PTM - 2 Flashcards
Factors contributing to lower oesophageal sphincter preventing reflux
Acute angle of entry of oesophagus (angle of his)
Phreno-oesophageal ligament encircling the GOJ
Prominent mucosal folds in GOJ
What is achalasia
Oesophageal dysmotility
caused by disordered coordination of the perstaltic action of smooth muscle + non-relaxation of LES (loss of myenteric plexus)
Manometry findings of achalasia
High pressure in lower oesophageal sphincter
Failure to relax lower oesophageal sphincter on swallowing
Aperistalsis
Where do ophthalmic veins drain
Cavernous sinus
Clinical fx of orbital blow fracture
Infraorbital sensory loss
Enophthalmos
Diplopia
Orbital emphysema
Posterior relations of kidney
Diaphragm
Psoas
Quadratus lumborum
What lies anterior to IVC at its origin
Right common iliac artery
What lies anterior to IVC at its origin
Right common iliac artery
What ligament joins coracoid to clavicle
Coracoclavicular ligament made off conoid and trapezoid ligaments
Under which ligament does supraspinatous get impinged
coracoacrominal ligament
Under which ligament does supraspinatous get impinged
coracoacrominal ligament
Boundaries of posterior mediastinum
Superior = T4/5
Anterior: pericardium
Posterior: T5-T12 body
Lateral: pleura
Inferior: diaphragm
Boundaries of posterior mediastinum
Superior = T4/5
Anterior: pericardium
Posterior: T5-T12 body
Lateral: pleura
Inferior: diaphragm
Path of azygous vein
Formed by union of first ascending lumbar and subcostal vein below diaphragm, right of vertebral column.
Enters diaphragm through aortic hiatus
Ascends in the posterior thorax
Empties into SVC
Tributaries of azygous vein
Hemiazygous vein (joins at T8)
Accessory hemiazygous vein (Joins at T7)
Path of hemiazygous vein
Forms from left ascending lumbar + left subcostal
Ascends left of vertebral column before entering azygous at T8
Path of accessory hemiazygous vein
Formed by the union of 4th-8th left intercostal vein
Descends on the left before draining into azygous at T7
Path of sympathetic trunk
Exits the skull through carotid canal
Travels lateral to vertebral column from base of skull to coccyx
Passes anterior to the neck of the first rib
Passes behind median arcuate ligament of the diaphragm
Lowest cervical and upper thoracic join to form stellate ganglion
Thoracic ganglia give greater, lesser and least splanchnic nerves
Path of thoracic duct
Formed at the confluence of left and right lumbar lymph trunks and left and right intestinal lymph trunks (cisterna chyli)
Crosses diaphragm through the aortic hiatus at T12
Crosses from right to left at T4/5
Empties into the angle between internal jugular and subclavian vein
Where does the right thoracic lymphatic trunk drain into?
Into the right brachiocephalic vein
What does right lymphatic trunk drain?
Right upper limb
Right lung
Right breast
Right head+neck
Between which layers is the intercostal bundle found
Between innermost intercostal and internal intercostal
Between which layers is the intercostal bundle found
Between innermost intercostal and internal intercostal
Blood supply to intercostal space
Anterior:
- interior thoracic -> top 6 intercostal arteries
- musculophrenic -> bottom 6
Posterior:
- subclavian -> costocervical: highest inercostal -> top 2 intercostal
- descending aorta -> remaining branches
Blood supply to intercostal space
Anterior:
- interior thoracic -> top 6 intercostal arteries
- musculophrenic -> bottom 6
Posterior:
- subclavian -> costocervical: highest inercostal -> top 2 intercostal
- descending aorta -> remaining branches
On which cartilage is thyroid gland located
Below the thyroid cartilage
Isthmus below the cricoid cartilage
Attaches to 2-4th tracheal ring by Berry ligament
On which cartilage is thyroid gland located
Below the thyroid cartilage
Isthmus below the cricoid cartilage
Attaches to 2-4th tracheal ring by Berry ligament
How to perform needle cricothyroidotomy
Aseptic field
14G needle with syringe half filled with sterile water
Extend neck, cricothyroid recess
Aspirate as entering,
Once bubbles, remove syringe
Make sure help on its way
Innervation of strap muscles
Ansa cervicalis except thyrohyoid (C1)
Pharyngeal origin of thyroid
1st pharyngeal arch
Pharyngeal arch origin of parathyroid
Superior parathyroids: 4th pharyngeal arch
Inferior parathyroid: 3rd pharyngeal along with thymus
Most common site of cerebral anaeurysm
85% in anterior circulation (ant cerebral and communicating arteries 35%, ICA and post communicating 35%)
Ix for subarachnoid haemorrhage
CT H picks up 95%
Lumbar puncture after 12 hrs for xanthochromia
CT angio for aneurysms
What age do the cranial sutures ossify
18-24 months
Craniosynostosis
Condition where cranial sutures are fused at birth
Boundaries of middle cranial fossa
Anterior: lesser wing of sphenoid and anterior margin of chiasmatic groove
Lateral: lesser wing of sphenoid + temporal bone
Posterior: Crest of temporal bone and dorsum selae
Where are cavernous sinuses found
Either side of sella turcica
What drains into cavernous sinus
Superficial middle cerebral
Superior and inferior ophthalmic
Sphenoparietal
What drains into cavernous sinus
Superficial middle cerebral
Superior and inferior ophthalmic
Sphenoparietal
What muscle responsible for tongue protrusion
Genioglossus
Which nerve at risk of damage during submandibular gland excision
Marginal mandibular
Lingual
Hypoglossal
Where are parts of brachial plexus
Roots: between anterior and middle scalene
Trunks: base of posterior triangle
Divisions: Posterior to middle 1/3 of clavicle
Cords: 2nd part of axillary artery
End branches: 3rd part of axillary artery
Klumpske palsy cause
Damage to lower part of brachial plexus usually during breech delivery and shoulder dystocia
Klumpske presentation
Claw hand (damage to ulnar nerve and median)
Erbs palsy cause
RTA stretching the upper brachial plexus nerve roots (falling/streaching shoulder)
Erbs presentation
Waiter’s tip
Why sensation to thenar eminence intact in carpal tunnel
palmar cutaneous branch of median comes off before the tunnel
Why sensation to thenar eminence intact in carpal tunnel
palmar cutaneous branch of median comes off before the tunnel
Nerve supply to parietal and visceral pleura
Parietal: intercostal and phrenic nerve
Visceral: pulmonary plexus autonomic nerves (vagus and sympathetic)
