Thorax card (new curriculum) : MBBS item viva questions (bangladesh)

THORAX

(Viva- item examination)

Item no-1: Thoracic Wall, thoracic cavity, Pleura & Mediastinum

1. Give the skeletal boundary of thoracic cage. Tell about content of thoracic cavity
2. Give the  boundary of thoracic inlet
3. Give the  boundary of thoracic outlet
4. What do you mean by typical intercostal space?
5. Mention the name of intercostal muscles with origin, insertion & NS
6. Define mediastinum with different subdivision. Give the boundary of superior / inferior (anterior/ middle/ posterior)  mediastinum and list their contents.
7. Joint: sternocondal jt & costochondal jt:  formation & type.
8. What do you mean by i) True ribs ii) False rib iii) Floating ribs
9. Identify sternal angle and write importance of sternal angle.
10. Bones: Typical rib, 1^st rib, 12^th rib
11. Figure- 1^st & 12^th rib

Item-2: Different joint of thorax

1.      Name different joint of thorax, mention their formation & type.

2.      Write about peculiarities of clavicle.

3.      Define joint. Classify joint

4.      Classify (fibrous/cartilaginous/ synovial joint)

5.      Write features of synovial joint.

6.      Difference between primary & secondary cartilaginous joint.

7.      Bone: Clavicle, Sternum  

8.      Figure: clavicle /Sternum/Typical synovial joint./Fibrous joint/Cartilaginous joint.

Item-3:

1.      Define pericardium. Write different layers with blood & nerve supply

2.      How many chambers present within heart.

·         Write a flow chart to describe systemic circulation.

·         Write a flow chart to describe pulmonary circulation

·         Write a flow chart to describe portal circulation

3.      List the name of structure enter into the right atrium of heart.

4.      How sternocostal surface of heart is formed?

5.      Draw & label arterial supply,venous supply of heart and nerve supply of heart

6.      Discuss the  role of sympathetic& para sympathetic nervous system on heart

7.       Mention difference layers of heart.

8.      Identify/formation 

Four chamber of heart 

 Surfaces- sternocostal, diaphragmatic,  left surfce , base

Borders-Right border Left border, interior border

Grooves – Coronary sulcus, ant. & pos. interventricular grooves

Vessels: Rt & Lf coronary artery, coronary sinus

Root of great vessels- SVC, IVC, ascending thoracic aorta, arch of  aorta, descending thoracic aorta, four pulmonary vein, pulmonary trunk

         Interior of heart- Interventricular septum/Papillary muscle/Corda tendenae/Cups/

                                        musculae pectinae/fossa Ovalis /Limbus fossa ovalis.

             Figure:    1. Arterial supply of heart

                               2. Venous system of heart

                               3. Conducting system of heart

Item-4:

1.      Define pleura mention its different layers. Mention blood & nerve supply of pleura.

2.      Extension of trachea. Difference between Rt & left principal bronchus. Blood supply of trachea

3.      Extension of conducting & respiratory part.

4.      Lining epithelium of conducting & respiratory part. 

5.      Identify-

    Surfaces- medial i) Vertebral   ii) Mediastinal, 

    Costal, Base, Apex, Hilum

      

              Bordar- Anterior border & inferior  border.

              Ligament- Pulmonary ligament.

              Groove- Groove for azygous vein, Groove for SVC, IVC, Descending thoracic aorta.

        6.  Function of conducting & respiratory part.

        7.  Define Branchopulmonary segment. Draw & label B.S of both Lung.

 Figure- pleura   

                       - Supra-plueral membrane - formation, attachment function.

  Item-5:The Diaphragm & Oesphagus:

Esophagus: Extension, Lining epithelium, Blood supply,  peritoneal relation, Porto-systemic anastomosis

The Diaphragm- Anatomical points

                          -Formation

                         - Parts

                         - Openings – vertebral label & structure passing through it.

                         - Functions.

                         - Nerve supply- sensory and motor.

                         - Type of muscle present in the diaphragm.

Bones: Typical thoracic vertebrae, Atypical thoracic vertebrae

Item-6:

Phrenic nerve- root value.

                      - Important relation.

                       - what type of nerve it is?

                       -arises from which plexus 

                      - supplied area.

Spinal nerve: Formation & location.  

                      Branches.

                      what type of nerve it is?

                      Draw & label

                      Number.

Intercostal nerve: Formation

                             Location

                             Difference between spinal nerve & intercostal nerve.

Lymphatic drainage:

What are right lymphatic duct, thoracic duct & cisternal chyli?

Branches of ascending aorta & desconding aorta tributaries of SVC, azygous & hemiazygous vein  

Spinal cord at a glance

Spinal Cord & Nerves

This is the viscera of spinal cord and spinal meninges

1.         Anatomical points:

             I.         anteriror median fissure lies anteriorly

          II.      cauda equine lies inferiorly

2.         length : 45cm                    wide 2.5 cm

3.          Extension of spinal cord:

   Adult: at the level of foramen magnum to lower border of 1^st lumbar vertebra

   Children: at the level of the foramen magnum to the 3^rd lumber vertebra

4.         Terminal part of sub-arachnoid space of the spinal cord : lower border of 2^nd sacral vertebra

5.         termination of filum terminalis: at the 1^st coccyx

External feature of spinal cord :

i)                    anteriorly : anterior median fissure

ii)                  posteriorly : posterior median septum

iii)                inferiorly : filum terminalis and cauda equine

iv)                two enlargement in cervical and lumbar region

v)                  external surface is covered by spinal meninges : outer meningeal dura mater, middle arachnoid mater and  inner pia mater

vi)                ventral roots, dorsal roots and dorsal root ganglia and spinal nerve

6.         How many enlargement present within the spinal cord and why?

i)                    Cervical enlargement: extend from the foramen magnum to 1^st thoracic vertebra. Supply upper limb

ii)                  Lumbar enlargement: extend from thoracic 10^th to 12^th vertebra. Supply lower limb.

7.         What is spinal segment?

 Ans: Part of the spinal cord to which one pairs of spinal nerve is attached.

8.         How many spinal segments present in the spinal cord? – 31 spinal segments

9.         What is conus medullaris? – cone shaped terminal part of spinal cord

 1.         What is filum terminalis ? – it is the prolongation of pia mater which extend from the cunus medullaris to 1^st coccyx

2.         What is cauda equine: the lumbar and sacral roots below the termination of spinal cord continue as a leash of nerve roots known as cauda equine.

3.         What is legamentum denticulate: it is the thickening of pia mater situated on either side of spinal cord between nerve roots. (Figure ellis 364)

Spinal nerve

How many Spinal nerves present in our body? Number: 31 pairs. 8 cervical spinal nerve, 12 thoracic spinal nerve, 5 lumbar spinal nerve, 5 sacral spinal nerve and 1 coccygeal spinal nerve

How a spinal nerve is formed? :  Spinal nerve form by union of ventral and dorsal nerve roots

Location of spinal nerve: within the intervertebral foramen

Exit : C1-C7 spinal nerves exit ABOVE C1-C7 vertebrae

                         C8 spinal nerve projects below C7 vertebra

                         T1-S5 spinal nerves project BELOW T1-S5 vertebrae

 Branches of a Spinal Nerve:

                        1. dorsal ramus – supply deep muscles and skin of back

                        2. ventral ramus – supply upper and lower extremities, ventrolateral trunk

                        3. meningeal branch - back into the spinal column

                        4. rami communicantes - for autonomic nerve fibers

Type of spinal nerves: they are mixed nerve (both sensory and motor ).

Component: GSA (general somatic afferent –carry impulse from periphery to CNS) and GSE( general somatic efferent- impulse goes from CNS to skeletal muscle)

Plexus of spinal nerve: plexus of spinal nerve is formed by ventral rami of different spinal nerves. There are four spinal nerve plexus  present within the body.

Name of plexus	Formation	Supplied area	Important nerve of the plexus
1. cervical plexus	ventral rami of C1-C4 with some C5	a. muscles/skin of head, neck, some shoulder b. phrenic nerve - diaphragm muscle (breathing)	phrenic nerve -
2. brachial plexus	ventral rami of C5-C8 and T1	Upper limb and shoulder	Axillary N, musculocutanous  N, Radial N, median N, Ulnar N
3. lumbar plexus	- ventral rami of L1-L4	a. abdominal wall, genitals, part of lower limb	Femoral N, Obturator N
4. sacral plexus	ventral rami of L4-L5 and S1-S4	a. buttocks, perineum, part of lower limb b. sciatic nerve	Sacral n- largest nerve of body,  pudendal n, Sup and inf Gluteal n

                       

 Dermatomes: area of skin is supplied by single spinal nerve

           

Internal feature of spinal cord:

Inner grey matter contains a central canal. Parts of grey matter, ant horn and pos horn and lateral horn only in thoracic and lumbar region

Grey matter contain motor and internuncial neuron

Parts of outer white matter: 1. anterior (ventral) column

                        2. posterior (dorsal) column

                        3. lateral (intermediate) column

white matter contain ascending and descending tracts:

fasciculi/tracts –they are collection  axon bundles within the CNS. They are two types:                                a. ascending tracts – carry sensory impulse to the brain. Spinothalamic tract

            b. descending tracts – carry motor impulse from brain to the effector organ (skeletal muscle). corticospinal tract

Important tract within the spinal cord :

ASCENDING TRACTS (SENSORY)
anterior (ventral) spinothalamic	touch and pressure to thalamus
lateral spinothalamic tract	pain & temperature to thalamus
fasciculus gracilis	touch, 2-pt. discrimination,
fasciculus cuneatus	conscious proprioception,      vibration
posterior spinocerebellar                                  anterior spinocerebellar	subconscious proprioception

DESCENDING TRACTS (MOTOR)
lateral corticospinal                                          anterior corticospinal tract	Carry motor output from cortex to motor neuron of ant. Grey horn which stimulate the skeletal muscles

Blood supply: one ant and two posterior spinal arteries. Other branches: ascending cervical a, pos intercostals a, and the lumbar a

Vein: ant and pos spinal vein.

Development : caudal part of neural tube (neuroectodarm)

Cell cycle: easy and brief description

Cell cycle

Cyclic changes of a cell involving interphase and mitosis is known as the cell cycle.

There are two stages of cell cycle

1. Inter-phase : divided into three phases:

                            G1 Phase

                             S phase and

                              G2 phase

2. Mitosis

Interphase

The phase between two mitoses is called inter-phase

Phase	Duration	Synthesize
The G1 phase it began at the end of M phase	longest duration the most variable phase of the cell cycle	the RNA and protein synthesis
S phase	7 to 10 hrs	DNA synthesis
G2 phase	1hr	Accumulation of energy (for mitosis) Synthesis of tubulin (for formation of mitotic microtubules) Synthesize of chromosomal non-histone proteins

G0: Some terminally differentiated cells leave the cell cycle after the M phase and enter Go phase

Example : neuron

Trigone of urinary bladder

Trigone of urinary bladder: it is situated interior of base of urinary bladder 

Boundary:

Distance between ureter to ureter 2.5 cm

Distance between ureter to urethra 2.5 cm

But in distended bladder it is 5 cm

Inter-ueteric fold is formed by continuity of the longitudinal muscles of ureters across the bladder

Ureteric orifice close by distension of urinary bladder but it open rhythmically in response to ureteric peristalsis and a jet of urine injected into bladder (4 or 5 times a minute normally )

Trigone contain two group of muscles

Superficial trigone muscle :

1.       a triangular layer of muscles, morphologically distinct component of the trigone

2.       it contain small diameter smooth muscle cells

3.       it is a thin muscle layer except at interureteric fold and urethra-ureteric fold where it is thicken

4.       in both sex it is continuous with muscles of ureter and urethra and in male it is also continuous with muscles of ejaculatory duct near the opening  

5.       different from other part of urinary bladder , it is rich in sympathetic supply

Deep trigone detrusor muscle

Sympathetic supply of urinary bladder:

1.       Vasomotor

2.       Inhibit detrusor muscle

1.       Motor to superficial trigone muscle and muscles of bladder neck in male

Parasympathetic supply of urinary bladder

1.       Contraction of detrusor muscle

2.       Sense of filing – travel by parasympathetic system then spinal cord then by tract of gracile

3.       But pain sensation travel by both sympathetic and parasympathetic then lateral spinothalamic tract