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MD3001 > Week 7 > Flashcards

Week 7 Flashcards

1
Q

What is HCAI?

A

Healthcare Associated Infection

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2
Q

What is HAI?

A

Hospital associated Infection

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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
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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)
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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
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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

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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
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8
Q

What is the Terminology?

A
  1. Standard precautions

2. Standard Infection control precautions

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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
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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
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11
Q

What are the Airborne Precautions?

A
  • Particles (<5microns) that can be widely dispersed
  • Single room
  • Apron
  • Gloves
  • High efficiency filter mask
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12
Q

When do healthcare providers have to wash their hands?

A
  1. Before touching the patient
  2. Before clean/septic procedure
  3. After body fluid exposure risk
  4. After touching a patient
  5. After touching patients surrounding
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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.
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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.
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15
Q

What are Gram positive organisms with antibiotic resistance?

A
  1. Meticillin Resistant S. aureus (MRSA)

2. Vancomyocin Resistant Enterococcus (VRE)

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16
Q

What are Gram negative organisms with antibiotic resistance?

A
  1. Extended spectrum -Lactamse producing Enterobacteriaceae (ESBL producer)
  2. Carbapenum resistant Enterobacteriaceae (CRE)
  3. Carbapenemase Producing Pseudomonas
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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
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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
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19
Q

What is the commonest cause of a hospital acquired S. aureus bacteraemia?

A

Vascular access devices (VADs)

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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

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21
Q

Define “approaching the end of life”?

A

Likely to die within 12 months

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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
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23
Q

What are the 3 aims of palliative care?

A
  1. Whole person approach
  2. Focus on quality of life, including good symptom control
  3. Care encompassing patient and those that matter to them
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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
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25
Q

What is Generalist Palliative care?

A

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.

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26
Q

What is Specialist Palliative care?

A

Same as generalist but catering for people with more COMPLEX palliative care needs

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27
Q

What are some Physical Symptoms of dying?

A
  • Pain
  • Dyspnoea
  • Nausea
  • Anorexia
  • Constipation
  • Cough
  • Fatigue
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28
Q

How may Psycho-spiritual distress affect end of life care?

A
  • May exacerbate physical symptoms

- May be due to uncontrolled physical symptoms, alcohol/drug withdrawal, depression or other medical causes

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29
Q

Describe Advance & Anticipatory care planning?

A

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

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30
Q

What sort of things should be discussed in advanced?

A
  • Preferences, fears
  • Beliefs/values
  • Who should be involved in decisions
  • Emergency interventions
  • Preferred place of care
  • Spiritual support
  • Formalise wishes regarding care
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31
Q

What 3 documents exist to formalise wishes regarding the future of care in the terminally ill?

A
  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
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32
Q

What does “ADRT” stand for?

A

Advance Refusal of Treatment

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33
Q

What are the limitations of the Advance decisions?

A
  • Future decisions can’t be bound by their statement

- Validity and applicability need to be considered

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34
Q

How do you know advance decisions are valid?

A
  • 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?
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35
Q

What are the PROS of the Advance Statement?

A
  • Enhances autonomy
  • May encourage end of life discussions
  • Avoid breaching patient’s beliefs/ religious beliefs
  • Enables death with dignity
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36
Q

What are the CONS of the Advance Statement?

A
  • 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
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37
Q

What is the Gold standards framework (GSF)?

A

Systematic, evidence based approach to optimising care for all patients approaching end of life, delivered by generalist frontline care providers

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38
Q

What are the 4 prinicples for “care for people in the last days and hours of life”?

A
  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
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39
Q

What are the 5 priorities for care of dying people?

A
  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
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40
Q

What support is on offer for families after death?

A
  • Chaplain, counsellors, family workers, health care professionals.
  • Facilitated with good relationship with family prior to death
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41
Q

What is WHO analgesic ladder for pain?

A
  1. Non-opioid (aspirin, paracetamol)
  2. Weak Opioid (codeine)
  3. Strong Opioid (morphine)
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42
Q

What is the Structure of taking a History?

A
  • 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)
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43
Q

Presenting Complaint (PC)?

A

Description symptoms in patient’s own words

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44
Q

History of Presenting Complaint (HPC)?

A
  • 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
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45
Q

What are the Respiratory Questions?

A
  • Chest pain
  • Dyspnoea
  • Cough
  • Sputum
  • Haemoptysis
  • Wheeze
  • Systemic upset
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46
Q

What does “SOCRATES” stand for in clarifying Chest pain?

A 
Site
Onset
Character
Radiation
Associated symptoms
Timing
Exacerbators/relievers 
Severity (1-10 rating)
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47
Q

What can be the causes of Central Chest pain?

A
  • Tracheitis
  • Angina/MI
  • Aortic dissection
  • Massive PE
  • Oesophagitis
  • Lung tumour/metastases
  • Mediastinal tumour/mediastinitis
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48
Q

What can be the causes of Pleural Chest pain?

A
  • Pneumonia/Bronchiectasis/TB
  • Lung Tumour/metastases/mesothelioma
  • PE
  • Pneumothorax
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49
Q

What can be the causes of Chest wall pain?

A
  • Muscular/rib injury
  • Costochondritis
  • Lung tumour/bony metastases/ mesothelioma
  • Shingles (herpes zoster)
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50
Q

What is Orthopnoea?

A

Breathlessness when lying down

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51
Q

If the Dyspnoea has an onset of minutes what could the conditions be?

A
  • PE
  • Pneumothorax
  • Acute LVF
  • Acute asthma
  • Inhaled foreign body
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52
Q

If the Dyspnoea has an onset of hours-days what could the conditions be?

A
  • Pneumonia
  • Asthma
  • Exacerbation of COPD
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53
Q

If the Dyspnoea has an onset of weeks-months what could the condition be?

A
  • Anaemia
  • Pleural effusion
  • Respiratory neuromuscular disorders
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54
Q

If the Dyspnoea has an onset of months-years what could the condition be?

A
  • COPD
  • Pulmonary fibrosis
  • Pulmonary TB
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55
Q

What are the 3 categories of causes for Dyspnoea?

A
  1. Respiratory causes
  2. Cardiovascular causes
  3. Non Cardio-respiratory causes (anaemia, obesity)
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56
Q

What is the cause of Acute Coughs?

A
  • Viral or bacteral infection
  • Pneumonia
  • Inhalation of foreign body
  • Irritants
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57
Q

What is the cause of Chronic Cough?

A
  • Gastro-oesophageal reflux
  • Asthma
  • COPD
  • Smoking
  • Lung Tumour
  • Bronchiectasis
  • Interstitial lung disease
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58
Q

What are the Red Flags for a Cough?

A
  • Haemoptysis
  • Breathlessness
  • Weight loss
  • Chest pain
  • Smoker
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59
Q

What are the characteristics for Infection/Bronchiectasis?

A

Productive cough

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60
Q

What are the characteristics for COPD?

A

Persistent “moist” cough worse in the morning

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61
Q

What are the characteristics for Asthma/COPD?

A

Associated with wheeze

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62
Q

What are the characteristics for Tracheitis?

A

Painful cough

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63
Q

What are the characteristics for Laryngitis/laryngeal tumour?

A

Harsh/Barking cough

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64
Q

What are the characteristics for Interstitial lung disease?

A

Chronic, dry cough

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65
Q

What are the characteristics for Bronchial carcinoma?

A

Persistent with haemoptysis

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66
Q

What are the characteristics for Left recurrent laryngeal nerve invasion / Neuromuscular disorders?

A

“Bovine” cough (non-explosive cough)

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67
Q

What is the cause/appearance of serous Sputum?

A

Appearance- clear, watery, frothy, pink

Cause- acute pulmonary oedema

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68
Q

What is the cause/appearance of Mucoid Sputum?

A

Appearance- clear, grey, white, viscid

Cause- COPD, asthma

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69
Q

What is the cause/appearance of Purulent Sputum?

A

Appearance- yellow, green, brown

Cause- Infection

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70
Q

What is the cause/appearance of Rusty Sputum?

A

Appearance- rusty red

Cause- pneumococcal pneumonia

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71
Q

What is an example of Malignant Haemoptysis?

A
  • Bronchial carcinoma

- Metastatic lung disease

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72
Q

What is an example of Infective Haemoptysis?

A
  • Acute infection
  • Bronchiectasis
  • TB
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73
Q

What is an example of Vascular Haemoptysis?

A
  • Pulmonary infarction

- Pulmonary embolus

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74
Q

What is an example of Cardiac Haemoptysis?

A
  • Mitral valve disease

- Acute LVF

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75
Q

What is an example of Vasculitis Haemoptysis?

A
  • Wegener’s granulomatosis

- Good pasture’s syndrome

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76
Q

What is an example of Other types of Haemoptysis?

A
  • Trauma
  • Anticoagulation (consider warfarin)
  • Clotting disorder
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77
Q

What to ask in Past Medical History?

A
  • Medical conditions
  • Visits to the doctor
  • Investigations/procedures
  • Operations
  • Establish if problems on-going/resolved fully/managed
  • Time-line of events
  • Allergies
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78
Q

What are The Golden Rules of Medication history taking?

A
  • 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?
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79
Q

Questions to ask regarding Prescribed Medication?

A
  • 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?
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80
Q

What is Intentional non-concordance?

A

Definite decision to not take medicines

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81
Q

What is Unintentional non-concordance?

A

Can be due to physical dexterity, reduced vision, cognitive impairment, poor understanding

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82
Q

What are the different types/forms of inhalers?

A
  • Mdi= metered dose inhaler
  • Accuhaler
  • Autohaler
  • Easibreathe
  • Handihaler
  • Via spacer/aerochamber
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83
Q

What do the different inhaler colours mean?

A
  • BLUE: “reliever” ie. salbutamol (beta agonist)

- BROWN: “preventer” ie. beclomethasone (steroid)

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84
Q

Give examples of some Oral Respiratory Medicines?

A
  • Mucolytics ie. carbocisteine
  • Xanthines ie. theophylline
  • Oral steriods ie. prednisolone
  • Leukotriene receptor antagonists ie. montelukast
  • Antihistamines ie. cetirizine
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85
Q

Systems Enquiry/Review Questions?

A 
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
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86
Q

What is Radical Surgery?

A

Removal of blood supply, lymph nodes & sometimes adjacent structures of a diseased organ/ tumor during surgery

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87
Q

What is the Primary Purpose of the NHS?

A

To secure, through resources available, the greatest possible improvement in the physical and mental health of the population

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88
Q

What is Sackett et al (1996) definition of EBP?

A

The conscientious, explicit and judicious use of current best evidence in making nursing decisions about the care of individual patients

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89
Q

What is Carnwell (2001) definition of EBP?

A

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

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90
Q

What does EBM/EMP stand for?

A

Evidence Based Medicine

Evidence Based Practice

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91
Q

What are the 3 Principles of EBM?

A
  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
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92
Q

Why is EBM now essential?

A
  • 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
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93
Q

What is the Order from bottom up of the Evidence Pyramid?

A
  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
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94
Q

What does HTA stand for?

A

Health Technology Assessment

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95
Q

What is Methylphenidate/Ritalin a treatment for?

A

ADHD

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96
Q

How should a doctor practice EBM?

A
  • 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
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97
Q

What are the 3 functions of the conducting pathway of the respiratory system?

A
  1. Moistens
  2. Warms
  3. Filters
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98
Q

Name the vertebral level the trachea begins and ends at?

A

C6-T4/5 (at carina)

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99
Q

Name the muscle that alters the tracheal diameter?

A

Trachealis

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100
Q

Which bronchus is shorter, wider and more vertical?

A

Right main bronchus

foreign bodies

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101
Q

Which side of the midline does the trachea deviate?

A

Slightly right to the midline

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102
Q

Between what structures does the left recurrent laryngeal nerve lie?

A

Trachea and oesphagus (oesphagus posterior)

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103
Q

What arteries supply the trachea?

A

Inferior thyroid & bronchial

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104
Q

What veins drain the trachea?

A

Inferior thyroid

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105
Q

What lymph drain the trachea?

A

Pretracheal and Paratracheal lymph nodes

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106
Q

What nerves supply the trachea?

A

Vagus nerve sending recurrent laryngeal nerve & sympathetic trunks

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107
Q

How many lobes does the left lung have?

A

2

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108
Q

How many lobes does the right lung have?

A

3

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109
Q

Name the lobes (2) of the left lung?

A

Upper (lingular), Lower

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110
Q

Name the lobes (3) of the right lung?

A

Upper, Middle and Lower

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111
Q

What is the series of branching of the Bronchi?

A

Main bronchi –> lobar bronchi –> segmental bronchi

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112
Q

Which bronchus drops off posteriorly first?

A

Bronchus to apical segment of lower lobe

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113
Q

What is a bronchopulmonary segment?

A

Portion of lung supplied by a specific segmental bronchus and arteries

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114
Q

What is E. Coli?

A
  • Escherichia coli
  • A bacterium that lives in the gut.
  • It commonly causes urinary tract and food borne infection.
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115
Q

What is MRSA?

A

Meticillin Resistant Staphylococcus aureus

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116
Q

What is C. difficile?

A
  • Clostridium difficile

- A bacterium often associated with outbreaks of diarrhoea, especially in elderly patients who have received antibiotics

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117
Q

What is Hepatitis B & C?

A

Blood-borne viruses which causes inflammation of the liver

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118
Q

What is HIV?

A
  • Human Immunodeficiency virus

- Blood-borne virus that can lead to AIDS

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119
Q

What is S. aureus?

A
  • Staphylococcus aureus

- A bacterium often carried in the nose that is a major cause of wound infections after surgery

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120
Q

What is Salmonella?

A

A bacterium, found in animals such as poultry, that is a common cause of food borne infection

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121
Q

What is Inoculation?

A

Introduction of an infectious agent into the body via the skin

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122
Q

What are the 3 bronchopulmonary segments of the left & right lungs Upper (superior) lobe?

A
  1. Apical (superior)
  2. Anterior
  3. Posterior
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123
Q

What are the 2 bronchopulmonary segments of the Middle lobe of the right lung?

A
  1. Medial

2. Lateral

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124
Q

What are the 2 bronchopulmonary segments of the Lingula (middle lobe) of the left lung?

A
  1. Superior

2. Inferior

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125
Q

What are the bronchopulmonary segments of the lower lobe of the left & right lungs?

A
  1. Apical (superior)
  2. Medial
  3. Lateral
  4. Anterior
  5. Posterior
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126
Q

How many bronchopulmonary segments are there in each lung?

A

10

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127
Q

List the progression from segmental bronchi to alveoli?

A

Segmental bronchi –> Conducting bronchi –> Terminal bronchi –> Respiratory bronchi –> Alveolar ducts –> Alveolar sacs –> Alveoli

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128
Q

What kind of epithelium covers the conducting portion of the respiratory system?

A

Pseudostratified columnar epithelium (mucus secreting cells)

129
Q

What kind of epithelium covers the respiratory bronchioles?

A

Cubiodal epithelium with no goblet cells

130
Q

What is the clinical significance of the apical bronchopulmonary bronchus fo the lower lobe?

A

In bed ridden patient, mucus accumulates there, susceptible to infection

131
Q

At which vertbral level do the pulmonary arteries divide just below?

A

T4/5

132
Q

At which side of the midline does the pulmonary trunk divide?

A

Left

133
Q

Which structure does the right pulmonary artery lie behind?

A

Ascending Aorta

134
Q

What structure does the left pulmonary artery lie in front of?

A

Descending Aorta

135
Q

What arteries supply the tissue of the lung?

A

Bronchial arteries

136
Q

Where does the right bronchial artery orginate from?

A

3rd Posterior Intercostal Artery

137
Q

Where do the two left bronchial arteries originate from?

A

Aorta directly

138
Q

Which arteries do the Bronchial arteries anastamose with?

A

Pulmonary arteries in the walls of the bronchioles

139
Q

Which venous system drains the Bronchial veins?

A

Azygos

140
Q

What and where are the two lymphatic plexuses found in the lungs?

A
  1. Deep along side bronchial tree

2. Superficial beneath pleura

141
Q

What is the series of lymph drainage from both deep & superficial lung plexuses on right side?

A

Lung plexuses –> Pulmonary nodes –> Bronchopulmonary nodes –> Inferior & Superior tracheobronchial nodes –> Paratracheal nodes –> Right lymphatic trunk

142
Q

What does the left paratracheal node drain into?

A

Thoracic duct before emptying into the venous circulation

143
Q

What are the 3 borders of the lung?

A
  1. Anterior
  2. Posterior
  3. Inferior
144
Q

What are the 3 surfaces of the lung?

A
  1. Costal
  2. Diaphragmatic
  3. Mediastinal
145
Q

Describe the anatomical landmarks for the oblique fissure?

A

Spine of T4 to rib 6

146
Q

Describe the anatomical landmarks for the horizontal fissure?

A

Rib 4/5

147
Q

What structures can be seen leaving impressions on the right lung?

A

SVC, right atrium, azygos vein

148
Q

What structures leave impressions on the left lung?

A

Aorta & left ventricle

149
Q

How many pulmonary arteries in right lung hilum?

A

2

150
Q

How many bronchi in right lung hilum?

A

2

151
Q

Describe the position of the pulmonary veins in both hilar?

A

Anterior and inferior

152
Q

What is the function of the pulmonary ligament?

A

Its a fold of pleura which allows hilar movement during respiration and vessel expansion

153
Q

Where do the nervous pulmonary plexuses lie?

A

Anterior & posterior to main bronchi at root of the lung

154
Q

What 3 fibres contributes to the pulmonary plexuses?

A
  1. Parasympathetic fibres from the vagus nerve
  2. Sympathetic fibres from the sympathetic ganglia
  3. Pain fibres with sympathetic
155
Q

Which pleura has a sensory supply?

A

Parietal (from intercostal and phrenic)

156
Q

What is the clinical consequence of a tumour iminging on phrenic nerve?

A

Paralysis of diaphragm on affected side

157
Q

What’s the clinical consequence of a tumour impinging on sympathetic trunk supplying head?

A

Horner’s syndrome- drooping of eyelid with constricted pupil, dry but flushed face on affected side

158
Q

Whats the clinical significance of a tumour impinging on left recurrent laryngeal nerve?

A

Hoarseness of voice

159
Q

What sort of cartilage is the spetal cartilage?

A

Hyaline

160
Q

What is the nerve supply to the muscles in the nose?

A

Facial nerve- cranial nerve VII (7)

161
Q

What is a conchae?

A

Long, narrow, curled bone shelf to make air turbulent

162
Q

What is a meatus?

A

Space underneath the conchae

163
Q

What bone makes up the anterior nose and upper jaw?

A

Maxilla

164
Q

What bone makes up the septum and most of the lateral frontal nasal cavity?

A

Ethmoid

165
Q

What is an ethmoidal labyrinth?

A

Air cells within the ethmoidal bone (sinuses), which open into the nasal cavity

166
Q

Which bone gives the superior and middle conchae?

A

Ethmoid

167
Q

What bone makes up the anterior part of the septum (not cartilage)?

A

(perpendicular plate of) Ethmoid

168
Q

Through which structure does air pass through posteriorly to get into the nasopharynx?

A

Posterior conchae

169
Q

What are the superior and middle conchae extensions of?

A

The Ethmoid bone

170
Q

What about the Inferior Conchae?

A

It is a separate bone to superior and middle conchae

171
Q

What clinical consequence may occur if the septum deviates from the midline?

A

Sinus drainage problems

172
Q

What plane does the hard palate take?

A

Horizontal (nasogastric tube)

173
Q

What is the name of the projection fromt he ethmoid bone intot he cranium?

A

Crista gali

174
Q

What is the name of the plate though which oflactory nerves pass?

A

Cribiform plate

175
Q

Where does mucus from sinuses and tears from the eye (via nasolacrimal duct) drain to?

A

Meati

176
Q

What number is the trigeminal nerve?

A

V (5)

177
Q

What are the divisions of the trigeminal nerve?

A

Ophthalmic and Maxillary

178
Q

What other fibres join on with the divisions of the trigeminal nerve?

A

Parasympathetic

179
Q

What supply does the trigeminal nerve give to tissue?

A

Sensory & Parasympathetic Secretomotor

180
Q

What bone binds the nasal cavity superiorly?

A

Sphenoid

181
Q

What is the lateral wall of the nasal cavity related to?

A

Orbit

182
Q

What bone houses the ophthalmic nerve and accompanying artery?

A

Orbit

183
Q

What is the nerve supply of the lateral wall and medial wall of the nasal cavity derived from?

A

Ophthalmic & Maxiallary branches of the trigeminal nerve (trigeminal V)

184
Q

What is V1/Va?

A

Ophthalmic Devision of Trigeminal nerve

185
Q

What is V2/Vb?

A

Maxillary Devision of Trigeminal nerve

186
Q

Which are the only nerves capable of regeneration?

A

Olfactory nerves

187
Q

What passes through the Sphenopalatine foramen?

A
  • Sphenopalatine artery

- Nasopalatine nerve

188
Q

Which nerve passes through the incisive canal to supply the anterior palate?

A

Nasopalatine nerve

189
Q

What structures does the greater palatine canal transmit?

A
  • Descending palatine artery
  • Descending palatine Vein
  • Greater and lesser palatine nerves
190
Q

If the palatine canal is dehiscent, what does this predispose to?

A

Severe Epitaxis from the greater palatine artery

191
Q

Which main arteries supply the septum?

A

Septal branches of the maxillary and opthalmic arteries

192
Q

Which site of anastamosis is prone to epistaxis?

A

Little’s or KIesselbach’s areas

193
Q

Which main arteries form an anastamosis in the anterior portion of the septum (4)?

A
  1. Anterior ethmoidal
  2. Greater palatine
  3. Sphenopalatine
  4. Labial branches of the facial
194
Q

What is epistaxis?

A

Nose bleed

195
Q

What does the nasal vein drain into?

A

Foramen caecum (drains into intercranial sinuses)

196
Q

What does the cavernous sinus drain into?

A

Cranial cavity

197
Q

Where is the pterygoid plexus located?

A

Intratemporal fossa

198
Q

How does the frontal sinus drain?

A

Frontonasal duct & infundibulum (with anterior ethmoidal cells) to haitus semilunaris (middle meatus)

199
Q

How does the maxillary sinus drain?

A

Opens into Hiatus semilunaris posteriorly

200
Q

Why is the clearance of mucus from the maxillary sinus depedent on cillia?

A

Opening is high on the medial wall (may lead to sinusitis)

201
Q

Where does the posterior ethmoidal cells drain?

A

Into Superior meatus

202
Q

Where does the sphenoid sinuses drain?

A

Into Sphenoethmoidal recess

203
Q

Where does the nasolacrimal duct open to?

A

Into Inferior meatus

204
Q

Which nerve and artery supply the frontal, ethmoidal and sphenoid sinuses?

A

Supra-orbital & ethmoidal branches of the ophthalmic nerve and artery

205
Q

What is the nerve and artery supply of the maxillary sinuses?

A

Maxillary nerve and artery

206
Q

Which lymph nodes drain the anterior part of the nasal cavity?

A

Submandibular nodes

207
Q

Which lymph nodes drain the posterior nart of the nasal cavity?

A

Retrophayngeal nodes to upper deep cervical nodes

208
Q

What is the main function of the larynx?

A

Protective sphincter

209
Q

Where are the adenoid tonsils found? (Pharyngeal tonsil)

A

Roof and posterior wall of the nasopharynx

210
Q

What does the tubular tonsil cover?

A

Opening of pharyngotympanic tube

211
Q

Where are the palatine tonsils found?

A

Back of mouth

212
Q

Where are the lingual tonsils found?

A

Base of tongue

213
Q

What is the name of the ring formed by tonsils around the opening of the respiratory and gastro-intestinal tracts?

A

Waldeyer’s

214
Q

What may happen as a result of tubal tonsil swelling?

A

Obstruct the pharyngotympanic tube and cause middle ear infections

215
Q

What may results of swelling of the pharyngeal tonsil?

A

Obstruction of airway leading to mouth breathing

216
Q

Under which bone does the larynx hang from?

A

Hyoid bone

217
Q

Apart from the epiglottis, what kind of cartilage is the larynx made from?

A

Hyaline

218
Q

Which ligament may be pierced in emergency access of the airway?

A

Median cricothyroid ligament

219
Q

What object describes the shape of the cricoid cartilage?

A

Signet ring

220
Q

Which cartilages does the signet ring articulate with?

A

Arytenoids and thyroid

221
Q

Which cartilage does the thyroid cartilage articulate with?

A

Cricoid (through inferior horns)

222
Q

What is the thyroid angle for men & women?

A

90 - 120

223
Q

What type of cartilage is the epiglottis?

A

the ONLY elastic cartilage

224
Q

What attaches to the muscular process of the arytenoid?

A

Posterior and lateral cricoarytenoid

225
Q

What attaches to the vocal process of the arytenoid?

A

Vocal ligament/fold

226
Q

Which ligaments are produced as thickenings of the thyrohyoid membrane?

A
  • Anteriorly as median thyrohyoid ligament (site of emergency access)
  • Posteriorly as the lateral thyrohyoid ligaments
227
Q

What are the two intrinsic ligaments of the larynx?

A
  1. Quadrangular from the arytenoid to thyroid and epiglottis

2. Cricothyroid/Cricoval from cricoid and arytenoid to the thyroid forming the conus elasticus

228
Q

From superior to inferior name the folds of the laryngx?

A

Aryepiglottic fold –> Vestibular fold –> Vocal fold

229
Q

Which fold is fromed from the upper edge of the quadrangular membrane?

A

Aryepiglottic

230
Q

Which fold is formed by the Lower edge of the quadrangular membrane?

A

Vestibular fold

231
Q

Which folds from over the vocal ligament edge of cricovocal membrane?

A

Vocal Fold

232
Q

Which folds from the laryngeal inlet which is a protective sphincter?

A

Aryepiglottic folds

233
Q

How is the laryngeal inlet closed?

A

Elevation of the larynx

234
Q

Name things the layngeal diameter needs to be changed for?

A
  • Speech
  • Coughing
  • Sneezing
  • Raising intra-abdominal pressure
235
Q

What is the name for the opening between the vocal folds?

A

Rima glottis/glottidis

236
Q

What is the ventricle of the larynx?

A

In folding between the vestibular and vocal fold leading to the saccule which produces lubricating mucus

237
Q

Which muscles close the laryngeal inlet?

aryepiglotting folds

A
  1. Extrinsic muscles that elevate larynx
  2. Aryepiglotticus (purse string)
  3. Thyroepiglotticus (sphincteric affect)
238
Q

Which muscles open the laryngeal inlet? (aryepiglotting folds)

A

None, mainly by elastic recoil

239
Q

Which muscles open the rima glottidis?

vocal folds

A
  1. Posterior cricoarytenoid (externally rotates arytenoids and pulls them apart down the shoulders of cricoid)
240
Q

Which muscles close the rima?

A
  1. Transverse arytenoid (pull arytenoids together)

2. Lateral cricoarytenoids, (rotate cords back towards)

241
Q

Which muscle lengthens the vocal folds?

A

Cricothyroid (rocks thyroid forwards)

242
Q

Which muscle shortens the vocal folds?

A

Thyroarytenoid (rocks thyroid back)

243
Q

What does decreasing and increasing tension of vocal fold do to someones voice?

A

DECREASING- lowers pitch

INCREASING- raises pitch

244
Q

Which muscles makes small adjustments to the vocal folds?

A

Vocalis

245
Q

Which cranial nerve sends the superior laryngeal nerve?

A

Vagus Nerve (Cranial X)

246
Q

What does the superior layrngeal nerve divide into?

A

Internal and external branches

247
Q

What does the internal branch of the superior laryngeal nerve cover?

A

Sensation from the larynx down to just above the vocal folds

248
Q

Which artery gives off the superior laryngeal artery?

A

Superior thyroid artery

249
Q

Which is the only muscle in the larynx not supplied by the recurrent laryngeal nerve?

A

Cricothyroid

250
Q

Which nerve supplied the cricothyroid muscle?

A

External branch of the superior laryngeal nerve

251
Q

What does the recurrent laryngeal nerve supply?

A
  • All muscles except for cricothyroid

- Sensation to vocal cords & larynx below them

252
Q

What happens as a result of complete paralysis of the recurrent laryngeal?

A

Vocal fold lies in a semi abducted position (compensation through extra movement by the opposite fold)

253
Q

What happens if there is partial paralysis of the recurent laryngeal nerve?

A

Vocal fold moves over to midline/crosses it (therefore if bilater-life threatening)

254
Q

What happens if there is paralysis of the external laryngeal nerve?

A
  • Hoarseness of voice

- Recovery is good due to hypertrophy of the opposite cricothyroid

255
Q

What artery acompanies the superior layngeal nerve?

A

Superior laryngeal artery

256
Q

What is the venous drainage of the superior larynx?

A

Superior thyroid vein

257
Q

What is the lymph drainage of the superior larynx?

A

Drains to upper deep cervical nodes

258
Q

What artery accompanies the recrrent laryngeal nerve?

A

The inferior laryngeal artery (branch of inf. thyroid artery) (supplies vocal cords and below)

259
Q

What does the inferior larynx drain venously with?

A

Inferior thyroid vein

260
Q

What is the lymph node draining the inferior larynx?

A

Lower deep cervical nodes

261
Q

What kind of joint is the sternal angle?

A

Symphysis (firbocartilage)

262
Q

What is the normal realation for articulation with ribs and the vertebrae?

A

Articulates with it’s own vertebra and the one above

263
Q

What structures are effected by cervical ribs?

A
  • Subclavian artery, trauma causes thromboemboli

- Compression of lower trunk of the brachial plexus: weakness of the small muscles of the hand

264
Q

Name characteristics of thoracic vertebra?

A
  • 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
Q

What kind of joints are the costovertebral joints?

A

Synovial

266
Q

Which ribs articulate with the superior demifacet of the vertebra above?

A

2-10

267
Q

What kind of joints are the costotranverse joints?

A

Synovial

268
Q

Which bony landmark of the rib articulates with the transverse process?

A

Tubercle

269
Q

Which costotransverse joints have curved facets?

A

1-7 (rotation)

270
Q

Which costotransverse joints have plane facets?

A

8-10 (gliding)

271
Q

What kind of joint is it between the ribs and the costal cartilage?

A

Primary cartilaginous (hyaline)

272
Q

Which ribs are classified as the true ribs?

A

Ribs 1-7

273
Q

What kind of joint is it between the true rib’s costal cartilage and the sternum?

A

Synovial (to allow movement)

274
Q

Which rib’s costal cartilage joins to the sternum by means of a primary cartilaginous joint (hyaline)?

A

1st rib, making the thoracic inlet more stable

275
Q

Which are classed as the “false ribs”?

A

Ribs 8-10

276
Q

Which ribs are classified as “floating ribs”?

A

Ribs 11, 12

277
Q

Which ribs does the breast overly?

A

2-6

278
Q

Name the 3 Types of intercostal muscles?

A
  1. External intercostal
  2. Internal intercostal
  3. Innermosts intercostal
279
Q

Describe the direction of external intercostals?

A

Inferior & medial

280
Q

Describe the direction of internal intercostals?

A

Inferior and lateral

281
Q

What do the External Intercostal muscles do?

A

Raise ribs, inspiration

282
Q

What do the Internal intercostal muscles do?

A

Aid elastic recoil by moving ribs inferiorly in expiration

283
Q

Which artery does the internal thoracic branch off?

A

Subclavian

284
Q

How does the internal thoracic terminate?

A

Superior epigastric & musculophrenic arteries

285
Q

How many parts do innermost intercostal muscles have?

A
  1. Subcostales
  2. Innermost intercostal
  3. Transversus Thoracis
286
Q

Which ribs do the Anterior intercostals arteries supply?

A

2 per space 1-6

287
Q

Which artery suplies intercostal spaces 7-10 anteriorly?

A

Musculophrenic

288
Q

What supplies the 1st two spaces posteriorly?

A

Costocervical trunk from subclavian, forming supreme intercostal artery

289
Q

Which intercostal spaces does the thoracic aorta supply posterioly?

A

2 per space ribs 3-11

290
Q

Name the 12th posterior branch of the thoracic aorta?

A

Subcostal

291
Q

What is the venous drainage equivlant to the internal thoracic arteries?

A

Venae comitantaes to internal thoracic vein

292
Q

Describe the posterior intercostal venous drainage?

A
  • 1st space: brachiocephalic vein
  • 2nd and 3rd: superior intercoastal vein
  • Others: azygous
293
Q

What is the anterior intercostal lymph drainage?

A

Parasternal lymph nodes

294
Q

What does the Azygos system do?

A
  • Drains posterior wall of trunk

- Connects IVC & SVC

295
Q

Where is the Anterior thoracic wall lymph drainage?

A

Parasternal Nodes

296
Q

Where is the Posterior thoracic wall lymph drainage?

A

Intercostal Nodes

297
Q

How do superficial chest wall structures drain lymph?

A

Axillary nodes

298
Q

What is main breast tissue arterial supply?

A

Mainly superior thoracic, thoraco acromial, lateral branches of AXILLARY ARTERY

299
Q

What sensory branches do the intercostal nerves give off?

A

Lateral and anterior branches to skin

300
Q

Why is there not an anterior T1 dermatome?

A
  • 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
Q

What do the ventral rami (intercostal nerves) of T2-11 carry?

A
  • Motor fibres to intercostals
  • Sensory to skin/ parietal pleura
  • Sympathetic to body wall structures
302
Q

What is the ventral ramus of T12 called?

A

Subcostal nerve

303
Q

Where does the intercostal nerve give a collateral branch?

A

Angle of the rib

304
Q

Describe the sensory coverage of T2?

A

Large lateral cutaneous branch supplies thorax and axilla, upper and medial parts of UL, and intercostal nerve

305
Q

What does the needle pass through during pneumothorax surgery?

A
  1. Skin
  2. Pectoralis Major
  3. (Pectoralis Minor)
  4. External, internal & innermost intercostal muscles
  5. Endothoracic fascia
  6. Parietal pleura
306
Q

What medical procedure puts the T2 ventral rami at risk?

A

Breast surgery

307
Q

Would a doctor be obliged to give medical attention to someone who asks them on the street and not their patient?

A
  • Not legally required

- GMC says you must offer help if emergency due to it being professionalism and ethically right

308
Q

How is animal research regulated by law?

A
  • Cruelty to Animals Act

- Animals Scientific Procedures Act (ASPA)

309
Q

What aspects do people consider when performing animal research?

A
  • Benefits
  • Model
  • Sentience
  • Value
  • Moral agency
  • Spiritual/religious potential
  • Human achievement
310
Q

What does “ASPA” stand for?

A

Animals Scientific Procedures Act

311
Q

What do the Home Office do?

A
  • 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
Q

How are licenses granted?

A

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
Q

What are the key principles in ASPA (3 R’s)?

A
  1. Replacement - alternative technologies, lower organisms
  2. Reduction - better study design, fewer animals
  3. Refinement - minimise pain and improve welfare
314
Q

How is human research regulated?

A
  • 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
Q

What is “assent”?

A

Its not legal consent but the expression of approval or agreement i.e. Children

316
Q

What is the difference between therapeutic & Non-therapeutic research?

A
  • Therapeutic research has the potential to benefit the person
  • Non-therapeutic research does not!
317
Q

What is “rigour”?

A
  • 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
Q

What is “validity”?

A

Whether a measurement instrument actually measures what it is purported to measure.

319
Q

What is the 4 criteria for valid consent?

A
  1. Patient must have capacity
  2. Patient must give consent voluntarily
  3. Patient must be informed
  4. Consent must be continuing

MD3001 (15 decks)

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