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2nd year > Anatomy - oxygen supply and exchange week 1 > Flashcards

Anatomy - oxygen supply and exchange week 1 Flashcards

1
Q

which ribs are most commonly fractured?

A

4th-10th

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2
Q

which ribs are least commonly fractured?

A

1-3 as they are protected by the clavicles

then 11-12 as they are mobile

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3
Q

risk of rib fractures in children

A

less likely to sustain rib fractures because their ribs are more elastic

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4
Q

what is the weakest part of the rib?

A

anterior to angle

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5
Q

what are the contents of the superior thoracic aperture?

A 
sternohyoid muscle
sternothyroid muscle
thymic remnants 
trachea 
recurrent laryngeal nerves
oesophagus 
thyroid veins 
thoracic duct 
internal thoracic artery
sympathetic trunk
intercostal vessels 
ventral ramus of T1 
common carotid artery 
subclavian arteries 
vagus nerves 
brachiocephalic trunk
brachiocephalic vein 
phrenic nerves
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6
Q

carina

A

division of trachea into 2 main bronchi

T4/5 level

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7
Q

signs and symptoms of tension pneumothorax

A 
pleuritic chest pain 
SOB
hypotension 
tracheal deviation 
reduced breath sounds
hyperresonance on percussion 
raised JVP 
diaphragm pushed down 
kinking of vena cava 
worsening signs 
haemodynamically unstable 
respiratory distress
reduced chest expansion 
distended neck veins
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8
Q

haemodynamically unstable

A

hypotension
tachycardia
elevated respiratory rate

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9
Q

respiratory distress

A

cyanosis
restlessness
diaphoresis

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10
Q

what is diaphoresis ?

A

excessive abnormal sweating

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11
Q

what is a needle thoracostomy?

A

immediate insertion of large-bore needle into 2nd intercostal space along midclavicular line

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12
Q

where should a chest tube be placed?

A

4-5th intercostal space
along nipple line
between anterior and median axillary line
always check CXR after insertion

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13
Q

thoracic outlet syndrome

A

compression of certain anatomical structures within the thoracic aperture

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14
Q

what is commonly compressed in thoracic outlet syndrome?

A

brachial plexus

subclavian artery/vein

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15
Q

compression of brachial plexus

A

pain in neck and arm

atrophy of intrinsic hand muscles

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16
Q

compression of subclavian vein

A 
swelling 
venous distension 
diffuse hand/arm pain 
heaviness
risk of thrombosis of arm
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17
Q

compression of subclavian artery

A 
mild arm ache 
fatigue 
pulselessness 
pain 
pallor 
paresthesia 
poikilothermia 
reduced BP >20mmHg in affected arm 
ischaemia - ulcerations and gangrene
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18
Q

what is poikilothermia?

A

inability to control body temperature

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19
Q

when does haemothorax require surgery?

A

if >1500ml of blood has accumulated or there is ongoing production of >200ml of blood per hour
when the haemothorax cannot be treated/bleeding stopped by catheter or chest drain

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20
Q

most common cause of haemothorax?

A

penetrating trauma

gun/stab wounds

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21
Q

thoracic-abdominal injury

A

any wound below nipple line or inferior to tip of scapula

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22
Q

level of suprasternal notch

A

T2/3

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23
Q

level of sternal angle/ angle of louis

A

T4/5

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24
Q

level of inferior angle of scapula

A

T8

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25
Q

level of xiphisternum

A

T9

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26
Q

level of lowest part of costal margin

A

10th rib - L3

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27
Q

top part vs bottom part of rib

A

top part = blunt

bottom part = groove for intercostal nerve, artery and vein

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28
Q

fracture of lower ribs

A

can penetrate liver, spleen, diaphragm, abdominal viscera or chest cavity

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29
Q

what can fracture of the first rib cause injury to?

A

brachial plexus
subclavian artery or vein
pleural covering of apex of lung
apex of lung - causing pneumothorax

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30
Q

pathological fracture

A

brought on by coughing
sign of underlying bone pathology
breast, renal, prostate or lung metastases to bones

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31
Q

what is flail chest?

A

bifocal fracture of 3 or more adjacent ribs
segment of chest wall becomes unstable and free from rest of chest wall
this segment will move in on expiration and out on inspiration
needs surgical treatment/ventilation

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32
Q

what is a tension pneumothorax?

A

opening in pleura acts as a 1-way valve so air comes in on inspiration but valve closes on expiration so air cannot escape again
positive intrapleural pressure collapses lung so hypoxia and mediastinal shift occurs

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33
Q

pulmonary collapse

A

pleural cavity becomes real space
diaphragm elevates on affected side
ribs come closer together and narrow intercostal spaces
mediastinal shift towards the affected side
collapsed lung appears dense

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34
Q

what is primary atelectasis

A

collapse of previously inflated lung

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35
Q

what is secondary atelectasis

A

where mucus plugs develop and cause additional collapse

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36
Q

treatment of tension pneumothorax

A

medical emergency
large bore cannula into mid clavicular line into 2nd costal space
when bubbles stop it is drained
risk of cardiac arrest

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37
Q

visceral pleura innervation

A

afferent nerves
nociception
sympathetic fibres of upper thoracic spinal nerve sensory ganglia - autonomic

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38
Q

what is the visceral pleura sensitive to

A

not pain

sensitive to chemical burns

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39
Q

parietal pleura innervation

A

very sensitive to pain and supplied by intercostal nerves - somatic general sensory
irritation may produce local or referred pain

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40
Q

pain caused by irritation of phrenic nerve

A

referred to root of neck and over shoulder

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41
Q

where to give intercostal nerve block

A

just below rib

to avoid the intercostal neurovascular bundle go above rib

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42
Q

how to give an intercostal nerve block?

A

just below rib
draw back to ensure not in vein/artery
anaesthetic injected around intercostal nerve trunk
complete loss of sensation not usually achieved - overlap between adjacent dermatomes
2 or more intercostal spaces/nerves need to be anaesthetised for complete loss of sensation at a particular region of thoracic wall

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43
Q

thoracocentesis

A

obtain fluid sample or remove blood/pus from pleural cavity

hypodermic needle inserted superior to rib

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44
Q

where is a chest tube inserted?

A

incision into 5/6th intercostal space in mid-axillary line - nipple level

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45
Q

what is a haemothorax?

A

accumulation of blood and fluid in hemithorax

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46
Q

what does haemothorax do?

A

compresses lung
prevents adequate ventilation
can cause hypovolaemic shock

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47
Q

management of haemothorax?

A

simultaneous drainage and replacement of blood
chest drain required
thoracotomy

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48
Q

what is a thoracotomy?

A

anterior cur through costal cartilages or posterior/lateral cut between intercostal space and retractor - 5-7th intercostal spaces

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49
Q

rapid thoracotomy

A

clamshell
used in trauma - blunt trauma
gives good access to all parts of mediastinum
used in penetrating chest wound

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50
Q

uses of clamshell

A

cardiac tamponade release
to collapse and compress lung for haemostasis if unilateral lung injury
to compress thoracic aorta if exanguinating

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51
Q

apical lung cancer

A

tumours may disrupt recurrent laryngeal nerve and cause voice hoarseness

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52
Q

who is thoracic outlet syndrome most common in?

A

females 30-40 years old

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53
Q

symptoms/ signs of thoracic outlet syndrome

A

ulnar guttering
loss of intrinsics
loss of adduction and abduction of fingers
pain in neck and shoulder
weakness and paraesthesia over ulnar aspect of hand and forearm
axillary vein thrombosis
digital ischaemia

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54
Q

potential cause of thoracic outlet syndrome

A

cervical rib

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55
Q

diagnosis of thoracic outlet syndrome

A

neck x-ray
ultrasound arm
nerve conduction studies
venography

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56
Q

what makes up the thoracic cage?

A

12 pairs of ribs
rib costal cartilages
sternum

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57
Q

articulations of ribs

A

anterior and posterior

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58
Q

posterior rib articulations

A

all 12 articulate with vertebrae of spine

each rib forms 2 joints = costotransverse and costovertebral joints

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59
Q

costotransverse joint

A

between tubercle of rib and transverse costal facet of corresponding vertebrae

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60
Q

costovertebral joint

A

between head of rib, superior costal facet of corresponding vertebrae and inferior costal facet of vertebrae above

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61
Q

anterior rib articulation

A

varies depending on which rib
ribs 1-7 = attach independently to sternum
ribs 8-10 = attach to costal cartilages superior to them
ribs 11 and 12 = no anterior attachment and end in abdominal musculature

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62
Q

what are the muscles of inspiration?

A 
accessory = sternocleidomastoid, scalenes group, pectoralis minor 
principal = external intercostals, diaphragm and interchondral part of internal intercostal muscles
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63
Q

what are the muscles of expiration?

A

quiet breathing = expiration results from passive, elastic recoil of the lungs, rib cage and diaphragm
active breathing uses muscles

64
Q

what muscles are used in active expiration?

A

internal intercostals

abdominals

65
Q

what is the intercostal space?

A

space between 2 ribs

66
Q

how many intercostal spaces are there?

A

11

67
Q

what are the contents of the. intercostal space?

A 
essential respiratory muscles
intercostal muscles - external, internal and innermost 
intercostal nerves
intercostal arteries 
intercostal veins 
investing fascia
68
Q

where is the intercostal neurovascular bundle found?

A

just below the rib

69
Q

what are the compartments of thoracic cavity?

A

left pleural cavity
right pleural cavity
mediastinum

70
Q

what are the divisions of the mediastinum?

A 
anterior
posterior 
inferior
middle
superior
71
Q

what is the pleural cavity?

A

potential space between parietal and visceral pleura of lungs
contains pleural fluid, pleura and lungs

72
Q

contents of superior mediastinum

A 
thymus
trachea 
oesophagus 
aortic arch 
brachiocephalic trunk
left common carotid artery 
left subclavian artery 
internal thoracic arteries 
superior vena cava 
left superior intercostal vein 
brachiocephalic veins
phrenic nerves 
vagus nerves 
left recurrent laryngeal nerve 
thoracic duct 
lymph nodes 
lymph vessels
73
Q

contents of anterior mediastinum

A 
portion of thymus 
adipose and connective tissue 
lymph nodes
branches of internal thoracic vessels 
sternopericardial ligaments
74
Q

contents of middle mediastinum

A 
pericardium 
heart 
pulmonary trunk 
ascending aorta 
pulmonary veins 
superior vena cava 
inferior vena cava 
tracheal bifurcation 
main bronchi
75
Q

posterior mediastinum contents

A 
oesophagus 
oesophageal plexus 
thoracic aorta and its branches 
azygos and hemiazygos venous systems 
thoracic duct 
sympathetic trunk 
thoracic splanchnic nerves
76
Q

what makes up the thoracic wall?

A 
ribs 
associated costal cartilages 
thoracic vertebrae 
sternum 
intercostal muscles 
external, internal and innermost intercostal muscles 
internal and external membranes 
subcostal muscles 
transversus thoracis muscles 
serratus posterior 
levatores costrum muscles 
subcutaneous tissues 
skin
77
Q

what are the joints of the thoracic wall?

A 
costovertebral joints 
sternocostal 
costochondral 
sternoclavicular 
manubriosternal 
xiphisternal 
interchondral
78
Q

costovertebral joints

A

between head of ribs and vertebral bodies/ intervertebral discs
costotransverse joints - between tubercle of rib and transverse process of vertebrae

79
Q

sternocostal joint

A

sternum and costal cartilages

80
Q

costochondral joint

A

costal cartilages and ribs

81
Q

what makes up the thoracic cage?

A

12 pairs of ribs
rib costal cartilages
sternum

82
Q

articulations of ribs

A

anterior and posterior

83
Q

posterior rib articulations

A

all 12 articulate with vertebrae of spine

each rib forms 2 joints = costotransverse and costovertebral joints

84
Q

costotransverse joint

A

between tubercle of rib and transverse costal facet of corresponding vertebrae

85
Q

costovertebral joint

A

between head of rib, superior costal facet of corresponding vertebrae and inferior costal facet of vertebrae above

86
Q

anterior rib articulation

A

varies depending on which rib
ribs 1-7 = attach independently to sternum
ribs 8-10 = attach to costal cartilages superior to them
ribs 11 and 12 = no anterior attachment and end in abdominal musculature

87
Q

what are the muscles of inspiration?

A 
accessory = sternocleidomastoid, scalenes group, pectoralis minor 
principal = external intercostals, diaphragm and interchondral part of internal intercostal muscles
88
Q

what are the muscles of expiration?

A

quiet breathing = expiration results from passive, elastic recoil of the lungs, rib cage and diaphragm
active breathing uses muscles

89
Q

what muscles are used in active expiration?

A

internal intercostals

abdominals

90
Q

what is the intercostal space?

A

space between 2 ribs

91
Q

how many intercostal spaces are there?

A

11

92
Q

typical intercostal nerves

A

3rd-6th intercostal nerves
confined within their own intercostal space
connection with corresponding sympathetic trunk

93
Q

where is the intercostal neurovascular bundle found?

A

just below the rib

94
Q

what are the compartments of thoracic cavity?

A

left pleural cavity
right pleural cavity
mediastinum

95
Q

what are the divisions of the mediastinum?

A 
anterior
posterior 
inferior
middle
superior
96
Q

what is the pleural cavity?

A

potential space between parietal and visceral pleura of lungs
contains pleural fluid, pleura and lungs

97
Q

contents of superior mediastinum

A 
thymus
trachea 
oesophagus 
aortic arch 
brachiocephalic trunk
left common carotid artery 
left subclavian artery 
internal thoracic arteries 
superior vena cava 
left superior intercostal vein 
brachiocephalic veins
phrenic nerves 
vagus nerves 
left recurrent laryngeal nerve 
thoracic duct 
lymph nodes 
lymph vessels
98
Q

contents of anterior mediastinum

A 
portion of thymus 
adipose and connective tissue 
lymph nodes
branches of internal thoracic vessels 
sternopericardial ligaments
99
Q

contents of middle mediastinum

A 
pericardium 
heart 
pulmonary trunk 
ascending aorta 
pulmonary veins 
superior vena cava 
inferior vena cava 
tracheal bifurcation 
main bronchi
100
Q

posterior mediastinum contents

A 
oesophagus 
oesophageal plexus 
thoracic aorta and its branches 
azygos and hemiazygos venous systems 
thoracic duct 
sympathetic trunk 
thoracic splanchnic nerves
101
Q

what makes up the thoracic wall?

A 
ribs 
associated costal cartilages 
thoracic vertebrae 
sternum 
intercostal muscles 
external, internal and innermost intercostal muscles 
internal and external membranes 
subcostal muscles 
transversus thoracis muscles 
serratus posterior 
levatores costrum muscles 
subcutaneous tissues 
skin
102
Q

what are the joints of the thoracic wall?

A 
costovertebral joints 
sternocostal 
costochondral 
sternoclavicular 
manubriosternal 
xiphisternal 
interchondral
103
Q

costovertebral joints

A

between head of ribs and vertebral bodies/ intervertebral discs
costotransverse joints - between tubercle of rib and transverse process of vertebrae

104
Q

sternocostal joint

A

sternum and costal cartilages

105
Q

costochondral joint

A

costal cartilages and ribs

106
Q

sternoclavicular joint

A

clavicle and sternum

107
Q

manubriosternal joint

A

manubrium and body of sternum

108
Q

xiphisternal joint

A

sternum and xiphoid process

109
Q

interchondral joint

A

costal cartilages and lower ribs

110
Q

directions of internal and external muscles

A

external = inspiration
internal = expiration
perpendicular to each other

111
Q

contents of intercostal space

A

intercostal muscles
intercostal muscle membranes
main and collateral intercostal vessels and nerves

112
Q

naming of intercostal spaces

A

according to rib forming superior border of space

space below 12th rib doesn’t lie between ribs so = subcostal space

113
Q

rhizotomy

A

posterior and anterior roots and rootlets are the only sites where motor and sensory fibres of a spinal nerve are segregated
nerve roots could be selectively sectioned to relieve intractable pain or spastic paralysis

114
Q

how many intercostal nerves are there?

A

12 pairs of thoracic spinal nerves
11 intercostal nerves
anterior rami of T1-11 form intercostal nerves within intercostal spaces

115
Q

subcostal nerve

A

anterior ramus of T12 runs inferior to 12th rib

116
Q

what are the types of intercostal nerves?

A

typical and atypical

117
Q

what do the typical intercostal nerves supply?

A 
intercostal muscles 
serratus posterior 
parietal pleura 
skin of thoracic and abdominal walls 
anterior aspect of thorax and abdomen
118
Q

atypical intercostal nerves

A

not confined to intercostal space
supply structures outside the intercostal space
1st,2nd and 7-11th intercostal nerves

119
Q

T1 intercostal nerve supply

A

brachial plexus

skin of axilla

120
Q

T2 intercostal nerve supply

A

intercostobranchial nerve

floor of axilla and upper medial aspect of arm

121
Q

7-11th intercostal nerve supply

A

lateral cutaneous branches

anterior abdominal wall skin and muscles and parietal peritoneum via sensory branches

122
Q

arterial supply of typical intercostal space

A

large posterior intercostal artery from thoracic aorta

small pair of anterior intercostal arteries from internal thoracic/ mammary artery

123
Q

venous drainage of intercostal space

A

intercostal veins accompany intercostal arteries and nerves

124
Q

intercostal neurovascular bundle

A

life inferior to the rib along costal groove
vein, artery, nerve, with nerve most inferior
and nerve artery vein of superior border of the rib below

125
Q

cutaneous innervation of anterior thoracic wall

A

supraclavicular nerves - C3 and 4

126
Q

T4 dermatome

A

nipple

127
Q

T10 dermatome

A

umbilicus

128
Q

what is referred pain?

A

pain felt away from site of cause

129
Q

referred pain from coronary artery disease

A

medial side of arm

130
Q

referred pain from disease of thoracic wall

A

dermatome that extends across the costal margin into the anterior abdominal wall

131
Q

referred pain from PE/pneumonia

A

if costal parietal pleura involved abdominal pain and tenderness and rigidity of abdominal musculature

132
Q

uses of intercostal nerve block

A

repair of thoracic or abdominal wall lacerations
relief from rib fracture
to allow pain free respiratory movements
thoracostomy tube insertion

133
Q

herpes zoster infection/ rash distribution

A

infection of spinal ganglia
sensory neuropathy with dermatomally distributed skin lesions - shingles affects the dermatome of the infected spinal nerve

134
Q

innervation of thoracic viscera

A

autonomic

135
Q

sympathetic supply of thoracic viscera

A

cardiac branches = T1-5

T1-L2 sympathetic chain

136
Q

what does sympathetic innervation of thoracic viscera do?

A

increases rate and strength of cardiac contraction

dilates coronary arteries

137
Q

parasympathetic supply of thoracic viscera

A

craniosacral outflow
cranial nerves 10,9,3,7 and S2-4
main contributor is vagus nerve

138
Q

what does parasympathetic innervation of thoracic viscera do?

A

decreases rate and strength of cardiac contraction

constricts coronary arteries

139
Q

lateral horn of spinal cord

A

autonomic horn

gives rise to sympathetic and parasympathetic nerves

140
Q

innervation of heart

A

cardiac plexus

sympathetic supply

141
Q

innervation of SAN and AVN

A

cardiac plexus

142
Q

visceral afferent fibres

A

convey reflexive.subconscious sensation and nociceptive sensation fibres from heart
detect stretch and chemical irritation

143
Q

what makes up the cardiac plexus?

A

sympathetic, parasympathetic and visceral afferent fibres

144
Q

what does atropine do?

A

speeds up heart rate in bradycardia

parasympathetic antagonist

145
Q

innervation of lungs and visceral pleura

A

vagal, sympathetic and visceral afferent fibres contribute to anterior and posterior pulmonary plexuses

146
Q

parasympathetic fibres to lungs and visceral pleura

A

motor to smooth muscle of bronchi
inhibition to pulmonary vessels
secretomotor innervation to glands

147
Q

parasympathetic effect on lungs

A

bronchoconstriction
vasodilation
increased gland secretion

148
Q

sympathetic fibres to lungs and visceral pleura

A

inhibition to bronchial smooth muscles
inhibition to alveolar glands
motor to pulmonary vessel smooth muscles

149
Q

sympathetic effect on lungs

A

bronchodilation
decreased secretions
vasoconstriction

150
Q

what innervates the parietal pleura

A

intercostal nerves

151
Q

what innervates intercostal muscles?

A

intercostal nerves

152
Q

sympathetic innervation of pulmonary vs coronary vessels

A

vasoconstriction of pulmonary and vasodilation of coronary

153
Q

what is pleurisy?

A

sharp pain due to irritation of peripheral parietal pleura

154
Q

irritation of diaphragmatic pleura

A

referred pain to neck and shoulders

155
Q

parasympathetic antagonists

A

used in asthma
bronchodilator
ipratropium - anticholinergic

156
Q

damage to phrenic nerve

A

traumatic injury above C3 = bilateral phrenic nerve paralysis and respiratory arrest
mediastinal/lung tumours may involve the phrenic nerve and cause unilateral diaphragmatic paralysis
new raised hemidiaphragm on CXR may indicate mediastinal malignancy

2nd year (48 decks)

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