Week 7 Flashcards
1
Q
What is HCAI?
A
Healthcare Associated Infection
2
Q
What is HAI?
A
Hospital associated Infection
3
Q
When can HCAI be an issue?
A
- Chronic disease
- Invasive medical devices
- Elderly population
- Immunosuppression
- More complex procedures
- Increasing antibiotic resistance
- Quality measures not developed in clinical medicine
4
Q
How do you measure the quality of your care?
A
- The Francis Report is leading to a paradigm shift is clinical care
- Health Improvement Scotland (HIS)
5
Q
How can doctors take measured to prevent HCAI?
A
- Recognition of risk factors in patients
- Behaviour & practice
- Hand hygiene
- Dress
- Personal protective equipment
- Use isolation facilities correctly
6
Q
What is the cycle for how Organisms are spread?
A
Infectious agent –> Reservoir –> Portal of Exit –> Mode of transmission –> Portal of entry –> Susceptible host
7
Q
Mode of Transmission?
A
- DIRECT/INDIRECT contact via fomites or ingestion ie. blood born virusus, diarrhoea, MRSA
- DROPLET Transmission ie. N. meningitis, norovirus
- AEROSOL (airborne) Transmission ie. chicken pox, influenza
8
Q
What is the Terminology?
A
- Standard precautions
2. Standard Infection control precautions
9
Q
What are Contact Precautions?
A
- For patients infected/colonised with organisms transmitted by direct or indirect contact
- Single room if possible
- Gloves
- Aprons
- Disposable masks/eye protection if at risk of splashes
10
Q
What are Droplet Precautions?
A
- For organisms transmitted in droplets, these travel only short distances
- Single room if possible
- Wear surgical mask when within touching distance (1 meter) of patient
11
Q
What are the Airborne Precautions?
A
- Particles (<5microns) that can be widely dispersed
- Single room
- Apron
- Gloves
- High efficiency filter mask
12
Q
When do healthcare providers have to wash their hands?
A
- Before touching the patient
- Before clean/septic procedure
- After body fluid exposure risk
- After touching a patient
- After touching patients surrounding
13
Q
What are invasive medical devices?
A
- Maybe long term or short term
- All break skin or mucous membrane barrier
- CVC, PVC, Urinary catheters etc.
14
Q
What are Indwelling prosthetic devices?
A
- Usually long term devices which are buried into tissue under the skin
- Heart valves, joints, pacing units etc.
15
Q
What are Gram positive organisms with antibiotic resistance?
A
- Meticillin Resistant S. aureus (MRSA)
2. Vancomyocin Resistant Enterococcus (VRE)
16
Q
What are Gram negative organisms with antibiotic resistance?
A
- Extended spectrum -Lactamse producing Enterobacteriaceae (ESBL producer)
- Carbapenum resistant Enterobacteriaceae (CRE)
- Carbapenemase Producing Pseudomonas
17
Q
Measles?
A
- Its a virus
- Airborne transmission
- You can inhale it
- Prevented by MMR vaccine
- Put measles patient in single room with airborne precautions in ID unit
18
Q
Which organism does not need contact precautions?
A
- MSSA
- We do have contact precautions but no need for isolation
- You are only concerned about a resistant organism
19
Q
What is the commonest cause of a hospital acquired S. aureus bacteraemia?
A
Vascular access devices (VADs)
20
Q
Define Palliative Care?
A
An approach that improves the quality of life of patients and their families facing the problems associated with life threatening illnesses, through the prevention and relief of suffering by means of early identification and impeccable assesment and treatment of pain and other problems, physical, psychosocial and spiritual
21
Q
Define “approaching the end of life”?
A
Likely to die within 12 months
22
Q
In what situations would people be deemed “approaching the end of life”?
A
- Advanced, progressive, incurable conditions
- General frailty
- At risk of dying form sudden crisis of condition
- Life threatening conditions caused by sudden catastrophic events
23
Q
What are the 3 aims of palliative care?
A
- Whole person approach
- Focus on quality of life, including good symptom control
- Care encompassing patient and those that matter to them
24
Q
What are some prinicples of good end of life care?
A
- Open lines of communication
- Anticipating care needs and encouraging discussion
- Effective multi-disciplinary team input
- Symptom control: physcial and psychosocial
- Preparing for death: patient and family
- Providing support for relatives, both before and after death
25
What is Generalist Palliative care?
Part of routine care delivered by ALL health care professionals to those living with a progressive and incurable disease, whether at home, in a care home, or in hospital.
26
What is Specialist Palliative care?
Same as generalist but catering for people with more COMPLEX palliative care needs
27
What are some Physical Symptoms of dying?
- Pain
- Dyspnoea
- Nausea
- Anorexia
- Constipation
- Cough
- Fatigue
28
How may Psycho-spiritual distress affect end of life care?
- May exacerbate physical symptoms
| - May be due to uncontrolled physical symptoms, alcohol/drug withdrawal, depression or other medical causes
29
Describe Advance & Anticipatory care planning?
Ongoing process of discussion betwen the patient, those close to them and their care providers, focusing on that person's wishes and preferences for their future. Umbrella term encompassing a number of planning components
30
What sort of things should be discussed in advanced?
- Preferences, fears
- Beliefs/values
- Who should be involved in decisions
- Emergency interventions
- Preferred place of care
- Spiritual support
- Formalise wishes regarding care
31
What 3 documents exist to formalise wishes regarding the future of care in the terminally ill?
1. Advance statement- what pt. wishes to happen in certain circumstances
2. Advance Decision- what patient does not wish to happen in certain circumstances
3. Power of Attorney
32
What does "ADRT" stand for?
Advance Refusal of Treatment
33
What are the limitations of the Advance decisions?
- Future decisions can't be bound by their statement
| - Validity and applicability need to be considered
34
How do you know advance decisions are valid?
- Is it clearly applicable
- When was it made?
- Did the patient have capacity when it was made?
- Was it an informed decision
- Were there any undue influences when made?
- Has their decision been withdrawn?
- Are more recent actions/decisions inconsistent?
35
What are the PROS of the Advance Statement?
- Enhances autonomy
- May encourage end of life discussions
- Avoid breaching patient's beliefs/ religious beliefs
- Enables death with dignity
36
What are the CONS of the Advance Statement?
- May not be valid
- May not be applicable
- Attitudes may change with onset of serious illness
- May have been advances in medicines since being made
37
What is the Gold standards framework (GSF)?
Systematic, evidence based approach to optimising care for all patients approaching end of life, delivered by generalist frontline care providers
38
What are the 4 prinicples for "care for people in the last days and hours of life"?
1. Informative, timely and sensitve communication is an essential component of each individual person's care
2. Significant decisions about a person's care, including diagnosing dying, are made on the basis of multi-disciplinarary decision
3. Each individual person's physical, psychological, social and spiritual needs are regonised and adressed as far as possible
4. Consideration is given to the wellbeing of relative carers attending the person
39
What are the 5 priorities for care of dying people?
1. Possibility person may die within days/hours is recognised and communicated clearly, decisions reviewed regularly in accordance with patients needs/wishes
2. Sensitive communication with patient
3. Patient and people close to them are involved in decisions
4. Needs of families/friends explored, respected and met as far as possible
5. An individual plan of care, including food and drink, symptom control, psychospiritual & social support is agreed and delivered with compassion
40
What support is on offer for families after death?
- Chaplain, counsellors, family workers, health care professionals.
- Facilitated with good relationship with family prior to death
41
What is WHO analgesic ladder for pain?
1. Non-opioid (aspirin, paracetamol)
2. Weak Opioid (codeine)
3. Strong Opioid (morphine)
42
What is the Structure of taking a History?
- Presenting Complaint (PC)
- History of presenting complaint (HPC)
- Past medical history (PMH)
- Medications/allergies (DH)
- Family history (FH)
- Social history (SH)
- Systems enquiry/review (SE)
43
Presenting Complaint (PC)?
Description symptoms in patient's own words
44
History of Presenting Complaint (HPC)?
- Allow the patient the opportunity to speak
- Remember initial open questions
- Try to establish time-lines
- Constantly thinking of possible diagnoses
- Summarisine may be helpful
45
What are the Respiratory Questions?
- Chest pain
- Dyspnoea
- Cough
- Sputum
- Haemoptysis
- Wheeze
- Systemic upset
46
What does "SOCRATES" stand for in clarifying Chest pain?
```
Site
Onset
Character
Radiation
Associated symptoms
Timing
Exacerbators/relievers
Severity (1-10 rating)
```
47
What can be the causes of Central Chest pain?
- Tracheitis
- Angina/MI
- Aortic dissection
- Massive PE
- Oesophagitis
- Lung tumour/metastases
- Mediastinal tumour/mediastinitis
48
What can be the causes of Pleural Chest pain?
- Pneumonia/Bronchiectasis/TB
- Lung Tumour/metastases/mesothelioma
- PE
- Pneumothorax
49
What can be the causes of Chest wall pain?
- Muscular/rib injury
- Costochondritis
- Lung tumour/bony metastases/ mesothelioma
- Shingles (herpes zoster)
50
What is Orthopnoea?
Breathlessness when lying down
51
If the Dyspnoea has an onset of minutes what could the conditions be?
- PE
- Pneumothorax
- Acute LVF
- Acute asthma
- Inhaled foreign body
52
If the Dyspnoea has an onset of hours-days what could the conditions be?
- Pneumonia
- Asthma
- Exacerbation of COPD
53
If the Dyspnoea has an onset of weeks-months what could the condition be?
- Anaemia
- Pleural effusion
- Respiratory neuromuscular disorders
54
If the Dyspnoea has an onset of months-years what could the condition be?
- COPD
- Pulmonary fibrosis
- Pulmonary TB
55
What are the 3 categories of causes for Dyspnoea?
1. Respiratory causes
2. Cardiovascular causes
3. Non Cardio-respiratory causes (anaemia, obesity)
56
What is the cause of Acute Coughs?
- Viral or bacteral infection
- Pneumonia
- Inhalation of foreign body
- Irritants
57
What is the cause of Chronic Cough?
- Gastro-oesophageal reflux
- Asthma
- COPD
- Smoking
- Lung Tumour
- Bronchiectasis
- Interstitial lung disease
58
What are the Red Flags for a Cough?
- Haemoptysis
- Breathlessness
- Weight loss
- Chest pain
- Smoker
59
What are the characteristics for Infection/Bronchiectasis?
Productive cough
60
What are the characteristics for COPD?
Persistent "moist" cough worse in the morning
61
What are the characteristics for Asthma/COPD?
Associated with wheeze
62
What are the characteristics for Tracheitis?
Painful cough
63
What are the characteristics for Laryngitis/laryngeal tumour?
Harsh/Barking cough
64
What are the characteristics for Interstitial lung disease?
Chronic, dry cough
65
What are the characteristics for Bronchial carcinoma?
Persistent with haemoptysis
66
What are the characteristics for Left recurrent laryngeal nerve invasion / Neuromuscular disorders?
"Bovine" cough (non-explosive cough)
67
What is the cause/appearance of serous Sputum?
Appearance- clear, watery, frothy, pink
| Cause- acute pulmonary oedema
68
What is the cause/appearance of Mucoid Sputum?
Appearance- clear, grey, white, viscid
| Cause- COPD, asthma
69
What is the cause/appearance of Purulent Sputum?
Appearance- yellow, green, brown
| Cause- Infection
70
What is the cause/appearance of Rusty Sputum?
Appearance- rusty red
| Cause- pneumococcal pneumonia
71
What is an example of Malignant Haemoptysis?
- Bronchial carcinoma
| - Metastatic lung disease
72
What is an example of Infective Haemoptysis?
- Acute infection
- Bronchiectasis
- TB
73
What is an example of Vascular Haemoptysis?
- Pulmonary infarction
| - Pulmonary embolus
74
What is an example of Cardiac Haemoptysis?
- Mitral valve disease
| - Acute LVF
75
What is an example of Vasculitis Haemoptysis?
- Wegener's granulomatosis
| - Good pasture's syndrome
76
What is an example of Other types of Haemoptysis?
- Trauma
- Anticoagulation (consider warfarin)
- Clotting disorder
77
What to ask in Past Medical History?
- Medical conditions
- Visits to the doctor
- Investigations/procedures
- Operations
- Establish if problems on-going/resolved fully/managed
- Time-line of events
- Allergies
78
What are The Golden Rules of Medication history taking?
- Be structureed
- Engaged with patient
- Ask carer about medications
- Use more than 1 source of information
- Alert to high risk medications (warfarin, insulin)
- Women of child bearing age ask contraception
- In any clinical trials?
79
Questions to ask regarding Prescribed Medication?
- Name of medicine?
- What is it for?
- What is the dose/strength?
- What is the route?
- Number of tablets or puffs or dose units taken?
- Type/form?
- How often do they take this?
- Recent changes to dose/frequency?
80
What is Intentional non-concordance?
Definite decision to not take medicines
81
What is Unintentional non-concordance?
Can be due to physical dexterity, reduced vision, cognitive impairment, poor understanding
82
What are the different types/forms of inhalers?
- Mdi= metered dose inhaler
- Accuhaler
- Autohaler
- Easibreathe
- Handihaler
- Via spacer/aerochamber
83
What do the different inhaler colours mean?
- BLUE: "reliever" ie. salbutamol (beta agonist)
| - BROWN: "preventer" ie. beclomethasone (steroid)
84
Give examples of some Oral Respiratory Medicines?
- Mucolytics ie. carbocisteine
- Xanthines ie. theophylline
- Oral steriods ie. prednisolone
- Leukotriene receptor antagonists ie. montelukast
- Antihistamines ie. cetirizine
85
Systems Enquiry/Review Questions?
```
CVS- palpitations, syncope
GI- change in bowels, abdominal pain
GU- urinary symptoms LMP
ENDOCRINE- lumps in neck, temp intolerance
MS- aches/stiffness joints/muscles/back
CNS- headaches, fits
```
86
What is Radical Surgery?
Removal of blood supply, lymph nodes & sometimes adjacent structures of a diseased organ/ tumor during surgery
87
What is the Primary Purpose of the NHS?
To secure, through resources available, the greatest possible improvement in the physical and mental health of the population
88
What is Sackett et al (1996) definition of EBP?
The conscientious, explicit and judicious use of current best evidence in making nursing decisions about the care of individual patients
89
What is Carnwell (2001) definition of EBP?
Systemic search for, and appraisal of, best evidence in order to make clinical decisions that might require changed in current practice, while taking into account the individual needs of a patient
90
What does EBM/EMP stand for?
Evidence Based Medicine
| Evidence Based Practice
91
What are the 3 Principles of EBM?
1. High quality health care rests on objective and clinically relevant information
2. There is a hierarchy of evidence where some types are stronger than others
3. Scientific data alone is not a sufficient basis for making clinical decisions about individual patients
92
Why is EBM now essential?
- To know the effects of therapy
- To know the utility of diagnostic tests
- To know the prognosis of diseases
- To know the atiology of disorders
93
What is the Order from bottom up of the Evidence Pyramid?
1. Personal communication
2. Case series & case studies
3. Cross-sectional studies
4. Case-control studies
5. Cohort studies
6. Non-randomised experimental designs
7. RCT
8. Meta-analysis/ Systemic review
94
What does HTA stand for?
Health Technology Assessment
95
What is Methylphenidate/Ritalin a treatment for?
ADHD
96
How should a doctor practice EBM?
- Craft a good clinical question (PICO) for the patient
- Search the medical literature
- Find the study that will best answer the question catered towards your patient
- Perform a critical appraisal (validity & bias)
- Determine how the results will help you care for your patient
- Evaluate the results in your patient/population
97
What are the 3 functions of the conducting pathway of the respiratory system?
1. Moistens
2. Warms
3. Filters
98
Name the vertebral level the trachea begins and ends at?
C6-T4/5 (at carina)
99
Name the muscle that alters the tracheal diameter?
Trachealis
100
Which bronchus is shorter, wider and more vertical?
Right main bronchus
| foreign bodies
101
Which side of the midline does the trachea deviate?
Slightly right to the midline
102
Between what structures does the left recurrent laryngeal nerve lie?
Trachea and oesphagus (oesphagus posterior)
103
What arteries supply the trachea?
Inferior thyroid & bronchial
104
What veins drain the trachea?
Inferior thyroid
105
What lymph drain the trachea?
Pretracheal and Paratracheal lymph nodes
106
What nerves supply the trachea?
Vagus nerve sending recurrent laryngeal nerve & sympathetic trunks
107
How many lobes does the left lung have?
2
108
How many lobes does the right lung have?
3
109
Name the lobes (2) of the left lung?
Upper (lingular), Lower
110
Name the lobes (3) of the right lung?
Upper, Middle and Lower
111
What is the series of branching of the Bronchi?
Main bronchi --> lobar bronchi --> segmental bronchi
112
Which bronchus drops off posteriorly first?
Bronchus to apical segment of lower lobe
113
What is a bronchopulmonary segment?
Portion of lung supplied by a specific segmental bronchus and arteries
114
What is E. Coli?
- Escherichia coli
- A bacterium that lives in the gut.
- It commonly causes urinary tract and food borne infection.
115
What is MRSA?
Meticillin Resistant Staphylococcus aureus
116
What is C. difficile?
- Clostridium difficile
| - A bacterium often associated with outbreaks of diarrhoea, especially in elderly patients who have received antibiotics
117
What is Hepatitis B & C?
Blood-borne viruses which causes inflammation of the liver
118
What is HIV?
- Human Immunodeficiency virus
| - Blood-borne virus that can lead to AIDS
119
What is S. aureus?
- Staphylococcus aureus
| - A bacterium often carried in the nose that is a major cause of wound infections after surgery
120
What is Salmonella?
A bacterium, found in animals such as poultry, that is a common cause of food borne infection
121
What is Inoculation?
Introduction of an infectious agent into the body via the skin
122
What are the 3 bronchopulmonary segments of the left & right lungs Upper (superior) lobe?
1. Apical (superior)
2. Anterior
3. Posterior
123
What are the 2 bronchopulmonary segments of the Middle lobe of the right lung?
1. Medial
| 2. Lateral
124
What are the 2 bronchopulmonary segments of the Lingula (middle lobe) of the left lung?
1. Superior
| 2. Inferior
125
What are the bronchopulmonary segments of the lower lobe of the left & right lungs?
1. Apical (superior)
2. Medial
3. Lateral
4. Anterior
5. Posterior
126
How many bronchopulmonary segments are there in each lung?
10
127
List the progression from segmental bronchi to alveoli?
Segmental bronchi --> Conducting bronchi --> Terminal bronchi --> Respiratory bronchi --> Alveolar ducts --> Alveolar sacs --> Alveoli
128
What kind of epithelium covers the conducting portion of the respiratory system?
Pseudostratified columnar epithelium (mucus secreting cells)
129
What kind of epithelium covers the respiratory bronchioles?
Cubiodal epithelium with no goblet cells
130
What is the clinical significance of the apical bronchopulmonary bronchus fo the lower lobe?
In bed ridden patient, mucus accumulates there, susceptible to infection
131
At which vertbral level do the pulmonary arteries divide just below?
T4/5
132
At which side of the midline does the pulmonary trunk divide?
Left
133
Which structure does the right pulmonary artery lie behind?
Ascending Aorta
134
What structure does the left pulmonary artery lie in front of?
Descending Aorta
135
What arteries supply the tissue of the lung?
Bronchial arteries
136
Where does the right bronchial artery orginate from?
3rd Posterior Intercostal Artery
137
Where do the two left bronchial arteries originate from?
Aorta directly
138
Which arteries do the Bronchial arteries anastamose with?
Pulmonary arteries in the walls of the bronchioles
139
Which venous system drains the Bronchial veins?
Azygos
140
What and where are the two lymphatic plexuses found in the lungs?
1. Deep along side bronchial tree
| 2. Superficial beneath pleura
141
What is the series of lymph drainage from both deep & superficial lung plexuses on right side?
Lung plexuses --> Pulmonary nodes --> Bronchopulmonary nodes --> Inferior & Superior tracheobronchial nodes --> Paratracheal nodes --> Right lymphatic trunk
142
What does the left paratracheal node drain into?
Thoracic duct before emptying into the venous circulation
143
What are the 3 borders of the lung?
1. Anterior
2. Posterior
3. Inferior
144
What are the 3 surfaces of the lung?
1. Costal
2. Diaphragmatic
3. Mediastinal
145
Describe the anatomical landmarks for the oblique fissure?
Spine of T4 to rib 6
146
Describe the anatomical landmarks for the horizontal fissure?
Rib 4/5
147
What structures can be seen leaving impressions on the right lung?
SVC, right atrium, azygos vein
148
What structures leave impressions on the left lung?
Aorta & left ventricle
149
How many pulmonary arteries in right lung hilum?
2
150
How many bronchi in right lung hilum?
2
151
Describe the position of the pulmonary veins in both hilar?
Anterior and inferior
152
What is the function of the pulmonary ligament?
Its a fold of pleura which allows hilar movement during respiration and vessel expansion
153
Where do the nervous pulmonary plexuses lie?
Anterior & posterior to main bronchi at root of the lung
154
What 3 fibres contributes to the pulmonary plexuses?
1. Parasympathetic fibres from the vagus nerve
2. Sympathetic fibres from the sympathetic ganglia
3. Pain fibres with sympathetic
155
Which pleura has a sensory supply?
Parietal (from intercostal and phrenic)
156
What is the clinical consequence of a tumour iminging on phrenic nerve?
Paralysis of diaphragm on affected side
157
What's the clinical consequence of a tumour impinging on sympathetic trunk supplying head?
Horner's syndrome- drooping of eyelid with constricted pupil, dry but flushed face on affected side
158
Whats the clinical significance of a tumour impinging on left recurrent laryngeal nerve?
Hoarseness of voice
159
What sort of cartilage is the spetal cartilage?
Hyaline
160
What is the nerve supply to the muscles in the nose?
Facial nerve- cranial nerve VII (7)
161
What is a conchae?
Long, narrow, curled bone shelf to make air turbulent
162
What is a meatus?
Space underneath the conchae
163
What bone makes up the anterior nose and upper jaw?
Maxilla
164
What bone makes up the septum and most of the lateral frontal nasal cavity?
Ethmoid
165
What is an ethmoidal labyrinth?
Air cells within the ethmoidal bone (sinuses), which open into the nasal cavity
166
Which bone gives the superior and middle conchae?
Ethmoid
167
What bone makes up the anterior part of the septum (not cartilage)?
(perpendicular plate of) Ethmoid
168
Through which structure does air pass through posteriorly to get into the nasopharynx?
Posterior conchae
169
What are the superior and middle conchae extensions of?
The Ethmoid bone
170
What about the Inferior Conchae?
It is a separate bone to superior and middle conchae
171
What clinical consequence may occur if the septum deviates from the midline?
Sinus drainage problems
172
What plane does the hard palate take?
Horizontal (nasogastric tube)
173
What is the name of the projection fromt he ethmoid bone intot he cranium?
Crista gali
174
What is the name of the plate though which oflactory nerves pass?
Cribiform plate
175
Where does mucus from sinuses and tears from the eye (via nasolacrimal duct) drain to?
Meati
176
What number is the trigeminal nerve?
V (5)
177
What are the divisions of the trigeminal nerve?
Ophthalmic and Maxillary
178
What other fibres join on with the divisions of the trigeminal nerve?
Parasympathetic
179
What supply does the trigeminal nerve give to tissue?
Sensory & Parasympathetic Secretomotor
180
What bone binds the nasal cavity superiorly?
Sphenoid
181
What is the lateral wall of the nasal cavity related to?
Orbit
182
What bone houses the ophthalmic nerve and accompanying artery?
Orbit
183
What is the nerve supply of the lateral wall and medial wall of the nasal cavity derived from?
Ophthalmic & Maxiallary branches of the trigeminal nerve (trigeminal V)
184
What is V1/Va?
Ophthalmic Devision of Trigeminal nerve
185
What is V2/Vb?
Maxillary Devision of Trigeminal nerve
186
Which are the only nerves capable of regeneration?
Olfactory nerves
187
What passes through the Sphenopalatine foramen?
- Sphenopalatine artery
| - Nasopalatine nerve
188
Which nerve passes through the incisive canal to supply the anterior palate?
Nasopalatine nerve
189
What structures does the greater palatine canal transmit?
- Descending palatine artery
- Descending palatine Vein
- Greater and lesser palatine nerves
190
If the palatine canal is dehiscent, what does this predispose to?
Severe Epitaxis from the greater palatine artery
191
Which main arteries supply the septum?
Septal branches of the maxillary and opthalmic arteries
192
Which site of anastamosis is prone to epistaxis?
Little's or KIesselbach's areas
193
Which main arteries form an anastamosis in the anterior portion of the septum (4)?
1. Anterior ethmoidal
2. Greater palatine
3. Sphenopalatine
4. Labial branches of the facial
194
What is epistaxis?
Nose bleed
195
What does the nasal vein drain into?
Foramen caecum (drains into intercranial sinuses)
196
What does the cavernous sinus drain into?
Cranial cavity
197
Where is the pterygoid plexus located?
Intratemporal fossa
198
How does the frontal sinus drain?
Frontonasal duct & infundibulum (with anterior ethmoidal cells) to haitus semilunaris (middle meatus)
199
How does the maxillary sinus drain?
Opens into Hiatus semilunaris posteriorly
200
Why is the clearance of mucus from the maxillary sinus depedent on cillia?
Opening is high on the medial wall (may lead to sinusitis)
201
Where does the posterior ethmoidal cells drain?
Into Superior meatus
202
Where does the sphenoid sinuses drain?
Into Sphenoethmoidal recess
203
Where does the nasolacrimal duct open to?
Into Inferior meatus
204
Which nerve and artery supply the frontal, ethmoidal and sphenoid sinuses?
Supra-orbital & ethmoidal branches of the ophthalmic nerve and artery
205
What is the nerve and artery supply of the maxillary sinuses?
Maxillary nerve and artery
206
Which lymph nodes drain the anterior part of the nasal cavity?
Submandibular nodes
207
Which lymph nodes drain the posterior nart of the nasal cavity?
Retrophayngeal nodes to upper deep cervical nodes
208
What is the main function of the larynx?
Protective sphincter
209
Where are the adenoid tonsils found? (Pharyngeal tonsil)
Roof and posterior wall of the nasopharynx
210
What does the tubular tonsil cover?
Opening of pharyngotympanic tube
211
Where are the palatine tonsils found?
Back of mouth
212
Where are the lingual tonsils found?
Base of tongue
213
What is the name of the ring formed by tonsils around the opening of the respiratory and gastro-intestinal tracts?
Waldeyer's
214
What may happen as a result of tubal tonsil swelling?
Obstruct the pharyngotympanic tube and cause middle ear infections
215
What may results of swelling of the pharyngeal tonsil?
Obstruction of airway leading to mouth breathing
216
Under which bone does the larynx hang from?
Hyoid bone
217
Apart from the epiglottis, what kind of cartilage is the larynx made from?
Hyaline
218
Which ligament may be pierced in emergency access of the airway?
Median cricothyroid ligament
219
What object describes the shape of the cricoid cartilage?
Signet ring
220
Which cartilages does the signet ring articulate with?
Arytenoids and thyroid
221
Which cartilage does the thyroid cartilage articulate with?
Cricoid (through inferior horns)
222
What is the thyroid angle for men & women?
90 - 120
223
What type of cartilage is the epiglottis?
the ONLY elastic cartilage
224
What attaches to the muscular process of the arytenoid?
Posterior and lateral cricoarytenoid
225
What attaches to the vocal process of the arytenoid?
Vocal ligament/fold
226
Which ligaments are produced as thickenings of the thyrohyoid membrane?
- Anteriorly as median thyrohyoid ligament (site of emergency access)
- Posteriorly as the lateral thyrohyoid ligaments
227
What are the two intrinsic ligaments of the larynx?
1. Quadrangular from the arytenoid to thyroid and epiglottis
| 2. Cricothyroid/Cricoval from cricoid and arytenoid to the thyroid forming the conus elasticus
228
From superior to inferior name the folds of the laryngx?
Aryepiglottic fold --> Vestibular fold --> Vocal fold
229
Which fold is fromed from the upper edge of the quadrangular membrane?
Aryepiglottic
230
Which fold is formed by the Lower edge of the quadrangular membrane?
Vestibular fold
231
Which folds from over the vocal ligament edge of cricovocal membrane?
Vocal Fold
232
Which folds from the laryngeal inlet which is a protective sphincter?
Aryepiglottic folds
233
How is the laryngeal inlet closed?
Elevation of the larynx
234
Name things the layngeal diameter needs to be changed for?
- Speech
- Coughing
- Sneezing
- Raising intra-abdominal pressure
235
What is the name for the opening between the vocal folds?
Rima glottis/glottidis
236
What is the ventricle of the larynx?
In folding between the vestibular and vocal fold leading to the saccule which produces lubricating mucus
237
Which muscles close the laryngeal inlet?
| aryepiglotting folds
1. Extrinsic muscles that elevate larynx
2. Aryepiglotticus (purse string)
3. Thyroepiglotticus (sphincteric affect)
238
Which muscles open the laryngeal inlet? (aryepiglotting folds)
None, mainly by elastic recoil
239
Which muscles open the rima glottidis?
| vocal folds
1. Posterior cricoarytenoid (externally rotates arytenoids and pulls them apart down the shoulders of cricoid)
240
Which muscles close the rima?
1. Transverse arytenoid (pull arytenoids together)
| 2. Lateral cricoarytenoids, (rotate cords back towards)
241
Which muscle lengthens the vocal folds?
Cricothyroid (rocks thyroid forwards)
242
Which muscle shortens the vocal folds?
Thyroarytenoid (rocks thyroid back)
243
What does decreasing and increasing tension of vocal fold do to someones voice?
DECREASING- lowers pitch
INCREASING- raises pitch
244
Which muscles makes small adjustments to the vocal folds?
Vocalis
245
Which cranial nerve sends the superior laryngeal nerve?
Vagus Nerve (Cranial X)
246
What does the superior layrngeal nerve divide into?
Internal and external branches
247
What does the internal branch of the superior laryngeal nerve cover?
Sensation from the larynx down to just above the vocal folds
248
Which artery gives off the superior laryngeal artery?
Superior thyroid artery
249
Which is the only muscle in the larynx not supplied by the recurrent laryngeal nerve?
Cricothyroid
250
Which nerve supplied the cricothyroid muscle?
External branch of the superior laryngeal nerve
251
What does the recurrent laryngeal nerve supply?
- All muscles except for cricothyroid
| - Sensation to vocal cords & larynx below them
252
What happens as a result of complete paralysis of the recurrent laryngeal?
Vocal fold lies in a semi abducted position (compensation through extra movement by the opposite fold)
253
What happens if there is partial paralysis of the recurent laryngeal nerve?
Vocal fold moves over to midline/crosses it (therefore if bilater-life threatening)
254
What happens if there is paralysis of the external laryngeal nerve?
- Hoarseness of voice
| - Recovery is good due to hypertrophy of the opposite cricothyroid
255
What artery acompanies the superior layngeal nerve?
Superior laryngeal artery
256
What is the venous drainage of the superior larynx?
Superior thyroid vein
257
What is the lymph drainage of the superior larynx?
Drains to upper deep cervical nodes
258
What artery accompanies the recrrent laryngeal nerve?
The inferior laryngeal artery (branch of inf. thyroid artery) (supplies vocal cords and below)
259
What does the inferior larynx drain venously with?
Inferior thyroid vein
260
What is the lymph node draining the inferior larynx?
Lower deep cervical nodes
261
What kind of joint is the sternal angle?
Symphysis (firbocartilage)
262
What is the normal realation for articulation with ribs and the vertebrae?
Articulates with it's own vertebra and the one above
263
What structures are effected by cervical ribs?
- Subclavian artery, trauma causes thromboemboli
| - Compression of lower trunk of the brachial plexus: weakness of the small muscles of the hand
264
Name characteristics of thoracic vertebra?
- Heart shaped body, circular vertebal canal
- Long overlapping spinous processes
- Body with superior and inferior demifacets (costal facets) for articulation with heads of two paris of ribs
- Tranverse processes that articulate with the tubercles with same level pair of ribs
- Superior and inferior articular facets that allow some rotation but no flexion
265
What kind of joints are the costovertebral joints?
Synovial
266
Which ribs articulate with the superior demifacet of the vertebra above?
2-10
267
What kind of joints are the costotranverse joints?
Synovial
268
Which bony landmark of the rib articulates with the transverse process?
Tubercle
269
Which costotransverse joints have curved facets?
1-7 (rotation)
270
Which costotransverse joints have plane facets?
8-10 (gliding)
271
What kind of joint is it between the ribs and the costal cartilage?
Primary cartilaginous (hyaline)
272
Which ribs are classified as the true ribs?
Ribs 1-7
273
What kind of joint is it between the true rib's costal cartilage and the sternum?
Synovial (to allow movement)
274
Which rib's costal cartilage joins to the sternum by means of a primary cartilaginous joint (hyaline)?
1st rib, making the thoracic inlet more stable
275
Which are classed as the "false ribs"?
Ribs 8-10
276
Which ribs are classified as "floating ribs"?
Ribs 11, 12
277
Which ribs does the breast overly?
2-6
278
Name the 3 Types of intercostal muscles?
1. External intercostal
2. Internal intercostal
3. Innermosts intercostal
279
Describe the direction of external intercostals?
Inferior & medial
280
Describe the direction of internal intercostals?
Inferior and lateral
281
What do the External Intercostal muscles do?
Raise ribs, inspiration
282
What do the Internal intercostal muscles do?
Aid elastic recoil by moving ribs inferiorly in expiration
283
Which artery does the internal thoracic branch off?
Subclavian
284
How does the internal thoracic terminate?
Superior epigastric & musculophrenic arteries
285
How many parts do innermost intercostal muscles have?
1. Subcostales
2. Innermost intercostal
3. Transversus Thoracis
286
Which ribs do the Anterior intercostals arteries supply?
2 per space 1-6
287
Which artery suplies intercostal spaces 7-10 anteriorly?
Musculophrenic
288
What supplies the 1st two spaces posteriorly?
Costocervical trunk from subclavian, forming supreme intercostal artery
289
Which intercostal spaces does the thoracic aorta supply posterioly?
2 per space ribs 3-11
290
Name the 12th posterior branch of the thoracic aorta?
Subcostal
291
What is the venous drainage equivlant to the internal thoracic arteries?
Venae comitantaes to internal thoracic vein
292
Describe the posterior intercostal venous drainage?
- 1st space: brachiocephalic vein
- 2nd and 3rd: superior intercoastal vein
- Others: azygous
293
What is the anterior intercostal lymph drainage?
Parasternal lymph nodes
294
What does the Azygos system do?
- Drains posterior wall of trunk
| - Connects IVC & SVC
295
Where is the Anterior thoracic wall lymph drainage?
Parasternal Nodes
296
Where is the Posterior thoracic wall lymph drainage?
Intercostal Nodes
297
How do superficial chest wall structures drain lymph?
Axillary nodes
298
What is main breast tissue arterial supply?
Mainly superior thoracic, thoraco acromial, lateral branches of AXILLARY ARTERY
299
What sensory branches do the intercostal nerves give off?
Lateral and anterior branches to skin
300
Why is there not an anterior T1 dermatome?
- Ventral ramus of T1 goes to the brachial plexus (lower trunk) to supply small muscles of the hand and the skin of medial aspect of arm and forearm
- Sends motor suppy to 1st intercostal space but no sensation
301
What do the ventral rami (intercostal nerves) of T2-11 carry?
- Motor fibres to intercostals
- Sensory to skin/ parietal pleura
- Sympathetic to body wall structures
302
What is the ventral ramus of T12 called?
Subcostal nerve
303
Where does the intercostal nerve give a collateral branch?
Angle of the rib
304
Describe the sensory coverage of T2?
Large lateral cutaneous branch supplies thorax and axilla, upper and medial parts of UL, and intercostal nerve
305
What does the needle pass through during pneumothorax surgery?
1. Skin
2. Pectoralis Major
3. (Pectoralis Minor)
4. External, internal & innermost intercostal muscles
5. Endothoracic fascia
6. Parietal pleura
306
What medical procedure puts the T2 ventral rami at risk?
Breast surgery
307
Would a doctor be obliged to give medical attention to someone who asks them on the street and not their patient?
- Not legally required
| - GMC says you must offer help if emergency due to it being professionalism and ethically right
308
How is animal research regulated by law?
- Cruelty to Animals Act
| - Animals Scientific Procedures Act (ASPA)
309
What aspects do people consider when performing animal research?
- Benefits
- Model
- Sentience
- Value
- Moral agency
- Spiritual/religious potential
- Human achievement
310
What does "ASPA" stand for?
Animals Scientific Procedures Act
311
What do the Home Office do?
- Advised by Animal Procedures Inspectorate and provides guidelines for local committees
- Weigh the likely adverse effects on the animals concerned against the benefit likely to accrue as a result of the programme to be specified to the license.
312
How are licenses granted?
Each local area has an animal ethics comittee which review and monitor all eligible research using ASPA and home office guidelines. Licenses are granted:
- Site license
- Personal license
- Project license
313
What are the key principles in ASPA (3 R's)?
1. Replacement - alternative technologies, lower organisms
2. Reduction - better study design, fewer animals
3. Refinement - minimise pain and improve welfare
314
How is human research regulated?
- If involving NHS staff, patients or premises: National Research Ethics Service (NRES) / NHS Research Ethics Committee (NREC)
- If not NHS, but Locally: Research Ethics Committee (REC)
315
What is "assent"?
Its not legal consent but the expression of approval or agreement i.e. Children
316
What is the difference between therapeutic & Non-therapeutic research?
- Therapeutic research has the potential to benefit the person
- Non-therapeutic research does not!
317
What is "rigour"?
- Open to critique and evaluation.
- The soundness of its method, the accuracy of its findings, and the integrity of its assumptions made or conclusions reached.
318
What is "validity"?
Whether a measurement instrument actually measures what it is purported to measure.
319
What is the 4 criteria for valid consent?
1. Patient must have capacity
2. Patient must give consent voluntarily
3. Patient must be informed
4. Consent must be continuing
