PTM - 2 Flashcards by K D

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

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What is achalasia

Oesophageal dysmotility

caused by disordered coordination of the perstaltic action of smooth muscle + non-relaxation of LES (loss of myenteric plexus)

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Manometry findings of achalasia

High pressure in lower oesophageal sphincter

Failure to relax lower oesophageal sphincter on swallowing

Aperistalsis

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Where do ophthalmic veins drain

Cavernous sinus

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Clinical fx of orbital blow fracture

Infraorbital sensory loss
Enophthalmos
Diplopia
Orbital emphysema

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Posterior relations of kidney

Diaphragm
Psoas
Quadratus lumborum

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What lies anterior to IVC at its origin

Right common iliac artery

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What lies anterior to IVC at its origin

Right common iliac artery

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What ligament joins coracoid to clavicle

Coracoclavicular ligament made off conoid and trapezoid ligaments

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Under which ligament does supraspinatous get impinged

coracoacrominal ligament

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Under which ligament does supraspinatous get impinged

coracoacrominal ligament

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Boundaries of posterior mediastinum

Superior = T4/5
Anterior: pericardium
Posterior: T5-T12 body
Lateral: pleura
Inferior: diaphragm

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Boundaries of posterior mediastinum

Superior = T4/5
Anterior: pericardium
Posterior: T5-T12 body
Lateral: pleura
Inferior: diaphragm

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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

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Tributaries of azygous vein

Hemiazygous vein (joins at T8)

Accessory hemiazygous vein (Joins at T7)

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Path of hemiazygous vein

Forms from left ascending lumbar + left subcostal
Ascends left of vertebral column before entering azygous at T8

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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

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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

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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

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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)