Week 1

Question 1

List the 4 principles of medical ethics

Answer 1

Respect for autonomy
Beneficence
Non-maleficence
Justice

Question 2

Name and explain the 4 quadrants of a medical case (ethical problem)

Answer 2

1. Medical indications:
   - treatment options
2. Quality of life:
   - will the treatment improve the patient’s quality of life?
3. Patient preferences:
   - what does the patient want?
   - do they have capacity?
4. Contextual features:
   - relevant religious / cultural / legal factors

Question 3

Define deontology & explain it’s weaknesses

Answer 3

Deontology = performing actions that are in line with a predetermined set of moral rules

Weaknesses:

• how do you decide on a set of moral rules and their hierarchy?
• consequences do matter

Question 4

Define consequentialism & explain it’s weaknesses

Answer 4

Consequentialism = performing actions that promote the best outcome (greatest good for the greatest number)

Weaknesses:

• some individuals may be treated unjustly
• the action itself may not be good

Question 5

Define virtue ethics & explain it’s weaknesses

Answer 5

Virtue ethics = performing an action that a virtuous agent would do in the same situation

Weaknesses:

• how do you decide on virtues?
• may differ between cultures

Question 6

Define rights theory and positive & negative rights

Answer 6

Rights theory = performing actions based on a person’s rights; both legal and moral

Positive rights impose a moral duty for another person to act
Negative rights prohibit intervention from other people

Question 7

Define narrative ethics

Answer 7

Narrative ethics = moral decisions should be based off the stories shared between patient & clinician

(Narrative ethics counters the rationality of deontology & consequentialism)

Question 8

List the GMCs 4 duties of a doctor

Answer 8

Put the patient’s safety first (via knowledge & skills)
Safety & quality of practice
Communication, partnership & teamwork
Maintaining trust

Question 9

List the steps involved in a structured case analysis

Answer 9

Summarise the case
State the moral dilemma
State the assumptions being made
Analyse the case
Acknowledge other approaches + state & explain the preferred approach

Question 10

What is the primary function of the thoracic cage?

Answer 10

Respiration

Question 11

List the borders of the thoracic cage

Answer 11

Posteriorly: thoracic vertebrae & the head and neck of the ribs
Laterally: the shaft of the ribs
Anteriorly: costal cartilage & the sternum

Question 12

Explain the difference between true and false ribs, and state which ribs belong to each type

Answer 12

Ribs 1-7 are true ribs, because their costal cartilage articulates directly with the sternum
Ribs 8-10 are false ribs, because their costal cartilage articulates with the costal cartilage of the ribs above

Question 13

Explain what a floating rib is, and which ribs are floating

Answer 13

Ribs 11 & 12 are floating ribs. They do not connect to the sternum or costal cartilage, but have a cap of hyaline cartilage

Question 14

List the structures that make up the thoracic inlet (sloping anteriorly)

Answer 14

T1 vertebra
1st ribs & their costal cartilages
Manubrium

Question 15

What type of joint joins the sternum to the costal cartilage?

Answer 15

Synovial joints

Except for the costal cartilage of the 1st rib, which connects to the manubrium via a 1º cartilaginous joint

Question 16

What joint connects the ribs to the costal cartilage?

Answer 16

1º cartilaginous joints

Question 17

What happens to the 1st costal cartilage with an increase in age?

Answer 17

Ossification

Question 18

What structures make up the thoracic outlet?

Answer 18

T12
12t ribs
Costal margin
Inferior sternal body (not the xiphoid process)

Question 19

What is the role of the diaphragm?

Answer 19

Aids in respiration & separates the thorax from the abdomen

Question 20

List the features of a typical thoracic vertebra

Answer 20

• Heart shaped vertebral body with a pair of demifacets on each side. The superior demifacet articulates with the inferior part of the same rib & the inferior demifacet articulates with the superior part of the rib below
• Transverse processes that articulate with the shaft of the same rib
• Long spinous processes that overlap inferior vertebrae & restrict movement
• Zygapophyseal joints between articular surfaces of adjacent vertebrae (superiorly & inferiorly)

Question 21

Describe a typical rib, and state which ribs are typical

Answer 21

Ribs 3-9 (and normally 10) are typical ribs

• Have a pointed head that lies in the intervertebral disc, and articulates with the vertebral body of each adjacent vertebra (costovertebral joints). Inferiorly with the same vertebra & superiorly with the vertebra above
• Project posterolaterally and turn at the angle of the rib to sweep antero-inferiorly
• The neck of the rib is between the head and the tubercle (superior)
• The tubercle has a smooth part for articulation with the transverse process of the same rib (costotransverse joint), and a rough part for attachment of the costotransverse ligament
• The shaft is smooth and rounded superiorly, and sharp inferiorly, with a groove to protect the costal neurovascular structures
• The rib joins to costal cartilage via 1º cartilaginous joints
• The costal cartilage joins to the sternum via synovial joints (except the 1st costal cartilage which is 1º cartilaginous)

Question 22

State which ribs are atypical, and explain why this is

Answer 22

Ribs 1, 2, 11 & 12 (sometimes 10) are atypical

Rib 1:

• Is flat superior-inferiorly (as apposed to A-P), and the neck is horizontal
• Articulates only with the vertebral body and transverse process of T1
• Has 2 notches, anteriorly from the subclavian vein, posteriorly from the subclavian artery (T1 root immediately posterior to that)
• Between the notches lies a scalene tubercle, for attachment of Scalenus Anterior

Rib 2:
- Has a tuberosity at which the origin of part of Serratus Anterior attaches

Ribs 11 & 12:

• Floating ribs that do not connect to costal cartilage
• Articulate only with the vertebral bodies and transverse processes of their same vertebra

Rib 10:
- If atypical, it is because it articulates only with the vertebral body and transverse process of T10 (not with T9)

Question 23

What is the weakest part of the rib?

Answer 23

The angle

Question 24

Name the 3 parts of the sternum, and the joint that connects them

Answer 24

Manubrium; Sternal body; Xiphisternum (xiphoid process)

The manubrium is joined to the body via a 2º cartilaginous joint (fibrocartilagenous)

Question 25

State the structures level with;

the manubrium, the sternal angle, the sternal body, and the xiphoid process

Answer 25

The manubrium is level with T3 & T4
The sternal angle is level with the intervertebral disc between T4 & T5
The sternal body is level with T5-T9
The xiphoid process is level with T10

Question 26

What kind of movement does the thoracic region of the spine allow?

Answer 26

Rotational

Question 27

Name the 3 notches at the superior surface of the manubrium

Answer 27

Sternal (jugular) notch medially

2 clavicular notches laterally

Question 28

What happens to the xiphoid process at around 40 years of age?

Answer 28

Ossification