SVC compression - SOB and Swelling of the arm
  4. Recurrent laryngeal nerve compression - hoarse voice
27
Q

What are the branches of the Subclavian Artery

A

Mnemoic: VIT C&D

Part 1:

  • Vertibral artery
  • Internal Thoracic
  • Thyrocervical Trunk

Part 2:

  • Dorsal Scapular
  • Costocervical Trunk

part 3:
No branches

28
Q

What are the branches of the Axillary Artery

A

Mnemonic: Some Time Life Seems A Pain

Part 1:
- Superior Thoracic

Part 2:

  • Thoracoacromial
  • Lateral Thoracic

Part 3:

  • Subscapular
  • Anterior circumflex
  • Posterior Circumflex
29
Q

At what level does the SCA become the Axillary Artery

A

The level of the first rib

30
Q

What happens at the angle of Louis? (T4/T5)

A

RAT PLANT
* R: rib 2
* A: aortic arch
* T: tracheal bifurcation
* P: pulmonary trunk
* L: ligamentum arteriosum
* A: azygos vein drains into SVC
* N: nerves
* loop of recurrent laryngeal nerve
* parasympathetic: contributions to the cardiopulmonary plexuses
* sympathetic: branches of the cardiopulmonary splanchnic nerves
* T: right-to-left movement of the thoracic duct

31
Q

What muscular structures are found in the Right Atrium?

A
  1. Crista Terminalis (junction between sinus venous and the heart)
  2. Pectinate Muscles (Ridges of the walls of the atrium)
32
Q

What muscular structures are found in the ventricles of the heart

A
  1. Papillary muscles
  2. Chordae Tendinae
  3. Trabeculae carnae (meaty ridges on surface of ventricles)

Extra:

  1. Vestibule
  2. Infundibuloventricular crest
33
Q

what is the nerve supply to the heart including the SAN and AVN

A

the vagus nerve

34
Q

what is the cardiac sinus composed of?

A
  • great cardiac veins
  • middle cardiac veins
  • small cardiac veins
  • oblique veins
35
Q

where do the thesbian veins drain and where do they drain in to?

A

these drain the anterior surface of the heart and drain directly in to the right atrium

36
Q

What are the abnormalities in tetralogy of fallot?

A
  • Overriding aorta
  • VSD
  • Pulmonary stenosis
  • Right ventricular hytertrophy
37
Q

What ECG findings do you get in hyperkalaemia?

A
  • Flat P wavs
  • Wide QRS
  • increased PR
  • Peaked T Waves
38
Q

What ECG findings do you get in hypokalaemia?

A
  • Tall P waves
  • U waves
  • Increased PR
  • Increased QT
39
Q

What ECG findings do you get in hypercalcemia?

A
  • decreased QT
  • Decreased ST
  • Osborns waves (J waves) If severe
40
Q

What ECG findings do you get in hypocalcemia ?

A
  • Increased QT
  • Increased ST
41
Q

What ECG findings do you get in hypothermia?

A

J waves

42
Q

What are the contents of the superior mediastinum?

A
  • Thymus
  • Oesophagus
  • Trachea
  • Brachiocephalic veins
  • Thoracic duct
  • Arch of Aorta
  • Vagus Nerve
  • Left recurrent laryngeal nerve
  • Phrenic nerve
43
Q

What are the structures in the anterior mediastinum?

A
  • lymph nodes and fat
44
Q

What structures are found in the middle mediastinum?

A
  • Heart
  • Aortic root
  • arch of azygos vein
  • main bronchi
  • phrenic nerve
45
Q

what structures are in the posterior mediastinum?

A
  • Thoacic aorta
  • Azygos vein
  • thoracic duct
  • vagus nerve
  • sympathetic nerve trunks
  • splancnic nerves
46
Q

Where is the thoracic duct positioned in relation to the oesophagus?

A

The thoracic duct lies posterior to the oesophagus

47
Q

Where does the thoracic duct drain in to?

A

The left subclavian vein which drains in to the left brachiocephalic vein which drains to the SVC

48
Q

What are the branches of the coeliac trunk

A

Left gastric

splenic

common hepatic

49
Q

What are the branches of the common hepatic artery

A
  • Right gastric
  • Gastroduodenal (becomes right gastroepiploic)
  • proper hepatic (left and right hepatic)
50
Q

What are the branches of the splenic artery

A
  • Short gastric
  • left gastroepoploic
51
Q

During the median sternotomy which structure would routinely require division?

A

Interclavicular ligament

52
Q

What is the nerve supply of the pectoralis major and minor

A

Pectoralis Major - Medial and lateral pectoral nerves

Pectoralis Minor - Medial pectoral nerves

53
Q

How many collateral circulations exist as alternative pathways of venous return if the SVC was obstructed?

A

4 alternative systems

  • Azygous system
  • Internal mammary venous pathway
  • Long thoracic venous system with connections to the femoral and vertebral veins (2 pathways)
54
Q

at what anatomical level does the descending aorta begin

A

T4/T5

55
Q

What is the blood supply to the ribs T1-T3

A

Costocervical arteries which become the superior intercostal arteries

56
Q

At what level does the Azygus vein drain in to the SVC

A

T4

57
Q
A
58
Q

What is the venous drainage of the chest wall above T4

A
  • The supreme intercostal veins OR
  • the intercostal veins

Both of these drain straight in to the brachiocephalic vein

59
Q

What is the pathophysiology of achalasia

A

The myenteric plexus of orbach is not developed and so you get no peristalsis

60
Q

What is the treatment for a pancosts tumour

A

Radiotherapy + chemotherapy + surgical removal

61
Q

Which structure is responsible for the coordination of the contraction of the papillary muscles

A

Moderator band

62
Q

what is the Mackler triad for borhaeves?

A

vommiting

throacic pain

subcutaneous emphasyma

MRCS Other (19 decks)

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