anatomy Flashcards
thoracic wall (bone)
thoracic vertebrae (t5-t8)
related to desending thoracic aorta
aorta contacts at t6 level
ribs
sternum
thoracic wall (muscles)
diaphgram
intercoastals
what will happen in case of an Aneurysm of the decending Thoracic aorta?
erode of t5-t6 vertebrae due to pressure atropy
intervertibular disc will remain unharmed as it it avascular structure.
In case of Sarcoma in thoracic cavity what will get affected?
only vertebral body not the discs
sarcoma metastasize through blood and discs are avascular
will tubercolosis affect vertebral disks?
yes. although Primary tuberculosis only affects four organs (lung,skin,tonsils and intestine)
but when you are immunocompromised the TB is reactivated and then can affect any other organ such as the Vertebrae
first it affects the body of the vertebrae and then extends to the disc forming a COLD absess.
ribs are the weakest at the________
Coastal angle
most commonly fractured rib?
middle ribs
Least commonly fractured ribs
first two ( protected by clavicle) last two (floating)
what is pluritic chest pain?
Chest pain related to breathing. not present when breathing stopped voluntarily (pain when lung or pleura is moving)
flail chest (stove in chest)
A segment of a rib cage breaks and gets detached from the thoracic wall.
what type of movement in seen in flail chest?
Paradoxical Movement (on inhalation affected part will move inward and outward during exhalation) (opposite as in normal breathing.
what is cervical rib?
an extra rib formed growing from the base of the neck just above the collarbone. You can have a cervical rib on the right, left, or on both sides. It may be a fully formed bony rib or just a thin strand of tissue fibres.
what is thoracic outlet syndrome? usually occuring due to extra rib formation such as cervical rib
Thoracic outlet syndrome (TOS) is a term used to describe a group of disorders that occur when there is compression, injury, or irritation of the nerves and/or blood vessels (arteries and veins) in the lower neck and upper chest area.
what is Coarctation of aorta?
in some kids there is abnormal marrowing of aorta so blood flow to the lower organs is compromised
narrowing=increase pressure=open of some anastamoses that should be closed opens
often can cause indentation/notching in the ribs as the blood flow and pressure becomes high in the intercoastal arteries
Why Sternum Fracture is a disaster waiting to happen? (sternum is one of the hardest bone to break)
it can cause
1) Traumatic rupture of the Aorta (the aorta is the weakest at the junction of the aortic arch and the decending part)
2) Cardiac contusion
3) pulmonary contusion
is it possible to live without a diaphgram?
yes. but cannot do vigorous task as only intercoastal muscles wil be helping with the respiration
What if half of the diaphgram is Paralysed?
other half have a completely diffrent nerve supply so it will work.
What does external intercoastal muscles do?
Expand chest outwards during inhalation to fill air in. same way vice versa the internal intercoastal muscles pull the chest inwards during expiratiok to move the air out
Before the lung? Tracheo bronchial tree
Between the lungs? Mediastinum
around? pleura
:)
Wuperior and inf mediastenum?
angle of lewis of sternum
what divides inf. med. into anterior, middle and post region?
Heart
what happens in lung contusion?
involving injury to the alveolar capillaries, without any tear or cut in the lung tissue. This results in accumulation of blood and other fluids within the lung tissue. The excess fluid interferes with gas exchange leading to hypoxia.
we give diuretics in this case.
what can pneumomediastinum leads to? (air in the mediastinum)
pneumothorax
pneumopericardium (air in layer of heart)
pneumoperitoneum( air in pleura of lung)
what is Beck’s triad? (pericardial Tamponade)
Pericardial Tamponade is a condition in which fluid is filed between the pleura/pericardium of the heart that causes pressure on the heart muscles
the high pressure prevents the heart to dilate fully thus reducing the blood flow to the body as a whole
Beck triad is a collection of three clinical signs associated with pericardial tamponade which is due to an excessive accumulation of fluid within the pericardial sac. The three signs are:
1) low blood pressure (weak pulse or narrow pulse pressure)
2) muffled heart sounds
3) raised jugular venous pressure.
What is Tension Pneumothorax?
When there’s damage to the pleura, either due to lung disease or trauma to the chest wall, air from the outside or from the lungs can flow freely into the pleural space, but cannot leave. The accumulated air in the pleural space puts positive pressure on the lung and prevents it from expanding properly, which causes respiratory distress. As the air continues to accumulate, the trachea and other structures of the chest can be pushed away from the pneumothorax, leading to increased difficulty breathing. Additionally, the increased pressure inside the chest can compress the heart and lead to a collapse of the blood vessels that drain to the heart, in turn decreasing venous return and cardiac output. If left untreated, tension pneumothorax can rapidly progress to cardiovascular collapse, which ultimately leads to cardiac arrest.
what is tracheal shift towards Normal side.
Okay so lets say in case of tension pneumothorax the air is filled in the pleura of left lung so pressure inside becomes positice. this furthur will push the organs including the trachea towards the right side (the unaffected or the normal suide) this shift is known as shift to normal side
what is shift to the affected side and where is it seen?
seen in pulmonary Fibrosis. affected side fibsosis=lung shrinks=space between the visceral and parietal pleura=space increase=negative pressure formed=pull stuff=pull organ toward affected side.
what is tracheal tugging?
it is a slight downward movement of trche with each inspration.
causes–
what is a carina
the ridge between two main bronchus division of lung. basically angle. if it widens it means there is a tumor that is growing in the LN between the carina or lymphadenitis infection (again increase in size of the LN)
if a child inhales a peanut , in which bronchus will it go?
most likely in the right as it is more vertically located. more downward slope
left is a little more horizontal
this will cause obstrutive atelectasis of lung once it passes the carina.
in the carina=cough
passes from carina to the lung (usually right lung)= no cough but a disaster waiting to happen]
if peanut is inhaled when child id in upright position= most likely to go in lower lobe
while supine= superior segment of rght lower lobe
while lying on his right side=right upper/middle lobe
(just see the gravity)
If there is a problem with respiratory muscles what will be afected and what kind of disease will occur?
the Inspiration will get affected as its an active process that requires muscle (expiration is passive)
inspiration damage=air cannot get in= Restrictive lung diseases
JOint diseases= Breathing problems occurs normally
costovertebral,costochondral and sternocoastal joints help in breathing)
What happens if a Segmental Bronchus is obstructed by something?
the collapse or atelectasis of that segment only (each lung segment is its own entitiy not depending n the other segments) called segmental obstructive atelectasis.
what happens if a segmental bronchus is affected by cancer/tubercolosis?
it will spreas to other segments and then to the whole lobe of the lung.
can visceral pleura sense pain?
no. visceral pleura in insensitive to pain but sensitive to distension. only parietal pleura can detect pain.
also the apex of the lung is located above the clavicle so in case og injury to the base of neck or near clavicle this pleura is affected and should be checked.
Diffrence between pleurisy(Inflammation od the sac surrounding the lungs) and pericarditiis (inflammation of the pericardium surrounding heart)
pain
1) in pleurisy the pain is pleuritic in nature (with breath) and stops when not breathing. sharp and stabbing pain. usually anywhere in the chest
radiates to apex (phrenic nerves) or intercoastal nerves
in pericarditis the pain doesnt stop with stopping breathing. often it can increase while inhaling but doesnt go away completely
it increases when lying backwards,doing heavy excersise, and improves while sitting in a good posture or leaning forward.
sharp pain present in cntre or left
radiates to the back
2) friction rub sound in pleurisy is biphasic (inhalation and exhalation)
pericarditis is triphasic (systole, early and late diastole)
extra pleural notes
water in pleura =hydrothorax (usually a transudate) reasons can be CHF, Nephrotic sundrome or cirrhosis
pus in pleura= pyothorax (usually an exudate due to increase permeability of vessel wall)
pleural empyema
How to manage tension pneumothorax?
1) needle decompression (thoracentesis) 2nd and 3rd rib , mid axillary line
2) thoracostomy tube 5th ic space at the anterior axillary line
at what point will you insert the needle if you want to take the sample of the pleural fluid in case of pneumothorax?
7th IC space on the posterior side. dont go very deep as it can injure the diaphrgm liver or spleen
where do Lymph nodes from the right lung drain?
Right Tracheo-Bronchial Lymoh Nodes (present at carina )
where do Lymph nodes from the left lung drain?
Left Tracheo-Bronchial L.N.
exception= the inferior lobe of left lung drains its L.N. into Right Tracheo Br. nodes
What if there is a painless Left Tracheobronchial Lymphadenopathy?
Cancer of left lung
What if there is a painless Right Tracheobronchial Lymphadenopathy?
Cancer of right lung OR the cancer of lower lobe of left lung
What is virchows node?
it is the left supraclavicular lymph node.
drains the contents of the abdominal cavity :)
AN Enlarged , Hard and painless virchoes node indicates what?
Carcinome (lymph lover) within the abdominal cavity.
Gastric cancer, Pancreatic cancer, Ovarian cancer, testicular, Breast.
this is called as troiesiers,s sign
AN Enlarged , Hard and painfull virchoes node indicates what?
Infection (infection is painfull, cancer is painless) such as tubercolosis, sarcoidosis and toxoplasmosis :)
what if you find an enlarged Virchows node and an enlarged sister mary joseph node? (at umblical)
indiacte abdominal malignancy
any malignancy in the right upper quadrant area will drain to?
right thoracic duct (righnt supraclavicular Lymph node)
any malignancy in the left upper and lower quadrant , as well as right lower quadrant area will drain to?
left thoracic duct ( virvhows node/ left supraclavicular node)
