Download Thorax Forum Questions 2010ish

Thorax Forum Question
1. Explain what you see in this image and why it has
significance!
2. You have to perform a pericardiocentesis, what
landmarks are you going to use to guide the
needle? What is your approach? (not in your text)
Infrasternal angle under the xiphoid process may be
the safest; follow the bottom of the ribs upward to
locate the xiphoid process
3. What is a stent and how is one placed in a coronary artery?
Inserted through the femoral artery, which then courses up through the external and common
iliac arteries into the aorta and then to the dysfunctional coronary artery; the catheter allows a
fine wire to pass through and a balloon to inflate the level of obstruction
4. What is CABG and where would you get the “spare” anatomy from?
Great saphenous vein is harvested to use as a graft; divided into several pieces to bypass the
blocked sections of the coronary arteries. Internal thoracic or radial arteries may also be used
5. What is a heart block? Where can one occur?
Blockage of the electrical conduction system of the heart and it can occur at the SA node, AV
node, bundle of his, bundle branches,
6. How can a physician gain access to the inferior vena cava without using one of its tributaries?
A catheter can be passed from the superior vena cava through the right atrium into the inferior
vena cava
7. Explain why when a patient has angina pectoralis they experience pain radiating down their
left arm.
This is caused by referred pain; sensory cell bodies coming from the heart will synapse near the
somatic sensory nerve cell body of similar spinal cord levels (in the case of a heart attack,
will cause somatic pain in areas innervated by T1-T4)
8. Moving from the anterior to posterior mediastium what great vessels and accompanying
structures will be encountered (need the right order!). AT THE LEVEL of T3 vertebra
a. brachiocephalic veins with phrenic nerves lateral b. brachiocephalic trunk c. left common
carotid artery d. trachea and left subclavian artery with lateral vagus nerves e. esophagus
AT THE LEVEL OF T4
a. thymus b. arch of aorta and left phrenic nerve c. superior vena cava and right vagus nerve d.
azygos vein, right vagus nerve, and trachea; e. left recurrent laryngeal nerve f. espophagus g.
thoracic duct
9. What is COPD? How does it relate to the respiratory system?
Chronic obstructive pulmonary disease is particulate accumulation that leads to chronic
bronchitis and inflammation; emphysema also occurs which is defined as enlargement of air
space distal to terminal bronchioles, reducing surface area.
10. An individuals suffering from a severing of the spinal cord … What would be the deficits
seen at each of these levels (relevance only to thorax): C2, C5, T4
11. What is aortic dissection? (not what you are doing in lab!)
12. What makes bleeding from an intercostal artery more difficult to stop than other locations?
13. What anatomical landmarks must be utilized to properly pace a chest tube?
14. Rupture of the esophagus would most likely lead to damage of what other structures?
15. What part of the heart would be ischemic should a coronary artery be occluded, do this for
each of the branches from the coronary arteries.
Be prepared to explain the anatomy behind the reasons!