CVPR Week 1: Thorax Overview Flashcards
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Describe thorax boundaries

Intercostal muscle location and function

The intercostal vein, artery, and nerve lie in the _________________ along the ___________ margin of the rib and pass between the ______________ muscles
- costal groove
- inferior margin
- intercostal muscles
Local anesthesia of intercostal nerves is used in?
patients with chest trauma and patient undergoing surgical procedures
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The diaphragm separates the _________ from the ___________.
Thorax from the abdomen
The major muscle of respiration
The diaphragm
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Inferior vena cava route through the diaphragm
through the central tendon
Abdominal aorta route through the diaphragm
behind the crura
Azygous vein route through the diaphragm
behind the crura
Vagus nerves route through the diaphragm
through the muscular part
Esophagus route through the diaphragm
through the muscular part
Phrenic nerve route through the diaphragm
through the central tendon and does not pass
Why does the inferior vena cava cross the diaphragm in the way that it does?
through the central tendon so that is is not constricted when the diaphragm contracts
Why does the esophagusinferior vena cava cross the diaphragm in the way that it does?
through the right Crus (muscular part) act as a sphincter to help prevent reflux
Why does the aorta cross the diaphragm in the way that it does?
behind the diaphragm (between crura) so not constricted when the diaphragm contracts
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The thoracic cavity is divided into?
The mediastinum and two pleural cavities

Pleura description
each lung is encased within a pleural sac formed by a continuous serous membrane called the pleura

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Thoracentesis description
is the insertion of a needle or catheter into the pleural cavity to remove excess fluid (pleural effusion)
Intercostal nerve block Indication
rib contusion or fracture
Intercostal nerve block Why
cutaneous anesthesia (pain relief)
Intercostal nerve block where?
appropriate rib level as well as 2 ribs above & below
between posterior axillary and midaxillary lines (blocks intercostal nerve before the cutaneous branches)
Intercostal nerve block how?
inferior margin of rib
Intercostal nerve block what?
infiltration of an anesthetic into the intercostal space (ICS)
ICS AKA
Intercostal space
Thoracentesis Indictation
pleural effusion
Thoracentesis why
Drain fluid
diagnostic (small amount) or therapeutic (large amount)
Thoracentesis where?
1-2 ICS below the level of effusion
no lower than the 8th ICS (superior to the 9th rib)
Sitting upright (mid scapular line)
Supine (midaxillary line)
Lateral decubitus (lying on side) posterior axillary line
Thoracentesis How
Superior margin of rib
Thoracentesis what?
Insertion of a needle or catheter into the pleural cavity
Thoracentesis overview

Pleura innervation

Identify innervation


Question 1

E. Parietal pleura
Question 2

C. just below the inferior margin of a rib

The heart and roots of the great vessels are surrounded by the _____________ and are located in the _____________.
- pericardial sac
- middle mediastinum
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The visceral pericardium reflects back to become __________ at the roots of the __________, forming the _______________.
- parietal pericardium
- great vessels
- pericardial sinuses

Identify


Identify plane of view


How many chambers does the human heart have?
4

How many valves does the human heart have?

Identify


Describe the walls of ventricles
Ventricles have walls with muscular ridges called…
- Trabeculae carneae
- papillary muscles
- Chordae tendineae

Describe the walls of atria
Atria have smooth and rigid walls with pectinate muscles

Identify


Papillary muscles description

The papillary muscles are specialized trabeculae carneae that have a free edge for attachment of the chordae tendineae

Papillary muscles function

Together they keep the AV valves closed and prevent them from everting into the atrium upon ventricular contraction

Identify


Identify the plane of view


left atrium pectinate muscles
in the left atrium, pectinate muscles are only found in the auricle
Crista Terminalis description
In the right atrium, the crista terminalis separates the muscular part from the smooth part (sinus venarum)
Coronary arteries description
the left and right coronary arteries branch off the ascending aorta to supply the heart muscle with blood

Cardiac veins description

the cardiac veins drain blood from the heart muscle into the right atrium via the anterior cardiac veins or the coronary sinus

% of the right dominant heart
85%
% of left dominant heart
15%
Right dominant heart description

Left dominant heart description

Question


autonomic innervation of the heart
from the vagus nerves and T1-T4 levels of the sympathetic trunk

heart sensory nerves path
travel back to the spinal cord with the sympathetics

Referred pain description
occurs when sensory information comes to the spinal cord from one location but is interpreted by the CNS as coming from another location innervated by the same spinal cord level
Referred Visceral pain example
- Visceral afferents from the heart enter at the T1-T4 spinal cord segments (with sympathetic axons)
- The pain is “felt” as coming from the chest and medial arm as somatic afferents from dermatomes also enter the spinal cord at that level

Referred somatic pain example
The fibrous pericardium is innervated by the phrenic nerves thus pericardial “pain” is referred to the shoulder or neck dermatomes for C3, 4, 5 (also true for the mediastinal parietal pleura and diaphragm)

Question


Cardiac valves are divided into 2 groups
2 listed
- Semilunar (aortic and pulmonary)
- Atrioventricular valves
The cardiac skeleton provides
mechanical stability and attachment for the cardiac muscles and valves

Atrioventricular AKA
AV
Identify


Which valves are atrioventricular?
- Mitral valve
- Tricuspid valve

How do semilunar valves function
Backflow closes the cusps of the aortic and pulmonary valves and in the aorta, fills the coronary arteries
How are the coronary arteries filled?
the aortic valve’s semilunar cusps prevent backflow and fill the coronary arteries
How are heart sounds produced
by the closure of the semilunar and AV valves are carried by blood flowing through the valve downstream (auscultation sites)

Auscultation position for the aortic valve
right 2nd intercostal space at the sternal margin

Auscultation position for the pulmonary valve
left 2nd intercostal space (at sternal margin)

Auscultation position for the tricuspid valve
left 5th intercostal space (at the sternal margin)

Auscultation position for the mitral valve
left 5th intercostal space (midclavicular line)

Identify valves and auscultation locations

Question


The first part of the conducting portion of the respiratory system?
The nasal cavity
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Larynx function
the larynx is a valve that closes the lower respiratory tract and an instrument to produce sound (voicebox)
Larynx composition
the larynx is composed of cartilages connected by elastic ligaments whose movement affects the tension and position of the vocal ligaments
Identify


The laryngeal cartilages are moved by?
The laryngeal muscles
the only laryngeal muscles that abduct (open) the vocal folds
posterior cricoarytenoids
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Identify function


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Identify function


The ___________ provide motor and sensory innervation of the larynx
The vagus nerves
The ___________ is motor to the cricothyroid and sensory to the mucosa above the vocal folds
Superior laryngeal branch of the vagus nerve
Superior laryngeal branch of the vagus nerve function
motor to the cricothyroid and sensory to the mucosa above the vocal folds
The _________ is motor to all muscles except the cricothyroid and sensory to the mucosa below the vocal folds
Recurrent laryngeal branch of the vagus nerve
Recurrent laryngeal branch of the vagus nerve function
provides motor to all muscles except the cricothyroid and sensory to the mucosa below the vocal folds
Identify


Question


Trachea structure
- The trachea is a flexible tube composed of C shaped cartilages closed posteriorly by smooth muscle
- The trachea bifurcates into a right and left main (primary) bronchus that divides into lobar (secondary) bronchi that divide into segmental (tertiary bronchi)

Identify


Blood supply of the tracheobronchial tree
receives its blood supply from the bronchial arteries

Identify


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The right main bronchus is ____ and more _________ than the left main bronchus so aspirated material is more likely to be found there
- wider
- more vertical
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Each segmental bronchus and branch of the pulmonary artery supply?
divisions within the lobes called bronchopulmonary segments

describe segmentectomy

describe lobectomy

describe pneumonectomy

Identify


Autonomic innervation of the tracheobronchial tree

Question


Overview
