Outline the principal anatomical features of the diaphragm that are important to its function.
Most candidates had a basic knowledge of diaphragmatic function however were
uncertain of anatomy and rarely related the two. Candidates were expected to
describe the attachments of the diaphragm, openings, nerve supply, actions,
including it’s role upon the oesophageal sphincter
Syllabus: B1b 2c
Recommended sources: Anatomy for Anaesthetists, Ellis and Feldman, pages 317 -
This question is quite similar to Question 21 from the second paper of 2015, except here the trainees were asked to to "outline the principal anatomical features of the diaphragm that are important to its function" rather than to "outline the anatomy of the diaphragm / describe the function of the diaphragm in respiration". From the rather different college comments on each question, the minor difference in wording may have some sort of special significance. Or, more likely, it does not.
Following the college recommendations from Question 21 where they suggested that "candidates who followed a traditional template for anatomy answers scored better", the following data comes from, and is structured like, Last's textbook (9th ed, p. 248-251). You can't get more traditional than Last's.
Anatomical features which are important to its function, if one could isolate those, would probably have to include the following:
Gauthier, ALAIN P., et al. "Three-dimensional reconstruction of the in vivo human diaphragm shape at different lung volumes." Journal of applied physiology 76.2 (1994): 495-506.
De Troyer, André, Peter A. Kirkwood, and Theodore A. Wilson. "Respiratory action of the intercostal muscles." Physiological Reviews 85.2 (2005): 717-756.
Poole, DAVID C., et al. "Diaphragm structure and function in health and disease." Medicine and science in sports and exercise 29.6 (1997): 738-754.
Hart, Nicholas, et al. "Effect of severe isolated unilateral and bilateral diaphragm weakness on exercise performance." American journal of respiratory and critical care medicine165.9 (2002): 1265-1270.
Luce, John M., and Bruce H. Culver. "Respiratory muscle function in health and disease." Chest 81.1 (1982): 82-90.