Applied Anatomy Thorax Flashcards
Explain the structures in a typical rib
How to tell the difference between anterior vs posterior ribs on a chest xray ?
The anterior part of the rib slopes from superior to inferior
Posterior more Horizontal
Where would you insert a chest drain to avoid the neurovascular bundle?
Above the rib
What are the two vertebral joints and where do they sit?
Costotransverse joint – Between the tubercle of the rib, and the transverse costal facet of the corresponding vertebra.
Costovertebral joint– Between the head of the rib, superior costal facet of the corresponding vertebra, and the inferior costal facet of the vertebra above
What is this ?
Kyphosis
What is this ?
Scholiosis
What is this ?
Barrel chest
What does visceral mean ?
Viscera are the large organs inside the body, such as the heart, liver, and stomach.
What is a fail chest
Life threatening condition
3 or more ribs broken at least in 2 places
Likely impending respiratory failure
Intubation and surgery are likely
Explain ventilation with a flail chest
In a flail chest, the fractures on adjacent ribs separate them from the rest of the chest wall. As a result, the paradoxical motion of the ribs occurs. For example, the affected area may move inward (sucked in by the negative pressure change in the thoracic cavity) while the rest of the chest wall moves outward. This altered movement can consequently impair breathing.
CASE STUDY
Primary care:
56 year old male
4/7 of productive cough & pyrexia
Sharp R sided chest pain
PMH & SH:
Smoker
Chronic cough
Haemoptysis
3 Kg weight loss in 3/12
On examination:
Hoarse voice
RR 22 breaths per minute
Dull percussion R mid
Bronchial breathing R lateral
HR 120 bpm & BP 145/90 mmHg
Temp 37.7oC
1) Describe & locate the abnormality on the chest X-ray
2) ΔΔ & likely diagnosis
3) Explain why the patient has a hoarse voice
Clinical Case 1:
Describe & locate the abnormality on the chest X-ray: there is loss of resolution between the right side of the heart and the adjacent lung. The pathology is not likely to be affecting the lower lobe as the lateral lung space and diaphragm appear to be normal, therefore the pathology is likely to be in the right middle lobe
ΔΔ & likely diagnosis: possible acute chest infection in right middle lobe, could also have an underlaying malignancy (causing the weight loss and haemoptysis). Other diagnosis to consider include - acute exacerbation of COPD and pulmonary embolism
Explain why the patient has a hoarse voice? mediastinal lymph node compression on the left recurrent laryngeal nerve
CAE STUDY
MAU
63-year-old woman
O/P: 1/7 SOB
SH: Nursing home 2/52 post stroke
O/E:
A/E: L > R
Dull to percussion at the R base
Reduced breath sounds R base
R hemiplegia
Observations:
RR 20 breaths per min
SpO2 90% (O2 10l/min)
HR 96 bpm, BP 160/96 mmHg
Temp 37.9oC
1) Using anatomy and physiology knowledge explain what has happened
2) What is the likely diagnosis?
Clinical Case 2:
Using anatomy and physiology knowledge explain what has happened: the patient had a stroke 2 weeks ago, which has likely caused a deficient swallowing and gag reflex. Therefore the patient has been unable to adequately protect their airway.
Meaning food, liquid or secretions have passed the epiglottis into the larynx and lower airways. As the right main bronchi is wider, shorter and more vertical it is more likely that the inhaled substance(s) have entered this part of the lungs and caused a subsequent infection. This is confirmed on the chest x-ray which shows that the right lower and middle lobes are likely affected
What is the likely diagnosis: aspiration pneumonia in right lower +/- middle lobe
Where are the palatine tonsils located?
Anterior wall of the oropharynx
Necrosis of the septal cartilage in the nose can be a result because of what ?
- A drug addict who snorts cocaine
- A haematoma sustained during a boxing match
- A local neoplastic tumour
- Pus collection following a localised infection
Which is the best place to listen for breath sounds in the middle lobe?
On the anterior right chest in the 5th intercoastal space, half way between the sternal border and mid clavicular line
