Thorax card : must know item questions for MBBS course in Bangladesh

THORAX

(Viva- item examination)

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

1. Give the skeletal boundary of thoracic cage. Write content of thoracic cavity
2. Give the boundary of thoracic inlet. Discuss the name of structures passing through it.
3. Give the  boundary of thoracic outlet. Which structure cover the outlet?
4. What do you mean by typical intercostals space? Discuss blood and nerve supply of it
5. What do you mean by intercostals nerve ?
6. Discuss the difference between spinal nerve and intercostals nerve
7. Mention the name of intercostal muscles with origin, insertion & nerve supply
8. What do you mean by innermost intercostalis?
9. Identify sternal angle and write importance of sternal angle.
10. Joint: sternocondal jt & costochondal jt formation & type.
11. What do you mean by i) True ribs ii) False rib iii) Floating ribs
12. Define mediastinum with different subdivision. Give the boundary of superior / inferior (anterior/ middle/ posterior)  mediastinum and list their content.
13. Bones: Typical rib, 1^st rib, 12^th rib
14. 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/artilaginous/ synovial joint)

5.      Write features of synovial joint.

6.      Defferene between primary & secondary cartilaginous joint.

7.      Bone: Clavicle, Sternum  

8.      Figure: clavicale /Sternoum/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-

Four chamber of heart- Rt/Lf atrium & nerve

 Surfaces- sternoostal, diaphragmalic left, base

Borders-Right border Left border, interior

Groove – Coronary suleus, ant. & pos. interventricular groove

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

         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.      Linning epithelium of conducting & respiratory part. i) Vertebral   ii) Mediastinal

5.      Identify-

    Surfaces- medial, 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:

Oesphagus: 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.

                      - supplied area.

Spinal nerve: Formation & location. 

                      Branches.

                      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  

Item No-2; heart with Pericardium

1. Define pericardium. Name its different layer’s.
2. Give the blood supply and nerve supply of different layer’s of pericardium.
3. Identify and demonstrate i) coronary sulcus ii) anterior interventricular sulcus iii) posterior interventricular sulcus iv) apex v) base vi) Right, left .inferior & superior border viii) stern costal, diaphragmatic and posterior surface of the heart.
4. Demonstrate the anatomical position of the heart.
5. Give the anatomical location of the apex of the heart.
6. How the following structures of the heart is formed i) apex ii) base iii) right ,left and inferior border.
7. Give the contents of the i) Coronary sulcus ii) Anterior interventricular sulcus iii) posterior interventricular sulcus.
8. Give the boundary and importance/ significance of i) transverse pericardial sinus ii) oblique pericardial sinus.
9. Name the different layer’s of the heart.
10. Give the features of the interior of i) right ventricle ii) left ventricle iii) right atrium iv) left atrium.
11. Give the location and structural components of i) aortic valve ii) pulmonary valve iii) Mitral valve iv)Tricuspid valve. Give their functional importance.
12. Give the blood supply of the heart.
13. Give the nerve supply of the heart.
14. What are the effects of sympathetic and parasympathetic stimulation on the heart.
15. Trace out the origin, course and area of supply of i) right coronary artery ii) left coronary artery.
16. Trace the course of coronary sinus
17. Name the veins of the heart and give their location.
18. Name the Junctional tissue of the heart. Give their location and blood supply.
19. What do you mean by fibrous skeletons of the heart. Name its different parts and give its functional importance.

Item no 3: Lung, trachea and Bronchus.

1. Identify and demonstrate the following structures of right and left lung i) apex, base, costal surface, mediastinal surface, vertebral surface, hilum of the lung, pulmonary artery, pulmonary vein, principal bronchus, transverse fissure. Oblique fissure, anterior border, posterior border, inferior border, cardiac notch and lingual of left lung.
2. Give the anatomical points of left and right lung.
3. Give the morphological difference between left and right lung.
4. Give the relation of i) vertebral surface ii) costal surface iii) mediastinal surface of both lung.
5. How will you differentiate a natural fissure of the lung from an artificial fissure.
6. Name the different segment of the bronchial tree.
7. Give the blood supply and nerve supply of the bronchial tree,
8. Give the blood supply of the lung.
9. How will you differentiate between lungs of a still birth from that of a live birth.
10. What do you mean by i0 respiratory membrane ii) respiratory epithelium.
11. Name the different layer’s of respiratory membrane.
12. Name the different cells of the alveoli.
13. Define broncho-pulmonary segments.
14. Draw and level bronchopulmonary segments of i) right and ii) left lung.
15. Give the difference between i) right principal bronchus ii) left principal bronchus.
16. Give the difference between hila of right and left lung.

Item NO 4: Blood vessels, Nerves and Lymphatic’s of the thorax.

1. Give the arterial supply of the intercostals space.
2. Give the venous drainage of the intercostals space
3. Give the lymphatic drainage of the intercostals space
4. Give the formation, tributaries and termination of the azygoes vein.
5. Give the origin, location and branches of internal thoracic artery.
6. Give the extension, location and branches of  i) ascending aorta ii) arch of aorta iii) descending thoracic aorta.
7. Give the origin, course(location), termination and area of drainage of i) right lymphatic duct ii) thoracic duct.
8. Give the site and attachment of suprarenal membrane. Give its function.

ItemNo-5: Bones and Joints of the thorax

1. Name the different bones of the thoracic cage.
2. Give the different parts, anatomical features, anatomical positions of the bones of the thoracic cage.
3. Name the joints of the thoracic cage .Give their formation and types.
4. Name ligaments, their attachments of the joints of the thoracic cage,
5. Define joints, classify joints , Give examples from thoracic region.
6. Give the identifying points of the followings i) 1^st rib ii) 2^nd rib iii) typical rib iv) Typical thoracic vertebra.
7. Give the posterior relation of the i) manubrium sterni ii) body of the sternum iii) anterior relation of the neck of the 1^st rib.
8. Give the muscular and ligamentous attachments of attachments i) 1^st rib ii) 2^nd rib iii) manubrium sterni iv) body of the sternum.

9.  

Pleura : must know SAQs

Pleura

1. define pleura 
2. mention the different parts of pleura 
3. discuss blood and nerve supply of pleura 
4. discuss the development of pleura 
5. define pleural effusion, pleuritis, pneumothorax
6. discuss pleural recesses 

Mediastinum: must know SAQs

Mediastinum

1. Define mediastinum with different subdivision.
2. Give the boundary of superior / inferior (anterior/ middle/ posterior)  mediastinum and list their content. 
3. how many vertebra present just behind the menubrium sternae 
4. sternal angle present in which level of vertebra  
5. which tumor involve superior , middle and posterior mediastinum ? 
6. which pathological condition widen mediastinum? 
7. what do you mean by pneumomediastinum? 
8. discuss cranial and caudal communication of mediastinum :  The mediastinum communicates cranially with the fascial planes of the neck via the thoracic inlet. Caudally the mediastinum communicates with the retroperitoneal space through the aortic hiatus. These communications provide the means for the spread of mediastinal disease to the neck and abdomen and vice versa.
9. how many mediastinal reflections are present in our body? There are three mediastinal reflections (Figs 1, 2, and 3) two of which are frequently identified in normal thoracic radiographs: (1) the cranioventral mediastinal reflection; (2) the caudoventral mediastinal reflection; and (3) the vena caval mediastinal reflection or the plica vena cava.
   The cranioventral mediastinal reflection is caused by extension of the right cranial lung lobe across the midline, pushing the mediastinum to the left. It is usually visible on the ventrodorsal or dorsoventral projection as a curvilinear soft tissue opacity extending from T1 or T2 to the cranial left border of the heart (approximately the level of the pulmonary artery segment). The thymus lies in this reflection. On the lateral projection, the cranioventral mediastinal reflection and the margin of the right cranial lobe may frequently be identified immediately cranial to the heart.
   The caudoventral mediastinal reflection is caused by extension of the right accessory lung lobe across the midline and is only seen on some ventrodorsal or dorsoventral radiographs. It is seen as a relatively straight, soft tissue opaque line extending from the left apex of the heart caudally to approximately the middle of the left diaphragm.
   The caudal vena caval mediastinal reflection, or plica vena cava, is not visible.
10.  DISCUSS RADIOGRAPHIC ABNORMALITIES OF THE MEDIASTINUM:
    
    Radiographic abnormalities of the mediastinum are related to:
    1.  Positional abnormalities (mediastinal shift)
    2.  Mediastinal effusion
    3.  Mediastinal masses
    4.  Abnormal visualization of mediastinal structures (pneumomediastinum)
11.  Discuss cause of mediastinal shift :
    
    A mediastinal shift occurs when the mediastinum is displaced by pressure differences between the right and left pleural cavities.
    Mediastinal shift is diagnosed by evaluating the position of the heart, trachea, aorta and caudal vena cava or the mediastinal reflections on dorsoventral or ventrodorsal views.
    When a mediastinal shift is seen on a radiograph, we must:
     Examine for a technical artifact, because rotation of the animal will mimic mediastinal shift
     Check for underlying lung disease (atelectasis or bronchial obstruction)
     Look for signs of a previous or present pleural disease
     Look for concomitant changes of the diaphragm, the spine or the thoracic wall.
12.  what do you mean by mediastinal effusion ?
    Free mediastinal fluid is usually of soft-tissue opacity; therefore, it may appear radiographically as a mediastinal mass or as cardiomegaly if it collects around the heart, or both.
    Mediastinal fluid may results in reverse fissures lines as fluid dissects into the interlobar fissures from hilar region. The reserve fissures line are wide centrally and narrow peripherally.
    The more common causes of mediastinal fluid are:
    1.  Feline infectious peritonitis
    2.  Trauma
    3.  Coagulopathy
    4.  Oesophageal perforation
    5.  Mediastinal masses