Blue Boxes Not Covered Yet Flashcards
What is a pneumonectomy?
removal of a lung
What is PaO2 like in the apex and base of the lung?
What about PaCO2?
apex = high PaO2, low PaCO2 base = low PaO2, high PaCO2
When correcting a VSD, what heart structure do you need to look out for so as not to suture it?
right bundle branch
What nerve is responsible for the innervation of the bronchial smooth muscle cells?
vagus N
What does percussion of the thorax assess?
helps establish whether underlying tissues are air filled, fluid filled, or solid
what can lung cancer derive from?
actual lung tissue or from bronchi (bronchogenic carcinoma)
If you had a blunt trauma to the sternum, what part of the heart would be most likely to be injured?
right ventricle - most anterior portion of heart, closest to sternum
What is ACE and where is it found in the body?
angiotensin converting enzyme - found primarily in the lungs
also metabolizes bradykinin
What malformations are associated with DiGeorge’s?
outflow problems: tetralogy of fallot and truncus arteriosus
interrupted aorta
What is ventilation like in the different parts of the lungs?
apex = low base = high
What is median sternotomy and when is it performed?
dividing of sternum in median plane and retracting
during open heart surgery or removal of tumors in superior lobes of lungs
What are the segments of the inferior lobe of the right lung?
superior anterior basal medial basal lateral basal posterior basal
What are the segments of the middle lobe of the right lung?
lateral and medial
What are the 4 starling forces in the lungs?
- hydrostatic pressure in capillary
- Hydrostatic pressure in tissue/alveoli
- oncotic/osmotic pressure of plasma
- Oncotic/osmotic pressure of tissue
What is funnel chest?
pectus excavatum
When do sternal fractures usually happen?
What type of fracture is one of the sternal body?
during crush injuries
comminuted fracture
What does Herpes zoster infect?
invades a ganglion –> produces sharp burning pain in the dermatome supplied by the involved N
muscle weakness occurs in 0.5-5% of ppl
What is a thoracotomy?
creation of an opening through thoracic wall to enter a pleural cavity
How do you perform an intercostal Nerve block?
inject anesthetic around intercostal nerves btw paravertebral line and area of required anesthesia –> gets intercostal n and collateral branches
What is eventration of the diaphragm? What is it caused by embryologically?
half of diaphragm ascends into the thorax during inspiration, while the other half contacts normally
caused by absence of musculature in one half of the diaphragm
What embryologic problem would cause tetralogy of fallot?
superior malalignment of the subpulmonary septum
Where is the most common site of sternal fracture in elderly people?
at sternal angle –> dislocation of manubriosternal joint
What are the segments of the superior lobe of the left lung?
apical posterior anterior superior inferior
What are the segments of the inferior lobe of the left lung?
superior anterior basal medial basal lateral basal posterior basal
What happens to costal cartilage as we age?
becomes less elastic and more brittle –> break easier in elderly people
what main bronchus is more likely to encounter foreign bodies? Why?
R main bronchus bc it is wider and more vertical than the left
What things are produced by the immune system activation in the lungs?
leukotrienes
prostaglandin/ thromboxane A2
(these are also removed in the lungs too)
What can failure to remove fluid from a lung cause?
the lung can develop a resistant fibrous covering that inhibits expansion unless it is peeled off
What will cause a left shift in oxy-hemoglobin curve?
increased pH
low CO2
Is the phrenic N sympathetic or parasympathetic?
sympathetic
also motor and sensory
What diagnostic procedure is the sternal body often used for?
bone marrow needle biopsies
pain from an MI that refers to the left arm is radiated through what nerve?
intercostobrachial N
What starling forces favor filtration (movement of liquid from capillary to tissue)?
Why is the hydrostatic pressure in alveoli not favoring resorption like it does in the rest of the body?
- hydrostatic pressure in capillary
- hydrostatic pressure in tissue/alveoli
- Oncotic pressure of tissue
* because of negative intrapleural pressure - hydrostatic pressure of tissue would usually do the opposite*
Why can the lungs accumulate a lot of carbon w/out adverse effects?
lymph going to lungs has phagocytes that will remove it
What part of pleurae is in particular danger for injury?
pleura in costovertebral angles inferomedial to 12th ribs –> pneumothorax may occurs
What is the major reason you don’t see problems with CO2 retention in people w/ lung disease until they have very extensive/severe disease?
O2 takes about 0.25 seconds to equilibrate in a capillary, while CO2 equilibrates almost immediately
The .75 seconds an RBC spends in an alveolar capillary is super long, so there is plenty of time for CO2 to leave
If you move from a seated position to supine, what occurs to TLC, ERV, and IRV?
TLC decreases
ERV decreases
IRV increases
What is primary atelectasis?
What is secondary atelectasis?
failure of a lung to inflate at birth
collapse of a previously inflated lung
What are the differences in fetal arterial blood?
hemoglobin have higher affinity for O2
PaCO2 higher and PO2 lower
pulmonary vascular resistance is higher
What are the segments of the superior lobe of the right lung?
apical
posterior anterior
That is thoracic outlet syndrome?
when structures emerging from superior thoracic aperture are obstructed/pinched
If you have an diaphragmatic hernia, what embryological structure most likely failed to develop properly?
pleuroperitoneal membrane
not septum transversum!
What does auscultation of the lungs assess?
airflow through the tracheobronchial tree into lobes of the lungs
What is sometimes a side effect of ACE inhibitor usage?
Blocks ACE, which also metabolizes bradykinin –> sometimes bradykinin will accumulate in the lungs and cause a cough
How/when does segmental atelectasis occur?
blockage of a segmental bronchus –> air in blocked segment will gradually be absorbed into blood –> collapse
Where are posterior thoracotomy incisions made?
posterolateral aspects of 5th-7th intercostal spaces
What is the most common accessory lobe of the lungs?
azygos lobe - in right lung of 1% of ppl
What is hydrothorax?
accumulation of excess fluid in pleural cavity
What happens to compliance in emphysema?
compliance increases
Where do you make an incision to insert a chest tube?
5th or 6th intercostal space in the midaxillary line
What is pigeon chest?
pectus carinatum
what is the sternal line of pleural reflection?
costal pleura becomes mediastinal pleura anteriorly
What nerve is solely responsible for the innervation of the pericardium?
phrenic N
Is the vagus N sympathetic or parasympathetic?
parasympathetic (CNX)
What are the divisions of parietal pleura?
costal pleura
mediastinal pleura
diaphragmatic pleura
cervical pleura
What is the vertebral line of pleural reflection?
costal pleura becomes mediastinal pleura posteriorly
Why is displacement of a bone fragment from a sternal body fracture unlikely?
sternum is invested by deep fascia and sternal attachments of the pectoralis major muscles
Can you have half of the diaphragm paralyzed?
Yes bc there are 2 phrenic nerves!
What is the major concern for sternal injuries?
can cause heart problems
25-45% death rate associated w/ sternal fractures
What will cause a right shift in oxyhemoglobin curve?
decreased pH
increased CO2
increased temp
metabolites (2,3 DPG)
What is the costal line of pleural reflection?
costal pleura becomes diaphragmatic pleura
If you have a pulmonary embolism, how does the alveolar gas change?
gas in good part of lung will be normal
gas in part of lung w/ no blood flow will have PCO2 of 0 and increased PO2 –> mix of gas will have reduced CO2 and increased O2
What does the right horn of the sinus venosus turn into?
half turns into sinus venerum of atria
other half turns into pulmonary veins
What is flail chest?
multiple rib fractures –> allow segment of thoracic wall to move in and out during breathing
impairs ventilation and affects oxygenation of blood
Malformation of what embryologic structures causes coarctation of the aorta?
3rd, 4th, and 6th pharyngeal arches
How does lymph drain from the breasts?
75% goes to subareolar LNs –> axillary LNs –> subclavian lymphatic trunk –> R lymph duct or thoracic duct
25% goes to subareolar LNs –> parasternal LNs –> L or R bronchomediastinal trunk –> R lymph duct or thoracic duct
What embryolic structures make up the muscular and membranous portions of the interventricular septum?
interventricular septum growing up toward endocardial cushions = muscular part
R and L bulbar ridges = membranous part - from neural crest!!! most common defects from this!!
If you have a metabolic acidosis, what formula do you use to calculate if the respiratory compensation is adequate?
PaCO2 = 1.5[HCO3] + 8 +/- 2
If you have a metabolic alkalosis, what formula do you use to calculate if the respiratory compensation is adequate?
change in PaCO2 = (0.5 to 1.0) x the change in HCO3
What lets you know a respiratory acidosis is acute?
increase in HCO3 per 10 mm Hg change in PaCO2 = 1
What lets you know a respiratory acidosis is chronic?
increase in HCO3 per 10 mm Hg change in PaCO2 = 4
What lets you know a respiratory alkalosis is acute?
decrease in HCO3 per 10 mm Hg change in PaCO2 = 2
What lets you know a respiratory alkalosis is chronic?
decrease in HCO3 per 10 mm Hg change in PACO2 = 5
What is the compliance of the lungs inversely related to?
the elastic recoil of the lungs
What is a normal anion gap?
less than or equal to 12 for calculations
8-16 is normal
What is a normal V/Q ratio?
0.8
normal v = 4, normal q = 5
What is normal cardiac output?
~5 L/min
