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Backup Gen > Thorax > Flashcards

Thorax Flashcards

1
Q

Which nerves in Superior MEdaistinum

A

Vagus
Phrenic
LEFT RCL

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2
Q

Sup Viscera

A

Trachea
Oesophagus
Thoracic Duct
Thymus and Thymic Remnants

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3
Q

The nerve in the middle mediastinum

A

Phrenic Nerve

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4
Q

Posterior Mediastinum Border

A

T5-T12

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5
Q

Nerves in Posterior Mediastinum

A

Vagus

Splanchnic

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6
Q

Superior MEdiastinum upper and lower boundaries

A

Jugular notch / Upper border of T1

to
Sternal angle lower border of T4

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7
Q

VEssels and viscera in posterior

A

Oesophagus
Thoracic duct

Azygous on right
Hemi + Accessory Azy on left

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8
Q

Angle of Louis

A
  1. Bifurcation of trachea (Carina of trachea)
  2. Bifurcation of pulmonary trunk
  3. Beginning and end of arch of aorta [aortic arch]
  4. Azygos vein enters the superior vena cava
  5. Superior vena cava enters the right atrium
  6. Crossing over of the thoracic duct from the right side to the left
  7. Left recurrent laryngeal nerve loops around aortic arch
  8. Level of ligamentum arteriosum
    9 2nd anatomical constriction of the oesophagus
    10.Thymus or thymic remnants
  9. Placement of central line tip
  10. Demarcates superior and inferior mediastinum
  11. Landmark for counting ribs
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9
Q

Oesopgaus levels

A

Oesopgaus levels
Cervical: C6-T1 3-5cm
Thoracic: T1-T10
Abdominal T11-T12

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10
Q

Oesophagus constriction distances

A

Oesophagus constriction distances

3 constrictions
• Cricopharyngeal sphincter (15 cm)
• Aortic arch and L main bronchus (23 cm)
• LOS (40 cm)

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11
Q

Oesophagus Blood supply:

A

Blood supply:
• Cervical — Inferior thyroid A
• Thoracic — Bronchial and oesophageal branches of thoracic aorta
• Abdominal — Ascending branches from left gastric A and inferior phrenic arteries

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12
Q

Oesophagus Microanatomy

A

Microscopic Anatomy: • Layer 1: Mucosa • Innermost layer • Stratified squamous epithelium 4 squamous epithelium
• Layer 2: Submucosa • Contains larger blood vessels, nerve plexus, oesophageal glands
• Layer 3: Muscle fibres • Inner circular and outer longitudinal fibres
• Layer 4: Fibrous layer • Dense connective tissue

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13
Q

Thorascopic sympathectomy – division of

A

Thorascopic sympathectomy – division of parietal pleura

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14
Q

Most anterior and Most posterior to lung root

A

Phrenic nerves most anterior and vagus most posterior to lung root

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15
Q

Phrenic - levels supplies

A

Phrenic - C3,4,5 - Diaphragm, sensation central diaphragm and pericardium

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16
Q

Phrenics are anterior to…

A

Phrenic
Lt – ant to 1st of subclavian artery
Rt – anterior to scalenus anterior

Both posterior to subclavian vein

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17
Q

CABG median sternotomy – division of

A

CABG median sternotomy – division of interclavicular ligament

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18
Q

Safe triangle -

A

latissimus dorsi, pectoralis major, superior to the nipple and apex at the axilla, 6th IC MAL

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19
Q

Pulmonary arteries = which pharyngeal pouch

A

Pulmonary arteries = 6th Pharyngeal pouch

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20
Q

Origin of trachea =, Carina bifurcates at

A

Origin of trachea = C6, Carina bifurcates at T5

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21
Q

Lung met with clear cells =

A

Lung met with clear cells – renal primary

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22
Q

Increased lung compliance =

A

Increased lung compliance = Older age, COPD

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23
Q

Widespread mets, big bronchial tumour, paraneoplastic syndrome
Least likely to resect!

A

Small Cell Lung Ca: Widespread mets, big bronchial tumour, paraneoplastic syndrome
Least likely to resect!

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24
Q

Small Cell Carcinoma

A

15% of lung cancers

60% already have mets on presentation
poor prognosis

PROXIMAL hilar mass - neuroendocrine cells - paraneoplastic

STRONG LINK TO SMOKING

(Both SCC acronyms are proximal)

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25
Q

Non Small-Cell

A

Majority - 85%

Adenocarcinoma 38%

  • PERIPHERAL lung tissue
  • glandular tissue

SCC (20%)

  • close to main bronchi
  • airway epithelial change from COLUMNAR CUBOIDAL to SQUAMOUS
Large CC (55)
RAPID GROWTH - proximal or peripheral
(Big boy does whatever he wants - peripheral or central)
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26
Q

Lung

A 
Heart
Brain
Liver
Adrenal Glands
Bone
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27
Q

Paraneoplastic

A

Small Cell and Squamous

  • Ectopic Cushing’s - stimualte adrenals
  • Increase ADH - stimulate kidneys to retain hormone
  • PTH like substance - hypercalcaemia
  • Hyperpulmonary osteoarthropahty - clubbing
  • Inflammatory myopathy - muscle weakness
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28
Q

Stabbed to the right of the Manubriosternal joint –

A

Stabbed to the right of the Manubriosternal joint – right recurrent nerve damage

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29
Q

Normal FEV1/FVC =

A

Normal FEV1/FVC = 70%

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30
Q

Burns – electrolyte and CO drop…

A

Burns – hypokalaemia and lose CO 50% in 30 minutes

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31
Q

Central tendon of diaphragm – derived form

A

Central tendon of diaphragm – derived form septum transversum

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32
Q

suture for chest drains

A

2/0 silk for chest drains

33
Q

Mesothelioma

A

Asbestos – Mesothelioma – NOT smoking
Mesothelial cells of lung pleura
Investigation: pleural biopsy, CT Scanning, (PET Scanning if surgery considered)

34
Q

Lung cancer: non-small cell management

Surgery contraindications

A

Surgery contraindications

Assess general health
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

  • However if FEV1 < 1.5 for lobectomy or < 2.0 for pneumonectomy then some authorities advocate further lung function tests as operations may still go ahead based on the results
35
Q

Left main bronchus is at

A

Left main bronchus is at T6

36
Q

ARDS = Pulmonary wedge / Swan Ganz

A

ARDS = Pulmonary wedge / Swan Ganz <18mmHg

37
Q

Stab in parasternal left L4

A

Stab in parasternal left L4 – RV

38
Q

Stab L4 MCL -

A

Stab L4 MCL - LV

39
Q

National Abdominal Aortic Aneurysm Screening Programme

A 
Started 2013 
65 yr invited for USS 
> 3cm enter surveillance 
3.0-4.5cm invited for annual USS 
>4.5cm for 3 monthly USS

Men - referred for treatment at 5.5cm
Women referred for treatment at 5.2cm

40
Q

False aneurysm – not

A

False aneurysm – not expansile – not all muscular layers

41
Q

ABPI of 0.3, ulcer without venous insufficiency -

A

ABPI of 0.3, ulcer without venous insufficiency - Chronic obliterative arterial disease

42
Q

Median sacral artery –

A

L4

43
Q

IVC formed

A

at L5

44
Q

Occlude common iliac bleeding point with

A

Occlude common iliac bleeding point with digital pressure and consider direct sutured repair with 5/0 polypropylene

45
Q

dressing for Ray diabetic foot amputation

A

VAC dressing for Ray diabetic foot amputation

46
Q

Asian females - Large vessel granulomatous arteritis

A

Takayasu – Asian females - Large vessel granulomatous arteritis

47
Q

Pathophysiology of AAA

A

Loss of intima, elastin from media

proteolytic activity, lymphocyte infiltration

48
Q

> 50yo infra-renal AA size in males and females

What size considered aneurysmal?

A

F 1.5cm and M 1.7cm.

> 3cm = aneurysmal

49
Q

Incisura

A

Incisura – elastic recoil of aorta on arterial line trace

50
Q

Femoropopliteal bypass graft:

A

3,000 units of unfractionated heparin, 3 minutes prior to cross-clamping

51
Q

for cardiopulmonary bypass

A

30,000 units of unfractionated heparin for cardiopulmonary bypass

52
Q

Klippel-Trenaunay-Weber Syndrome

A

Varicose Veins + Port wine stains!

+Bone/soft tissue hypertrophy

53
Q

Aortic rupture distal to left subclavian…

A

Aortic rupture distal to left subclavian more likely, ones prior would not survive

54
Q

Temporal artery biopsy – not diagnostic in

A

Temporal artery biopsy – not diagnostic in 50%

55
Q

PTFE graft - to minimise neointimal hyperplasia

A

PTFE graft – neointimal hyperplasia – use a Millar Cuff

56
Q

Marfann’s aorta –

A

Marfann’s aorta – medial cystic necrosis

57
Q

During a SFJ dissection - you at high risk of

A

Damage to the deep Deep internal pudendal artery

58
Q

Post-transplant infections…

A

<6months CMV

> 6months lymphoproliferative EBV

59
Q

AAA rupture rates

A

F 1.5cm and M 1.7cm.
>3cm = aneurysmal

5-6cm 25%,
6-7cm 35%,
>7cm 75%

60
Q

Thyroid ima –

A

Thyroid ima – brachiocephalic artery.

61
Q

Brachial artery embolectomy – nerve at risk

A

Brachial artery embolectomy – Median Nerve Risk

62
Q

has the most musculi pectinate

A

RA has the most musculi pectinate

63
Q

Persistent Left SVC – drains via

A

Persistent Left SVC – drains via coronary sinus

64
Q

Conus arteriosus –

A

Conus arteriosus – infundibulum – LVOT

65
Q

Normal Stroke Volume

A

50-110ml, 70ml for 70kg

66
Q

Inferior MI + Systolic Murmur = think..!

A

Inferior MI + Murmur = Proximal Aortic Dissection! Creation of false lumen between intima + media

67
Q

Apple green birefringence with polarised light =

A

Apple green birefringence with polarised light = amyloidosis

68
Q

Bainbridge reflex =

A

Bainbridge reflex is the increase in heart rate mediated via atrial stretch receptors that occurs following a rapid infusion of blood

69
Q

Stop unfractionated heparin how long before surgery

A

Stop unfractionated heparin 6 hours before surgery

70
Q

Great cardiac vein runs in

A

Great cardiac vein runs in the anterior IV groove - largest tributary of the coronary sinus.

71
Q

Thebesian veins drain into

A

chambers directly

72
Q

J waves are pathognomonic of

A

J waves are pathognomonic of hypothermia.

73
Q

1st heart sound =

A

Mitral and Tricuspid Valve closure =

74
Q

Proximal LAD occlusion – good conduit for bypass

A

Proximal LAD occlusion – internal mammery artery - good conduit for bypass!

75
Q

Endocarditis – typical organism is..

A

strep viridians!

76
Q

Middle cardiac vein - accompanies the

A

Middle cardiac vein - accompanies the posterior I-V artery within the posterior IV groove

77
Q

Verapamil – contraindicated in

A

tachycardias

78
Q

Sodium thiopentone – can cause

A

Sodium thiopentone – myocardial depression

Backup Gen (15 decks)

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