Re: True/False Clinical Correlate II - Lower Extremity and Thorax

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: : : True/False Clinical Correlate II - Lower Extremity and Thorax : : : These questions were not submitted by the lecturer : : : 1. Transatlantic flights and video games may lead to pulmonary embolism. : : TRUE. Transantlantic flights and videogames have in common the fact that they are essentially sedentary activities; pulmonary embolisms can be a result of deep vein thrombosis, which is a condition in which a clot forms in one of the deep veins of the leg (hence the name), and then can travel through the venous system to other, more life-threatening parts of the body. : Agreed. Notably from the popliteal fossa to the pulmonary artery. : : : 2. Bursitis may occur at the knee or hip joint. : : TRUE. Bursitis, which is an inflammation of a synovial capsule, can occur in any synovial joint. The most common locations for bursitis are the hip, shoulder, and elbow. : Agreed. Except to say; pair synovial with "cavity." Capsule is generally reserved for fibrous. Also, for example, the trochanteric bursa, prepatellar bursa, and infrapetalla bursa at at joints but they are not part of the synovial joint cavity. The suprapatellar bursa is a diverticulum of the synovial joint cavity. So much to know so little time. : : : 3. The genicular anastomosis provides collateral circulation across the ankle joint. : : FALSE. The genicular anastamosis provides collateral circulation across the knee joint, not the ankle joint. : Agreed. : : : 4. The malleolar anastomosis provides collateral circulation across the hip joint. : : FALSE. The malleolar anastomosis provides collateral circulation across the ankle joint, not the hip joint. : Agreed. Thus, know where the cruciate anastomosis is located. : : : 5. The suprapatellar bursa, but not the prepatellar bursa, is a diverticulum of the synovial cavity of the knee. : : TRUE. The prepatellar bursa, which sits superficial to the patella, is not a part of the synovial capsule of the knee, whereas the suprapatellar bursa is an extension of the synovial capsule of the knee which extends superiorly above and deep to the patella. : Agreed. Except, "an extension of the synovial joint CAVITY" : : : 6. The blood supply to lung tissue is by the pulmonary veins. : : FALSE. The blood supply to the lung tissue is by the bronchial arteries. : Agreed. : : : 7. The blood supply to lung tissue is by the bronchial veins. : : FALSE. The blood supply to lung tissue is by the bronchial arteries. : Agreed. A little redundancy there. But notice veins. Check this out. Veins can be worded to supply blood. Nevertheless, a poorly worded question. : : : 8. Enlarged pulmonary nodes may compress structures at the hilum of the lung (be careful). : : FALSE. The main lymph nodes to which the subsegmental, segmental, lobar and interlobar lymphatics drain are called the hilar nodes; as these nodes are located in the hilum of the lung, expansion or swelling of these nodes could potentially compress the structures of the hilum. : Agreed. Except to ask, where are the pulmonary nodes located? : : : 9. Bronchial arteries to the left lung are derived from the descending aorta. : : TRUE. The origin of the left bronchial arteries is from the thoracic (descending) aorta. : Agreed. And the right? : : : 10. A pulmonary embolism may raise right ventricular pressure. : : TRUE. If the pulmonary arteries are occluded (leading to lowered oxygen perfusion of the blood returning from the lungs), the right ventricle will overcompensate for the lack of perfusion by beating faster, and the pressure will increase. We would like to think that this has something to do with “vagus,” but then, we’re just MS1s. : Agreed. You know more than me on this. I was writing questions at the time. : : : 11. Bradycardia paired with chest pain may indicate a vagal nerve disturbance triggered by the sinuatrial node. : : TRUE. Given that reduction of the heartrate is primarily directed by the sinuatrial node, and that the innervation of the sinuatrial node comes from the vagus nerve, it would follow that a disturbance to the vagus nerve could manifest itself in the form of bradycardia and chest pain. As to whether the sinuatrial node can trigger a vagal nerve disturbance, we aren’t entirely sure. : Agreed. The idea is that the SA node becomes ischemic with RC blockage affecting the nodal artery. Ischemic excitable cells go nuts as they walk the path to death. The vagus gets a barrage of information that does not reflect physiologic regulation. : : : 12. A build up of fluid in the pericardial cavity may compress the heart and decrease filling of the heart chambers. : : TRUE. In a pericardial effusion, fluid fills the pericardium. Since the pericardium is fibrous and non-extensible, the fluid places additional pressure on the heart. If enough pressure builds up, the heart may stop beating all together. : Agreed. Excellent synopsis. Great for NBME commment. : : : 13. Pericardical centesis is performed at the right side of the xiphoid process. : : FALSE. Pericardical centesis is performed on the left side of the xiphoid process, not the right, due to the orietation and positioning of the heart within the middle mediastinum. : Agreed. Except to check my spelling. Not always a forte for me. Perhaps, pericardiocentesis. : : : 14. The sternochondral joints, but not the costochondral joints, are synovial. : : FALSE. The sternochondral joints are are synovial for ribs 2-7, and the costochondral joints between the ribs and costal cartilages of the sixth and ninth ribs are additionally synovial. : Agreed. I thought this to be true when I wrote it. I think I wrote this question on an exam once and had the pitch it. You appear to be citing chapter and verse. : : : 15. The costotransverse joints, but not the costovertebral joints, are synovial. : : FALSE. Both the costotransverse and costovertebral joints are planar-type synovial joints which facilitate a gliding motion of the ribs in relation to the vertebrae. : Agreed. Except to say that the upper costotransvers joints are "cupped." : : : 16. The esophagus may become compressed at the right main bronchus. : : FALSE. The right main bronchus does not run anteriorly to the esophagus, and thus the esophagus would be unlikely to become compressed at the right main bronchus. : Hmmmmmmmm. Please check this out. I thought that at the bifurcation (T4) the esophagus was still deviated to the the right side and posterior the right bronchus. The carina? Not the left bronchus? : : : 17. The costophrenic angle refers to a topography of the costodiaphragmatic recess. : : TRUE. The angle formed by the inferolateral margins of the diaphragm in relation to the inferolateral border of the costal margin (inferior edge of the ribs) is referred to as the costophrenic angle. : Agreed. A subtlety. : : Dr. Evey, any and all contributions or corrections would be immensely appreciated! Thanks again for all the help. : Your entirely welcome. Do well, and as hard as it may seem; Have fun! This exam is not meant to be merely a recital of previously learned anatomy; it is meant to give you the opportunity to reflect, to learn even more, and most of all; it is now your turn to be teachers of the staff. As you have become with this post. Thank you. Hey, I got to get going. I have a party to put on this AM.

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