SBA BOOK Flashcards
Pleurae margins for lungs
Both start 2.5cm above border between medial and middle third of clavicle Pleurae meet in the midline at 2nd CC Left Pleura leaves midline at 4th CC Right Pleura leaves midline at 6th CC Meet in mid clavicular line at 8th CC Mid axillary line at 10th CC Midline in back at 12th CC
Where do oblique fissures start and end
Start at the tip of T3
Parallel to rotated medial scalpula border
End at 6TH Costochondral joint
Where does Horizontal fissure start and finish
Runs medially from oblique fissure at mid axillary line along border of 4th rib
What level does Aorta pass Diaphragm
What structures pass here
T12 Aortic Hiatus
Aorta
Thoracic duct
Azygous vein
Describe the course of thoracic duct, what does it lie laterally to?
Lies lateral to AZV
Originates from the chyle cisterns in abdomen and ascends through T12 Aortic hiatus
Drains everything but RUQ of body (this is done by Right lymphatic trunk)
Courses between aorta (lateral) and Azygous vein (medial)
Oseophagus (anterior) until T5 WHERE IT CROSSES ANTERIORLY
Drains into left subclavian
Location of heart valves
Mitral Tricuspid - 4th
Aortic pulmonary - 3RD
Left coronary artery branches supply
LAD supplies both ventricles and interventricular septum
LMA Supplies left ventricle
LCIRC Left atrium and left ventricle
Right coronary artery braches supply
RCA - RA and RV
RMA- RV AND Apex
Posterior interventricular artery - RA and RV + Interventricular septum
What level is sternal angle?
What happens here
T4 Aortic arch is terminating Azygous vein enters SVC Left recurrent laryngeal loops around ligamentum venosum Bifurcation of ligamentum venosum
Arterial supply to the oesophagus
Cervical portion - Inferior thyroid artery
Thoracic portion - Descending aorta
Abdominal portion - Left gastric artery (Coeliac trunk)
Venous drainage of oesophagus
Cervical portion: Inferior thyroid vein
Thoracic portion: Azygous vein
Abdominal portion: Left Gastric Vein
What passes through Caval hiatus (T8)
Right phrenic
Vena Cava
What passes through Oesophageal hiatus (T10)
Oesophagus
Left gastric artery and vein
Vagus
What structures form from aoric arches
Six pairs Arise from truncus arteriosus 1st and 2nd arches disappear 3rd arch becomes carotid 4th arch Right side - Brachiocephalic + Subclavian 4th arch Left - Aortic arch 5th Disappears 6th Left and Right pulmonary arches
Commonest site for Bochdalek (diaphragmatic hernia)
Left posterior aspect
Most likely site for inhaled FB
Right lower lobe bronchus
Right main bronchus is wider, shorter and runs more vertically than left main bronchus
Lymphatic drainage of Oeseophagus
Cervical aspect - internal jugular nodes
Thoracic - Mediastinal
Abdomal - gastric and coeliac lymph nodes
When to use endocrine therapy in breast ca
Oestrogen receptor positive tumours
Downstaging primary lesions
Definitive treatment in old, infirm patients
When to use radiotherapy in breast ca
WLE
Large lesion, high grade or marked vascular invasion following mastectomy
When to use Chemotherapy in breast Ca
Downstaging advanced lesions to facilitate breast conserving surgery
Patients with grade 3 lesions or axillary nodal disease
Primary site Cancers likely for bone mets
BReast BRonchus REnal (tend to be hypervascular) Thyroid Prostate
Contraindication to lung ca excision
Stage IIIb or IV (i.e. metastases present)
FEV1 < 1.5 litres is considered a general cut-off point
Malignant pleural effusion
Tumour near hilum
Vocal cord paralysis
SVC obstruction
ECG changes for thrombolysis
ST elevation of > 2mm (2 small squares) in 2 or more consecutive anterior leads (V1-V6) OR
ST elevation of greater than 1mm (1 small square) in greater than 2 consecutive inferior leads (II, III, avF, avL) OR
New Left bundle branch block
GCS Parameters
Eye opening 4 Spontaneous 3 To speech 2 To pain 1 None
Verbal response 5 Orientated 4Confused 3 Words 2 Sounds 1 None
Motor response 6Obeys commands 5Localises to pain 4Withdraws from pain 3Abnormal flexion to pain (decorticate posture) 2Extending to pain 1 None
How to test for CSF in suspected base of skull ffracture
Beta 2 transferrin
Where does uterine artery originate and what else does it supply
Internal iliac artery
Found medial to levator ani
Branch is given off to ureter 2cm above the cervix ureter
Location of spleen
9-12 LEFT RIBS
Muscles of pelvic diaphragm
Puborectalis
Pubococcygeus
Iliococcygeous
Coccygrous
Four abnormalities of TOF
Overriding Aorta
Pulmonary stenosis
RVH
VSD
Three Cranial Nerves most likely to be injured during submandibular gland surgery
Marginal Mandibular (lower lip muscles - orbicularis oris etc - so drooling/pooling of saliva) Lingual (Sensory deficit anterior 2/3- Remember NOT taste) Hypoglossal (Motor - Ipsilateral tongue paralysis)
Lung hila structures
Pulmonary artery - superior
Pulmonary vein - inferior
Bronchus - posterior
Papillary carcinoma
papillary projections and pale empty nuclei Seldom encapsulated Lymph node metastasis predominate Haematogenous metastasis rare Account for 60% of thyroid cancers
Course of Brachial Plexus
Ventral rami, the roots of the plexus, lie between scalenus medius and anterior. (C5-T1)
Pass between Scalene anterior and medius
Nerves from Roots of Brachial Plexus
C5,6,7 Long thoracic nerve
Nerves from Trunks of Brachial plexus
Upper trunk - 2USS
Suprascapular (C5-6)
Subclavius (C5-6)
Nerves from Lateral cord of Brachial Plexus
Lateral Pectoral
Evenually gives musculocutateonus (C-5-7) branches
Nerves from Medial cord
Medial arm stuff Medial Pec Medial cut FARM Medial cut ARM Continues to give ulnar nerve CT T1
Nerves from Postreior cord
ULNAR U upper scapular L ower scapular Nerve to lat dorsi (thoracodorsal) Axillary (c5-6) Radial (C5-8)
Nerves involved in Erbs palsy
C5,6 MASS affect Muculocutaneous Axillary Suprascapular Subclavius Limp upper limp, Medially rotated, pronated Waiters tip
Nerves involved in Klumpkes
C8-T1
Ulnar and Median most affected
ie) Intrinsic muscles of the hand
Claw hand
Ulnar nerve damage at elbow
FDP ulnar aspect not at all supplied
So no DIP flexion
Less severe clawing
Ulnar never damage at wrist
FDP is working
So DIP is flexed
Clawing more obvious
Upper limb myotomes
Elbow flexors/Biceps C5 Wrist extensors C6 Elbow extensors/Triceps C7 Long finger flexors C8 Small finger abductors T1
Lower limb Myotomes
Hip flexors (psoas) L1 and L2 Knee extensors (quadriceps) L3 Ankle dorsiflexors (tibialis anterior) L4 and L5 Toe extensors (hallucis longus) L 5 Ankle plantar flexors (gastrocnemius) S1 2
Inguinal canal boundaries
Anterior wall: External Oblique Aponeurosis
Floor: EO, Lacunar ligament, inguinal ligament
Roof:Internal oblique Transversus abdominis
Posterior: Transversalis fascia
Conjoint tendon
Spermatic cord coverings and origins
External spermatic - external oblique
Cremasteric - Internal oblique
Internal sperm - TF
Adductor canal borders
Posteriorly Adductor longus, adductor magnus
Laterally Vastus medialis muscle
Roof Sartorius
Adductor canal contents
Saphenous Nerve
Superficial Femoral Artery and Vein
Structures passing through Parotid
Facial nerve (Mnemonic: The Zebra Buggered My Cat; Temporal Zygomatic, Buccal, Mandibular, Cervical)
External carotid artery
Retromandibular vein
Auriculotemporal nerve
Relations of parotid
Anterior: masseter, medial pterygoid, superficial temporal and maxillary artery, facial nerve, stylomandibular ligament
Posterior: posterior belly digastric muscle, sternocleidomastoid, stylohyoid, internal carotid artery, mastoid process, styloid process
Lymph drainage- deep cervical
Nerve stimulation of parotid causes?
Parasympathetic stimulation produces a water rich, serous saliva. - ready to eat
Sympathetic stimulation leads to the production of a low volume, enzyme-rich saliva.
Galeazzi fracture
Radial shaft fracture with associated dislocation of the distal radioulnar joint
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Monteggia Fracture
Dislocation of the proximal radioulnar joint in association with an ulna fracture
Osteomalacia picture
low: calcium, phosphate
raised: alkaline phosphatase
Perthes disease aetiology and radiological grading
Boys 2-12
Half a dozen half a head
Catterall staging
Stage Features
Stage 1 Clinical and histological features only
Stage 2 Sclerosis with or without cystic changes and preservation of the articular surface
Stage 3 Loss of structural integrity of the femoral head
Stage 4 Loss of acetabular integrity
Salter Harris
S (Type 1): Straight through the growth plate
A (Type 2): Above - through growth plate and Above involving the metaphysis
L (Type 3): Lower -through growth plate and beLow involving the epiphysis
T (Type 4):Through - Through both metaphysis, epiphysis and growth plate
E (Type 5): Everything - Crush / compression injury
R (Type 5): Ruined
