Diaphragm
In tension, the mediastinum is shifted and the diaphragm is flattened.
What our notes say
- In tension, the mediastinum is shifted and the diaphragm is flattened. (Pneumothorax)
- Free air is seen under the diaphragm on an erect chest X-ray. (General Surgery CAT 2 (MBSG 4600): 4 October 2021)
- The patch and diaphragm are short-acting, and tubal ligation is permanent. (Year 4 Gynaecology CAT (MBOG 4212): 15 March 2019, 39 of 40 MCQs)
- Abdomen - pregnancy and ascites - are associated with a raised diaphragm. (Cardiovascular system examination revised 2012 — Past Paper Questions & Answers)
- cough is a protective action, and it can be initiated both voluntarily and via stimulation of cough receptors located throughout the respiratory tract (ear, sinuses, upper and lower airways to the level of the terminal bronchioles, pleura, pericardium, and diaphragm). (Examination of Respiratory system — Past Paper Questions & Answers)
- Chest X-ray: hyperinflation, flattened diaphragms, bullae, enlarged hila; excludes lung cancer, pneumothorax, heart failure. (Chronic Obstructive Pulmonary Disease (COPD))
Study material on Diaphragm
- Examination of Respiratory system
- Cardiovascular system examination revised 2012
- Chest X-ray Interpretation Guide: ABCDE Approach for Medical Students
- Master First-Year Anatomy: Must-Know Essays & Key Concepts
- Amebae
- CVS History & Physical Exam: Symptoms, Chest Pain & Syncope
- Ovarian & Colorectal Cancer: Risks, Pathogenesis, Staging
- CVS History, Physical Exam & ECG: Master Clinical Assessment
- ANATOMY MCQs
Images
Practice questions on Diaphragm
A patient with Hodgkin lymphoma has disease on both sides of the diaphragm involving multiple lymph node groups and the spleen, with no systemic symptoms. What is his Ann Arbor stage and what does the absence of systemic symptoms signify?
- Stage II-A — disease on same side of diaphragm, no systemic symptoms
- Stage III-A — disease on both sides of diaphragm including spleen, no systemic symptoms
- Stage IV-B — disseminated disease with no systemic symptoms
- Stage III-B — disease on both sides of diaphragm with systemic symptoms
Answer: B. Stage III involves lymph node regions on both sides of the diaphragm; the S suffix denotes splenic involvement giving Stage IIIS. The suffix A indicates absence of systemic symptoms (fever, night sweats, unexplained >10% weight loss). Stage B would indicate presence of these symptoms. Stage IV requires disseminated extralymphatic organ involvement which is not described here. ---
A neonate presents with regurgitation during the first feeding, aspiration, and abdominal distention from gas below the diaphragm. What is the most likely oesophageal abnormality and its most common variant?
- Oesophageal stenosis from submucosal fibrosis — presents after weaning
- H-type tracheoesophageal fistula without atresia — most common in neonates
- Oesophageal atresia alone — blind-ended upper pouch with no fistula
- Oesophageal atresia with distal tracheoesophageal fistula — most common variant
Answer: D. The most common variant is oesophageal atresia with a distal tracheoesophageal fistula. Gas below the diaphragm indicates a distal fistula allowing air into the GI tract. ---
Which of the following structures is related to the spleen, stomach, pancreas, and the left crus of the diaphragm? ---
- Left suprarenal gland
- Left kidney
- Left gonadal vein
- Transverse mesocolon
Answer: A.
All of the following statements concerning the central tendon of the diaphragm are correct EXCEPT ---
- It has no bony attachments
- It is incompletely divided into three leaves
- It is perforated by the aorta
- It is perforated by the inferior vena cava
Answer: C.
The crura of the diaphragm are musculotendinous bundles that arise from which of the following structures? ---
- Posterior longitudinal ligament
- Sternum
- Bodies of lumbar vertebrae L1, L2, and L3
- Renal fascia
Answer: C.
The following is TRUE regarding the structures that pass through the openings in the thoracic diaphragm EXCEPT ---
- Right phrenic nerve passes through the caval opening at T8
- The thoracic duct passes through the aortic opening at T12
- The vagus nerve passes through the oesophageal opening at T10
- The left phrenic nerve passes through the caval opening at T8
Answer: D.