pop thor

Question 1

a) Draw and label a diagram showing the position of the lungs and pleura in relation to the bones and cartilages of the thorax (4 marks)

Answer 1

Bottom of pleura is 8th rib
Base of lung is 6th rib
Apex of lung/pleura is 1 inch above medial 3rd of clavicle
Xiphisternal joint
Cardiac notch rib 4-6 left side

Question 2

a) What enters/leaves the lungs via the hilum (6 marks)

Answer 2

• Primary bronchus
• Pulmonary artery (deoxygenated blood from RV)
• 2 pulmonary veins (oxygenated blood to LA)
• Bronchial arteries (oxygenated blood from descending aorta)
• Bronchial veins
• Pulmonary plexus of nerves (autonomic)
• Lymph vessels and nodes

Question 3

How can you identify the right from the left lung?

Answer 3

Right: Two fissures

Left: One fissure

Question 4

b) What is the surface marking for the fissure that is being pointed at? (2) (for the right lung)

Answer 4

Horizontal fissure follows 4th intercostal space from the sternum until it meets the oblique fissure as it crosses rib 5.

Question 5

c) Where would you percuss for the apex of the lung? (2)

Answer 5

2-3cm (1 inch) above the medial third clavicle

Question 6

d) What is the vessel that runs in the marked groove? (2)

Answer 6

Azygos vein.

Question 7

What is the blood supply to the trachea?

Answer 7

Bronchial artery (+ inferior thyroid?)

Question 8

Where are the locations of the pulmonary veins and arteries in the hilum of the lung?

Answer 8

Pulmonary artery on top

Pulmonary veins x2 under it

Question 9

a) If the right vagus nerve was damaged below where the laryngeal nerve emerges, what effect has it on your voice?

Answer 9

NO EFFECT

Interruption of the vagus nerves BEFORE the division of the recurrent laryngeal nerves can produce vocal symptoms. Hoarse voice, affect phonation, inability to speak. Vocal cord paralysis, recurrent laryngeal nerve palsy

Question 10

b) Where does the internal Carotid artery supply and how would you palpate it?

Answer 10

Brain

Between thyroid cartilage + Sternocleidomastoid muscle

Question 11

c) Pointed at Ligamentum Arteriosum; what was its embryological function?

Answer 11

Shunt blood away from pulmonary circulation; shunts blood from pulmonary trunk to aorta to prevent it entering pulmonary arteries and entering the lungs straight to aorta.

Question 12

d) What vein drains from the apex of the heart up?

Answer 12

Great cardiac vein (left coronary vein)

Question 13

What is the circulation supply to the structure of the bronchus?

Answer 13

Bronchial arteries from the aorta

Question 14

Describe the oxygen content of the pulmonary vein.

Answer 14

Oxygenated blood

Question 15

What is the direction of the external intercostal?

Answer 15

Like hands in pockets

Question 16

What is the role of the external intercostal?

Answer 16

Moves the ribs up and out and stiffens the rib cage inspiration

Question 17

6) Where would you insert a chest drain?

Answer 17

Triangle of safety:
anterior border of latissimus doors,

lateral border of pectoralis major,

a line superior to the horizontal level of the nipple and an apex below the axilla.

5th intercostal space anterior to mid axillary line.

Question 18

What information can be obtained from an angiogram of the left ventricle? (10 marks)

Answer 18

• Taking pictures of the heart by inserting a catheter via the femoral artery
• Prolapse common in mitral valve mitral regurgitation
• Left ventricular aneurysm
• Left ventricular size
• Intraventricular obstruction
• Tumour/thrombus
• Regional left ventricular function (akinesia/hypokinesia)
• Overall LV function (ejection fraction)

Question 19

What is the cause of the transradient area of the bottom of the heart?

Answer 19

Air in fundus of stomach

Question 20

What causes opaque areas in the lung field?

Answer 20

Hilum has pulmonary blood vessels

Question 21

What causes the transparent area superimposed on the vertebrae?

Answer 21

Trachea contains air

Question 22

What is the name of the features on the right of the trachea?

Answer 22

Aortic arch

Question 23

Write down the anatomical positions of the ECG chest electrodes as placed on the body.

Answer 23

V1: Right 4th ics next to sternum
V2: Left 4th ics next to sternum
V3: Left 5th ics between V2 and V4
V4: Left 5th ics at mid clavicular lin
V5: Left 5th ics at anterior-axilliary line
V6: Left 5th ics mid axillary line

Question 24

What are the structures anterior and posterior to oesophagus?

Answer 24

Behind: thoracic duct, azygos vein, simp trunks,

(thoracic vertebrae? Nerves?)

Anterior: trachea, aortic arch

Question 25

What is the definition of referred pain?

Answer 25

Sensory neurons relaying pain signals triggered in one area are felt in another part of the body the dermatome supplied by the spinal nerve also supplying the region where pain impulses are stimulated.

(Also called reflective pain - pain perceived at a location away from the site of painful stimulus)

Question 26

1) What can be palpated from the supramanubrial notch?

Answer 26

Trachea

Question 27

2) Which passes around the aortic arch?

Answer 27

Left recurrent laryngeal nerve

Question 28

3) What structure does the left bronchus pass anteriorly?

Answer 28

Oesophagus

Question 29

4) What arises from the cervical spinal cord?

Answer 29

Phrenic nerve - C3, 4 and 5

Question 30

5) Which postural part of lung will stiffen the most?

Answer 30

???

Question 31

During inspiration, what is the muscular mechanism for increasing the volume for lung expansion in: (2 marks)

(a) the vertical direction
(b) the transverse direction

Answer 31

(a)
o contraction of diaphragm
o lung expands into costo-diaphragmatic recess

(b)
o contraction of intercostal (and scalenus anterior)
o articulation of ribs at vertebrate and sternum plus rib shape means increased transverse diameter (‘bucket handle’, ‘pump handle’)

Question 32

a) During forced inspiration additional muscles may act to further increase the chest volume. Give an example of one such muscle and how it works. (1 mark)

Answer 32

Pectoralis minor will assist lifting of ribs if shoulder girdle fixed.