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MD3001 > MD3001 Week 7 > Flashcards

MD3001 Week 7 Flashcards

1
Q

Define palliative care

A

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

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2
Q

some principles of good end of life care

A
  • 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
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3
Q

advance statement

A

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

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4
Q

advance decision/directive

A

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

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5
Q

power of attorney

A

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

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6
Q

neurovascular supply of trachea

A

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

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7
Q

histological difference b/w of respiratory bronchioles from terminal

A
  • no goblet cells

- epithelium becomes cuboidal

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8
Q

mediastinal relations of R lung (5)

A
  1. vagus and phrenic nerve
  2. SVC and azygos vein
  3. oesophagus
  4. IVC
  5. liver
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9
Q

mediastinal relations of L lung (5)

A
  1. vagus and phrenic nerve
  2. aortic arch, subclavian artery, and descending aorta
  3. thoracic duct
  4. oesophagus
  5. spleen and stomach
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10
Q

pulmonary ligament

A

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

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11
Q

lymph drainage from lungs to thoracic duct

A

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

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12
Q

nerve supply of pleura

A

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

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13
Q

what nerves can L lung tumour affect (3)?

A
  1. phrenic nerve: cause paralysis of diaphragm
  2. sympathetic trunk: cause Horner’s syndrome
  3. recurrent laryngeal nerve: hoarse voice
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14
Q

respiratory cause of fine hand tremor

A

excessive use of B-agonists causes this symptom

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15
Q

terminal branches of internal thoracic artery (2)

A

this artery terminates as superior epigastric and musculophrenic arteries

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16
Q

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

A
  1. Replacement (alternates)
  2. Reduction (less use)
  3. Refinement (better care)
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17
Q

Outline Tuskegee Syphilis Trial

A

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
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18
Q

Outline case of HeLa cells

A

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.

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19
Q

which intercostal spaces are supplied by musculophrenic artery?

A

anterior intercostal spaces 7-10 supplied by this artery

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20
Q

outline arterial supply to posterior intercostal spaces

A

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

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21
Q

outline venous supply from posterior intercostal spaces

A

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

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22
Q

lymph drainage from thoracic wall

A

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

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23
Q

nerve supply through ventral ramus of T1 (2)

A
  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

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24
Q

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

A
  1. lat + ant cutaneous branch
  2. intercostal nerve + collateral branch (motor)
  3. sympathetic fibres to body
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25
Q

unique aspect of T2 intercostal nerve

A

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

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26
Q

where does the larynx begin?

A

this structure begins at the hyoid

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27
Q

where is the site of emergency access to airway?

A

clinical significance of median cricothyroid ligament

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28
Q

what lie on top of arytenoid? (2)

A
  1. corniculate

2. cuneiform

29
Q

what type of cartilage is epiglottis?

A

this laryngeal structure is elastic cartilage

30
Q

vocal ligament

A

upper edge of conus elasticus

31
Q

what is quadrangular membrane connected to?

A

this membrane connects arytenoid to thyroid and epiglottis

32
Q

what is conus elasticus connected to?

A

this membrane connects cricoid and arytenoid to thyroid

33
Q

what makes up the laryngeal inlet?

A

aryepiglottic folds make up this structure

34
Q

what muscles close the laryngeal inlet?

A

aryepiglotticus from oblique arytenoid does this

35
Q

posterior crico-arytenoid

A

this muscle externally rotates and slopes arytenoids laterally

36
Q

what muscle adduct the rima?

A

transverse arytenoid

37
Q

what muscle internally rotate the rima?

A

lateral crico-arytenoid

38
Q

what muscle shortens vocal cords?

A

thyro-arytenoid

39
Q

arterial supply to larynx

A

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

40
Q

lymph drainage from larynx

A

above vocal folds: upper deep cervical

below: lower deep cervical

41
Q

muscles that control diameter of nares (2)

A
  1. procerus

2. nasalis

42
Q

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

A
  1. nasal
  2. frontal
  3. ethmoid
  4. sphenoid
43
Q

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

A
  1. nasal
  2. maxilla
  3. lacrimal
  4. ethmoid
  5. palatine
  6. med. pterygoid plate of sphenoid
44
Q

what opening does air enter nasopharynx through?

A

air enters choanae to reach this part of pharynx

45
Q

what separates nasal cavity from cranial cavity?

A

cribiform plate

46
Q

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

A

crista galli lies on top of this part of ethmoid

47
Q

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

A

trigeminal nerve supplies sensory and parasympathetic innervation to this structure

48
Q

where does posterior inferior lateral nasal nerve arise from?

A

this nasal nerve arrives from greater palatine nerve

49
Q

where does anterior superior nasal artery branch from?

A

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

50
Q

where does posterior inferior nasal artery branch from?

A

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

51
Q

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

A
  1. ant ethmoidal
  2. greater palatine
  3. sphenopalatine
  4. labial branches of facial
52
Q

how does frontal sinus drain into nasal cavity?

A

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

53
Q

how does maxillary sinus drain into nasal cavity?

A

this sinus drains via hiatus semilunaris posteriorly

54
Q

how does nasolacrimal duct open into nasal cavity?

A

this sinus opens into inferior meatus

55
Q

what opens into the superior meatus?

A

posterior ethmoidal cells open into here

56
Q

outline neurovasculary supply of septums

A

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

57
Q

lymph drainage of nasal cavity

A

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

58
Q

what 4 structures make up Waldeyer’s ring?

A
  1. adenoid or pharyngeal tonsil
  2. tubal tonsil
  3. palatine tonsil
  4. lingual tonsil
59
Q

lymph drainage of tonsils

A

lymph from here drain into jugulodigastric node

60
Q

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

A

examples of indwelling prosthetic devices

61
Q

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

A

examples of invasive medical devices

62
Q

define evidence based medicine

A

using the best evidence to provide best care for individual patients

63
Q

3 principles of EBM

A
  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
64
Q

cons of EBM

A
  • 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
65
Q

pros of EBM

A
  • 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
66
Q

steps in practicing EBM (6)

A
  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
67
Q

systems factors of safe clinical handover

A
  1. protected time
  2. key staff
  3. location
  4. format
  5. clear leadership
  6. summary sheets
68
Q

histology of alveolar wall

A

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

MD3001 (10 decks)

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