MD3001 Week 7

Question 1

Define palliative care

Answer 1

approach that improves quality of life of patients and their families through prevention and relief of suffering by early identification and assessment and treatment of physical/psychosocial spiritual problems associated w/ life threatening illness

Question 2

some principles of good end of life care

Answer 2

• open lines of communication
• anticipating care needs and encouraging discussion
• effective multidisciplinary team input
• symptom control (physical and psycho-spiritual)
• preparing for death (patient and family)
• providing support for relative both before and after death

Question 3

advance statement

Answer 3

a statement that sets down your preferences, wishes, beliefs, and values regarding future care

Question 4

advance decision/directive

Answer 4

decision you can make now to refuse specific treatment in the future (eg. CPR)

Question 5

power of attorney

Answer 5

set an attorney to decide for patient when patient is in unable state

Question 6

neurovascular supply of trachea

Answer 6

arteries: inf. thyroid and bronchial
veins: inf. thyroid
lymph: pre and para tracheal
nerve: vagi, recurrent laryngeal, sympathetic trunk

Question 7

histological difference b/w of respiratory bronchioles from terminal

Answer 7

• no goblet cells

- epithelium becomes cuboidal

Question 8

mediastinal relations of R lung (5)

Answer 8

1. vagus and phrenic nerve
2. SVC and azygos vein
3. oesophagus
4. IVC
5. liver

Question 9

mediastinal relations of L lung (5)

Answer 9

1. vagus and phrenic nerve
2. aortic arch, subclavian artery, and descending aorta
3. thoracic duct
4. oesophagus
5. spleen and stomach

Question 10

pulmonary ligament

Answer 10

fold of pleura under hilum that allows hilar movement and vessel expansion

Question 11

lymph drainage from lungs to thoracic duct

Answer 11

pulmonary -> bronchopulmonary -> inferior/superior tracheobronchial -> paratracheal -> bronchomediastinal trunk

Question 12

nerve supply of pleura

Answer 12

visceral pleura has no sensory supply, parietal has sensory fibres from intercostal and phrenic nerves

Question 13

what nerves can L lung tumour affect (3)?

Answer 13

1. phrenic nerve: cause paralysis of diaphragm
2. sympathetic trunk: cause Horner’s syndrome
3. recurrent laryngeal nerve: hoarse voice

Question 14

respiratory cause of fine hand tremor

Answer 14

excessive use of B-agonists causes this symptom

Question 15

terminal branches of internal thoracic artery (2)

Answer 15

this artery terminates as superior epigastric and musculophrenic arteries

Question 16

3 principles governing the use of animals in research (from the Home Office policy)

Answer 16

1. Replacement (alternates)
2. Reduction (less use)
3. Refinement (better care)

Question 17

Outline Tuskegee Syphilis Trial

Answer 17

study to record natural history of syphilis in hopes of justifying treatment programs for blacks

• no informed consent: participants told they were being treated for “bad blood”
• not given diagnosis or treatment
• incentives: free medical exams, free meals, burial insurance

Question 18

Outline case of HeLa cells

Answer 18

these cells from her cervix cultured in vitro and became first immortal human cell line. Used all over the world. Made a lot of money. No knowledge or consent sought.

Question 19

which intercostal spaces are supplied by musculophrenic artery?

Answer 19

anterior intercostal spaces 7-10 supplied by this artery

Question 20

outline arterial supply to posterior intercostal spaces

Answer 20

1-2: subclavian -> costocervical -> superior intercostal
3-11: thoracic aorta -> post intercostal
12: subcostal

Question 21

outline venous supply from posterior intercostal spaces

Answer 21

1: BCV
2-3: superior intercostal vein to arch of azygos (R) and LBCV (L)
4-12: azygos system

Question 22

lymph drainage from thoracic wall

Answer 22

anterior: parasternal nodes
posterior: intercostal to bronchomediastinal trunk (superiorly) and thoracic duct (inferiorly)

Question 23

nerve supply through ventral ramus of T1 (2)

Answer 23

1. motor to muscles of 1st intercostal space

2. recruited to brachial plexus to supply small muscles of hand and skin of medial arm and forearm

Question 24

nerve supply through ventral ramus of T2-11 (3)

Answer 24

1. lat + ant cutaneous branch
2. intercostal nerve + collateral branch (motor)
3. sympathetic fibres to body

Question 25

unique aspect of T2 intercostal nerve

Answer 25

this intercostal nerve's lateral cutaneous branch doesn't divide and instead becomes intercostobrachial nerve supplying thorax wall in axilla and upper medial UL

Question 26

where does the larynx begin?

Answer 26

this structure begins at the hyoid

Question 27

where is the site of emergency access to airway?

Answer 27

clinical significance of median cricothyroid ligament

Question 28

what lie on top of arytenoid? (2)

Answer 28

1. corniculate | 2. cuneiform

Question 29

what type of cartilage is epiglottis?

Answer 29

this laryngeal structure is elastic cartilage

Question 30

vocal ligament

Answer 30

upper edge of conus elasticus

Question 31

what is quadrangular membrane connected to?

Answer 31

this membrane connects arytenoid to thyroid and epiglottis

Question 32

what is conus elasticus connected to?

Answer 32

this membrane connects cricoid and arytenoid to thyroid

Question 33

what makes up the laryngeal inlet?

Answer 33

aryepiglottic folds make up this structure

Question 34

what muscles close the laryngeal inlet?

Answer 34

aryepiglotticus from oblique arytenoid does this

Question 35

posterior crico-arytenoid

Answer 35

this muscle externally rotates and slopes arytenoids laterally

Question 36

what muscle adduct the rima?

Answer 36

transverse arytenoid

Question 37

what muscle internally rotate the rima?

Answer 37

lateral crico-arytenoid

Question 38

what muscle shortens vocal cords?

Answer 38

thyro-arytenoid

Question 39

arterial supply to larynx

Answer 39

above vocal folds: superior laryngeal branch of superior thyroid below: inferior laryngeal branch of inferior thyroid

Question 40

lymph drainage from larynx

Answer 40

above vocal folds: upper deep cervical | below: lower deep cervical

Question 41

muscles that control diameter of nares (2)

Answer 41

1. procerus | 2. nasalis

Question 42

what bones make up roof of nasal cavity? (4)

Answer 42

1. nasal 2. frontal 3. ethmoid 4. sphenoid

Question 43

what bones make up lateral wall of nasal cavity? (6)

Answer 43

1. nasal 2. maxilla 3. lacrimal 4. ethmoid 5. palatine 6. med. pterygoid plate of sphenoid

Question 44

what opening does air enter nasopharynx through?

Answer 44

air enters choanae to reach this part of pharynx

Question 45

what separates nasal cavity from cranial cavity?

Answer 45

cribiform plate

Question 46

what part of ethmoid bone lies on top of cribriform plate?

Answer 46

crista galli lies on top of this part of ethmoid

Question 47

what main nerve supplies the nasal cavity and what innervations does it serve?

Answer 47

trigeminal nerve supplies sensory and parasympathetic innervation to this structure

Question 48

where does posterior inferior lateral nasal nerve arise from?

Answer 48

this nasal nerve arrives from greater palatine nerve

Question 49

where does anterior superior nasal artery branch from?

Answer 49

this artery branches from anterior and posterior ethmoidal branches of ophthalmic artery

Question 50

where does posterior inferior nasal artery branch from?

Answer 50

this artery branches from greater palatine and sphenopalatine branches of maxillary artery

Question 51

what arteries anastomose at Kiesselbach's Area? (4)

Answer 51

1. ant ethmoidal 2. greater palatine 3. sphenopalatine 4. labial branches of facial

Question 52

how does frontal sinus drain into nasal cavity?

Answer 52

this sinus drains via frontonasal duct and infundibulum (w/ ant ethmoidal cells) to hiatus semilunaris)

Question 53

how does maxillary sinus drain into nasal cavity?

Answer 53

this sinus drains via hiatus semilunaris posteriorly

Question 54

how does nasolacrimal duct open into nasal cavity?

Answer 54

this sinus opens into inferior meatus

Question 55

what opens into the superior meatus?

Answer 55

posterior ethmoidal cells open into here

Question 56

outline neurovasculary supply of septums

Answer 56

frontal/ethmoidal/sphenoid: supra-orbital and ethmoidal branches of ophthalmic nerve and ophthalmic artery maxillary: maxillary nerve and maxillary artery

Question 57

lymph drainage of nasal cavity

Answer 57

anteriorly: submandibular nodes posteriorly: retropharyngeal nodes to upper deep cervical nodes

Question 58

what 4 structures make up Waldeyer's ring?

Answer 58

1. adenoid or pharyngeal tonsil 2. tubal tonsil 3. palatine tonsil 4. lingual tonsil

Question 59

lymph drainage of tonsils

Answer 59

lymph from here drain into jugulodigastric node

Question 60

what type of medical device are heart valves, pacing units, etc?

Answer 60

examples of indwelling prosthetic devices

Question 61

what type of medical device are IVs, urinary catheters, etc

Answer 61

examples of invasive medical devices

Question 62

define evidence based medicine

Answer 62

using the best evidence to provide best care for individual patients

Question 63

3 principles of EBM

Answer 63

1. high quality health care depends on objective and clinically relevant information 2. there is a hierarchy of evidence where some are better than others 3. scientific data alone not sufficient for making clinical decisions about individual patients

Question 64

cons of EBM

Answer 64

- just a new label - identifies statistically significant benefits that may be marginal in clinical practice - generated a massive volume of evidence and guidelines which are unmanageable - causes mindless application of population studies to treat individuals

Question 65

pros of EBM

Answer 65

- decisions are made on stronger evidence - only one part of the process - produce expert judgement in a format that clinicians can understand - last step is to decide whether info is applicable to individual patient

Question 66

steps in practicing EBM (6)

Answer 66

1. craft question 2. search medical literature 3. find study that will best answer question 4. perform critical appraisal (validity and vias) 5. determine how to use results to benefit patient 6. evaluate results

Question 67

systems factors of safe clinical handover

Answer 67

1. protected time 2. key staff 3. location 4. format 5. clear leadership 6. summary sheets

Question 68

histology of alveolar wall

Answer 68

this respiratory structure is type type I pneumocytes: squamous epithelial cells type II pneumocytes: surfactant