Blue Boxes Flashcards
What are the true ribs?
1-7
What are the false ribs?
8-10
What are the floating ribs?
11-12
What are the typical ribs?
3-9
What are the atypical ribs?
1-2 and 10-12
Which ribs are most commonly fractured? Where?
The middle ribs at their weakest locus, just anterior to the costal angle.
Which rib is rarely fractured?
The first rib due to its protected location. If it is fractured, this is seen as a hallmark of severe injury.
What are supernumerary ribs?
Extra ribs either in the cervical or lumbar region.
What are 2 problems associated with supernumerary ribs?
- ) Cervical ribs can compress the brachial plexus or subclavian a causing neural and circulatory problems.
- ) An extra lumbar rib can cause radiographic confusion
What does the head of each rib articulate with?
The inferior costal facet of the superior numeric thoracic vertebral segment and the superior costal facet of the same numeric thoracic vertebral segment
What is a dislocation of a rib?
Dislocation at the sternocostal joint
What is a separation of a rib?
Dislocation of the costochondral joint
Thoracentisis
Insertion of a needle between ribs to obtain a fluid sample or drain fluid from the pleural cavity. The needle is inserted inferior to the intercostal neurovascular bundle but superior to the collateral branches
Insertion of a chest tube
Insertion made in the 5th or 6th intercostal space in order to remove major amounts of air, blood, serous fluid, pus, etc.
Thorascopy
Insertion of a thorascope into the pleural cavity through small incisions for visualization and biopsying the space inside the pleural cavity
How many lobes does the left lung have?
2
How many lobes does the right lung have?
3
Oblique fissure of the left lung
Separates the superior and inferior lobes
Oblique fissure of the right lung
Separates the superior and middle lobes from the inferior lobe
Horizontal fissure of the right lung
Separates the superior and middle lobe
Where can lung cancer be derived?
- ) Actual lung tissue
- ) Bronchi (bronchogenic carcinoma)
- ) Phrenic N, Vagus N, and recurrent Laryngeal N
Treatment of lung cancer (3 things)
- ) Pneumonectomy
- ) Lobectomy
- ) Segmentectomy (removal of a specific bronchopulmonary segment)
Visceral pleura
Adherent to the lungs
Parietal pleura
Adherent to the thoracic wall, mediastinum, and the diaphragm
4 types of parietal pleura
- ) costal parietal pleura
- ) mediastinal parietal pleura
- ) diaphragmatic parietal pleura
- ) cervical parietal pleura
What is pleurisy (pleuritis)?
Inflammation of the pleura producing a roughness on the lungs. This can be heard by stethoscope
Primary atelectasis
Failure of a lung to inflate at birth
Secondary atelectasis
Collapse of a previously inflated lung
When does a lung collapse?
When enough air enters the pleural cavity to break the negative pressure and surface tension between the two layers of pleura
Pneumothorax
Entry of air into the pleural cavity from a penetrating wound or rupture of a pulmonary lesion into the pleural cavity
Hydrothorax
Accumulation of excess fluid in the pleural cavity, usually the result of pleural effusion (fluid in the pleural cavity)
Hemothorax
Accumulation of blood in the pleural cavity, usually as a result of a chest laceration with subsequent injury to one of the thoracic vessels
In which direction do external intercostal muscles slope=?
down and forward
Function of the scalene muscles
Raise the 1st and 2nd ribs
Function of the sternomastoids
Raise the sternum
Is expiration active or passive?
Passive, because the lungs want to “deflate.” Also due to the relaxation of the inspiratory muscles
Is expiration active or passive?
Passive, because the lungs want to “deflate.” Also due to the relaxation of the inspiratory muscles
What is a myocardial infarction?
A lack of blood flow to a specific area of myocardium, usually the result of a blockage in a Coronary A., coronary atherosclerosis, or buildup of lipids in the coronary arteries.
What is angina pectoris?
Pain that originates in the heart that produces a “strangling” pain in the chest.
What is angina pectoris from?
A narrow or obstructed coronary artery that produces ischemia of the myocardium
What is the right atrioventricular groove? What does it transmit?
The groove between the right atrium and right ventricle. It transmits the right coronary artery.
What is the left atrioventricular groove? What does it house?
The groove between the left atrium and left ventricle. It houses the coronary sinus
What is the anterior interventricular groove? What does it transmit?
Groove between left and right ventricles on the anterior aspect of the heart. The anterior interventricular A. and the Great Cardiac V.
What is the posterior interventricular groove? What does it transmit?
Groove between the left and right ventricles on the posterior aspect of the heart. The posterior interventricular A. and the Middle Cardiac V.
What is the ligamentum arteriosum?
The adult embryological remnant of the of the embryological Ductus Arteriosus which shunted blood from the pulmonary trunk to the aorta to bypass the nonfunctional lungs.
What is the sulcus terminalis?
The external vertical groove corresponding to the internal Crista Terminalis
Atrial septal defects
Involves incomplete closure of the foramen oval. It is estimated that 15-20% of adults have a small patency of the foramen oval which is clinically insignificant. Larger opening in there intertribal septum can be clinically significant as they allow a mixture of oxygen rich and oxygen depleted blood.
What is the right atrioventricular orifice?
Passage from the right atrium to the right ventricle. It is variably occluded by the right tricuspid valve
What are the three cusps of the tricuspid valve?
Anterior, posterior, and septal cusp’s.
What is the chordae tendinae?
Attaches the free ends of the three cusps to their corresponding papillary muscles
What are the three papillary muscles?
Anterior, posterior, and septal. They associate with each cusp of the tricuspid valve.
Cardiac cathetherization
Insertion of a catheter into the femoral vein which in then passed through the inferior vena cava allowing radiological imaging of the right atrium, right ventricle, pulmonary trunk and pulmonary arteries
What is the valve between the left atrium and left ventricle?
The bicuspid valve
Left atrioventricular orifice
Passage of the left atrium to the left ventricle, variably occluded by the bicuspid valve
Pulmonary valve
In-between the right ventricle and the pulmonary artery.
What cusps make up the pulmonary valve?
Right, left, and anterior cusps
What valve separates the left atrium from the left ventricle?
The mitral valve
What cusps make up the mitral valve?
Anterior and posterior cusps
Ventricular septal defects
Clinically important as they allow the mixture of oxygen rich blood and oxygen depleted blood
Artificial cardiac pacemaker
Produces a regular electrical impulse that is carried to the ventricles via electrodes which are inserted through a large vein to the superior vena cava, to the right atrium passed the tricuspid valve into the endocardium of the trabeculae of carnae of the right ventricle
Atrial fibrillation
Irregular twitching of the atrial cardiac muscle fibers to which the ventricles respond at irregular intervals. Circulation remains satisfactory
Ventricular fibrillation
Rapid irregular twitching of the ventricles rending the heart unable to pump blood. An electric shock can cease movement (defibrillation), in hopes that the heart will start again
Cardiac referred pain
Ischemia stimulates pain sensory fibers in the heart of the ANS. The visceral sensory fibers often share a spinal ganglion with the somatic sensory fibers of areas such as the upper limb and superior lateral chest wall.
Where is cardiac pain usually referred?
Anginal pain is typical referred to the area innervated by the left medial brachial cutaneous nerve, left substernal area, left pectoral area, and medial aspect of the upper limb.
3 types of pericardium
Fibrous pericardium (outer), parietal serous pericardium, visceral serous pericardium (epicardium)
Why is the transverse pericardial sinus important?
It allows surgeons to access the area posterior to the aorta and pulmonary trunk to clamp or insert the tubes of a bypass machine into the large vessels
Pericarditis
Inflammation of the pericardium which can make it rough and produce friction. This produces a pericardial friction rub and can be observed with a stethoscope
What is a rub?
Result of friction in the pericardium. Ex. pericarditis
Pericardial effusion
Inflammation of the pericardium can result in the accumulation of fluid or pus in the pericardial sac which can compress the heart
What is cardiac tamponade?
Compression of the heart
Pericardiocentesis
Drainage of fluid, blood, or pus from the pericardial sac. Usually done to relieve cardiac tamponade
Coronary artery bypass graft (CABG)
Obstruction of the coronary arteries may necessitate replacement of a segment of the coronary artery, this is called CABG.
What vessel is normally used in CABG?
The great saphenous vein, due to its comparable diameter, its easy dissection from the lower limb, and for its lengthy portions without branches
What vessel can sometimes be used in CABG?
The radial artery
Coronary angioplasty
Insertion of a small balloon catheter into the lumen of the coronary artery. The balloon is inflated to flatten the obstructing plaque against the wall.
What is the fibrous skeleton of the heart and what does it do? (4 things)
- ) Produces attachment points for the myocardium
- ) Produces attachment points for the cuspid valves
- ) Supports and strengthens AV and semilunar orifices
- ) Provides an electrically insulated barrier between the atria and ventricles
What are the 4 layers of the heart?
Epicardium, myocardium, endocardium, and fibrous skeleton of the heart
What is the epicardium made up of?
visceral serous pericardium
Where is the apex of the heart?
The inferolateral part of the left ventricle, projects to the left
Where is the base of the heart?
It is the posterior portion of the heart, near the left atrium
What are the 3 surfaces for the heart?
Sternocostal (right ventricle), diaphragmatic (R and L ventricles), and pulmonary (right atrium and left ventricle)
What are the four main internal parts of the right atrium?
- ) Sinus venarum
- ) Pectinate muscle
- ) Interatrial septum
- ) Crista terminalis
- ) Opening for the coronary sinus
What is the sinus venarum and what drains into it?
Posterior, smooth, thin walled region where the vena cavea and coronary sinus enter
What is the pectinate muscle of the right atrium?
Anterior, rough muscular wall.
What is the crista terminalis of the right atrium?
Internal ridge separating smooth and rough regions of the right atrium
Interatrial septum of the right atrium separates what? What does it contain?
The walls of the two atria. It contains the fossa ovalis which is the embryonic remnant of the Foramen Ovalis.
What are the 4 main internal features of the right ventricle?
- ) Tricuspid valve
- ) Pulmonary valve
- ) Trabecula carnae
- ) Conus arteriosus
What does the trabeculae carnae contain?
The septomarginal trabeculum (moderator band) from the interventricular septum to the base of the anterior papillary muscle. It transmits the right bundle branch of the atrioventricular bundle to the anterior papillary muscle.
What is the conus arteriosus?
Smooth walled structure leading into the pulmonary trunk
What are the three internal structures of the left atrium?
- ) Left auricle (contains pectinate muscle)
- ) Openings for the 4 pulmonary veins
- ) Interatrial septum
What does hemothorax usually result from?
Injury to a major intercostal or internal thoracic vessel rather than laceration of a lung
