Anatomy Flashcards
ectopia cordia
baby born with heart outside chest wall
pectus excavatum
“bowl shaped”overgrowth of costal cartilage. push sternum/xiphoid INWARD to chest
pneumothorax
lung deflates due to break in intraplural sealSx: absent breath soundsdyspnea
sternal angle of louis
2nd costal cartilage
mediastinum
“midway”central compartment of the thoracic cavity. It contains the heart, the great vessels of the heart, the esophagus, the trachea, the phrenic nerve, the cardiac nerve, the thoracic duct, the thymus, and the lymph nodes of the central chest.surrounded by loose connective tissue. superior and inferior portions divide at T4/T5
valvular areas for auscultation
places to put stethoscope where valvular sounds project to the chest surface (A,P, T, M)
aortic valve: 2RICS
pulmonic vlave: 2LICS
Tricuspid vavle: 4LICS
Mitral valve: apex, 4LICS or 5LICS at midclavicular line
primary mover of air in/out of lung
diaphragm
ventilation: movement of costovertebral joints and sternum
ribs rotate up and out to increase chest volume= “bucket handle”sternum pushes anterior= “pump handle”
chest tube btwn what muscles?
pect. major and latissimus dorsimid- or anterior- axillary line
placement of chest tube: where in ribs?
btwn 5th and 6th rib5th intercostal spacerun along TOP of rib to avoid V.A.N.mid- or anterior- axillary line
hemothorax
blood accumulates in the pleural spacelimiting the amount that the heart’s ventricles are able to fillSx: dyspnea, diminished (distant) blood soundspercussion= Dull resonance
flail chest
thoracic segment is loose and moves independently with “paradoxial motion”Sx: dyspnea
In expiration, the diaphragm rises to what level?
4th intercostal space at the level of the nipple, and thus chest drains should be placed above this level
pectus carinatum
pigeon chest/ “keel shaped”deformity of the chest characterized by a protrusion of the sternum and ribs.
dyspnea
Difficult or labored breathing; shortness of breath
what causes an elevated hemidiaphragm
see on XRAY: diaphragmatic position is not symmetricphrenic nerve palsy/damage”C3/C4/C5 keeps the diaphragm alive”
which fascia lines the entire thoracic cage
ENDOTHORACIC FASCIA
what is the hilum of the lung
the doorway of the lungthe vessels and bronchi pass through this (‘the root”)
XRAY: widened mediastinum
trauma/ rapid deceleration accident (MVA)torn aorta
posterolateral thoracotomy
an incision through fifth intercostal space on the back, and is often widened with rib spreaders. common approach for operations on the lung/mediastinum/ esophagus/pulmonary hilum (pulmonary artery and pulmonary vein)
poland syndrome
congenital abnorm: absence of stertnocostal head of pectoralis majorshortening of upper extremities/digitis
coarctation of the aorta
congenital abnormstenotic aorta (narrowed)intercostal arteries enlargedxray: notched/remodeling ribs(typically constriction found on aorta distal to branching of L subclavian artery)
arrangement of neurovascular bundle in costal grove
main intercostal Vein, Artery,m Nerve (VAN)superior to inferior
What as the embryonic origin of the respiratory system (trachea, bronci, lungs)?
respiratory diverticulum
at what age are the lungs fully mature?
8 years
compare development of right and left lungs/bronchi
right grows faster, and more vertically (has 3 lobes)left grows slower, more laterally- bronchi are oriented similarly (right is more vertical and wider)
Describe the most common tracheoesophageal fistula?
Proximal esophagus is closed off; distal esophagus communicates with trachea - Failure of primitive foregut to divide into ansterior trachia and posterior esophagus - Gastric acid could reflux into the lung
What develops from the M2A tube?
FILL IN
What is the origin of the pleural space?
Coelom (pocket of mesoderm)
Contrast the visceral and parietal pleura.
Visceral (splanchic) is adhered to the lung surface (can’t be separated). - autonomic innervation (no pain sens.)Parietal (somatic) lines the outside of the cavity, lines the inside of the ribcage; - innervated (intercostal and phrenic n.), can feel pain
Significance of rubbing sounds from the triangle of auscultation?
Pleurisy- inflammation of parietal pleura assc. w pneumonia- exudate is released (becomes invaded by fiboblasts)- rubbing causes pain and can be heard
What is pleural fluid?
a consituent of blood
What is the lowest portion of pleural cavity? Significance?
costodiaphragmatic recess- the site where fluid will accumulate when the patient is upright
What is another related association of shoulder pain?
pain sensation to the parietal pleura to the phrenic nerve (from same roots as nerves that supply the shoulder)
What is the origin of the visceral pleura?
derived from splanchnic mesoderm - innervated by pulmonary plexus (pressure/stretch, but not pain)
What lines the visceral pleura?
Simple squamous mesothelium
A trachial deviation is the hallmark of what underlying problem?
Tension pneumothorax- trachea will be pushed away from the pneumothorax by the influx of air pressure
What is a consolidation of the lung?
A lobe of lung that has filled with fluid; will appear opaque on chest radiograph
Where is the first division of the bronchi where air exchange occurs
respiratory bronchial
At which phase of lung development is gas exchange possible?
- Pseudoglandular period (6-16 weeks)2. Early Canalicular period (16-20 weeks)3. Late Canalicular period (20-26 weeks): fetus survival rare, but possible (answer)4. Sacular period (26-40 weeks)5. Alveolar period (term birth to 8 years)
What produces surfactant?
Type II Pneumocytes
most common site of FB/aspiration in lungs: R or L bronchus?
R bronchus intermediusR mainstem bronchus is shorter/straighter than the 90* L mainstemxray: airspace opacity in a lobe
In patients who aspirate while in a supine/recumbent position, which lung lobe is effected
superior segments of the RLL and the posterior segments of the RUL (right upper lobe)
In patients who aspirate while in a erect position, which lung lobe is effected
right lower lobe basilar segments
what are the five parts of the mediastinum?
- superior Inferior
- anterior
- middle
- posterior
what is located in the superior mediastinum (5)?
thymus
- great vessels (SVC, arch of Azygos, arch ofAorta) trachea
- esophagus thoracic duct
what is located in the anterior (inferior) mediastinum (1)?
THE THYMUS
what is located in the middle (inferior) mediastinum?
- heart
- pericardium
- roots of the great vessels
what is in the posterior (inferior) mediastinum (4)?
- thoracic aorta2. thoracic duct3. esophagus4. azygous venous system
in a trauma patient, what does an abnormally widened mediastinum indicate?
a torn aorta
what is usually torn in a trauma patient when the aorta tears?
the ligamentum arteriosum
What are the segments of the right superior lobe?
apical, posterior, anterior
what are the segments of the right middle lobe?
lateral and medial
what are the segments of the right inferior lobe?
superior, anterior basal, medial basal, lateral basal, posterior basal
what are the segments of the left superior lobe?
- apical, posterior (usu apicoposterior segment)
- anterior
- superior lingular
- inferior lingular
what are the segments of the left inferior lobe?
- superior
- anterior basal and medial basal (usu anteriomedial basal)
- lateral basal
- posterior basal
what are the three levels of brionchioles?
ConductingTerminalRespiratory
the mediastinum is a what vertebral level?
T4-T5(T5 vertebral disc)
the phrenic nerve is right against what tissue?
The pericardium
what nerve is located between the trachea and the arch of the aorta?
the left recurrent laryngeal nerve
what is hemopericardium? What does it cause?
blood in the paricardial cavityproduces cardiac tamponade
what is pericardiocentesis? what level is the wide-bore needle placed into?
drainage of fluid from the paricardial cavitythe 5th or 6th intercostal space
where do you listen to pleural rubs on a patient (be specific)?
in the triangle of ausculatation: bordered by trapezius, latissimus dorsi and rhomboid major (or medial border of scapula)
the phrenic nerve is sourced by which parts of the cervicalnerve?
“C3, 4, and 5 keep the diaphragm alive.”
what is the difference between pneumothorax and tension pneumothorax?
in tension pneumothorax, the air is not excaping the pleural spacewheras in pneumothorax, air is flowing freely through a hole in the pleura
what are the two layers of the pericardial sac?
the outer fibrous pericardiumand inner serous pericardium
what is the sinus venarum?
the smooth part of the right atrial wall that is derived from the sinus venosus
what is the sulcus terminalis?
the groove between the sinus venarum and the rest of the right atrium(*separates the rest of the atrium from the sinus venarum)
what is the crista terminalis?
the ridge deep to the sulcus terminalis
what is the musculi pectinati?
the pectinate muscles. The are found in the anterior wall as muscular ridges.(pectin= comb)
what is the fossa ovalis?
a remnant of the foramen ovale that is now simply a depression (in the righ atrium)
what is the infundibulum in the right ventricle?
the conus arteriosusinfundibulum is latin for funnel. It is a narrowing of the r.ventricle before the pulmonary semilunar valve.
what are the trabeculae carnae?
meaty columns thatare not musculi pectinatialso, pillars of cardiac muscles
what are the papillary muscles connected to?
the chordae tendineae
what is the function of papillary muscles?
the contract early in the cardiac cycle IOT anchor the cusps of the atrioventricular valve and prevent regurgitation or backwards flow of bloodinto the atrium.
what are the chordae tendineae and what is their function?
- tendinous cords that attachthe leaflets of the tricuspid valve to the papillary muscles
- they assist the papillary muscles in preventing regurgitation
what is the moderator band? What is significantabout it
septomarginal trebeculaethis band of muscle connects the interventricular septum to the papillary muscles.the moderator band contains electrical conducting fibers
where is the atrioventricular node located?
between the valve of the coronary sinus and the tricuspid valve
where is the SA node located?
between the SVC and the Right atrium