Pulmonary Flashcards
Parts of sternum
Manubrium
Body
Xiphoid process
What does the superior articular process articulate with
Vertebra above
What does the inferior articular process articulate with
Vertebra below
What does the transverse facet articulate with
Tubercle (costotransverse joint)
What do the demifacets articulate with
Head of rib on vertebra (costovertebral joint)
Atypical ribs
1 (flat and wide)
2 (flat)
10 (only articulates with T10)
11 (floating)
12 (floating)
True ribs
1-7
Directly articulate with sternum
False ribs
8-10
Indirectly attach to sternum through interchondral joints
Floating ribs
11-12
Do not articulate with sternum
Costochondral joints
Anterior portion of ribs meet costal cartilage
Interchondral joints
Indirect anchorage to sternum seen in ribs 8-10
Costal margin
Inferior margin of thoracic wall
Rib motions
1-7 pump up and down
8-10 swing up like bucket handle
11-12 move lateral-medially
Pectoralis minor
Ribs 3-5–> coracoid process of scapula
I: medial pectoral nerve
Protracts scapula
Deltoid
Cavicle, acromion, and spine–> deltoid tuberosity of humerus
I: axillary nerve
Abduct upper limb
Pectoralis major
Sternum and calvicle–> proximal humerus
I: lateral and medial pectoral nerve
Adduct, medialy rotate, and flex humerus at shoulder joint
Anterior scalene
TP of cervical vertebrae–> rib1
I: Anterior rami of cervival spinal nerves
Cervical rotation and elevation of rib1
Middle scalene
TP of cervical vertebrae–> rib 1
I: anterior rabmi of cervical spinal nerves
Cervical rotation and elevation of rib 1
Posterior scalene
TP of cervical vertebrae–> rib 2
I: anterior rami of cervical spinal nerves
Cervical rotation and elevation of rib 2
External intercostal membrane
Replace external intercostal muscles anteriorly and connect to sternum
External intercostal muscle
A primary muscel of inspiration
Elevates ribs.
Fibers run anteroinferiorly
I: intercostal nerves
Don’t go all the way to sternum
Internal intercostal muscles
Go from sternum to angle of ribs
Most active during expiration
Depress ribs
Fibers run inferoposteriorly
Internal intercostal membranes
Replace internal intercostal muscle to connect it to vertebrae
Innermost intercostal muscle
Fibers run inferoposteriorly
Acts with internal intercostal during inspiration
Occupy lateral-most parts of intercostal spaces (don’t go to sternum or vertebrae)
Fascia layers of thorax superficial to deep
Skin
Superficial fascia
Adipose tissue
Intercostals
Endothoracic fascia
Parietal pleura
Pleural cavity
Visceral pleura
Primary muscles of inspiration
Diaphragm
External intercostals
Accessory muscles of inspiration
Scalenes
Sternocleidomastoid
Accessory muscles of expiration
Rectus abdominis
Internal oblique
Transversus abdominis
External oblique
Airway order
Nasopharynx
Oropharynx
Laryngopharynx
Trachea
Mainstem (primary) bronchi
Lobar (secondary) bronchi
Segmental (tertiary) bronchi
Bronchioles
Alveoli
What levels does the trachea span
C6-T4/5 (bifurcates here into L and R mainstem bronchi)
What makes up posterior trachea
Trachealis muscle
What makes the anterior part of trachea
C shaped cartilaginous rings open posteriorly
How many lobar bronchi in right lung
3 one for each lobe
Middle and lower come off of bronchus intermedius
How many lobar bronchi in left lung
2 one for each lobe
Bronchioles
Lose hyaline cartilage
Elastic fibers of lung keep them open.
Subdivide to formm terminate alveoli
Where does the internal thoracic artery come from
Subclavian
What does the internal thoracic artery bifurcate into
Musculophrenic and epigastric
Parietal pleura
Around cavity
Visceral pleura
On organ
Intercostal nerve sensory to pleura
T1-11
Cervical
costal
Diaphragmatic
Carry motor, sensory, and autonomic fibers
Phrenic nerve
C3, C4, C5
Sensory to pleura at cervical, mediastinal, and diaphragmatic
Sensory to pericardium
Motor to diaphragm
What gives atonomic innervation to cisceral plerua
Vagus nerve
Pneumothorax
Air in pleural cavity
Pleural effusion
Any fluid in pleural cavity
Hydropneumothorax
Serous fluid with pneumothorax
Hemothorax
Blood in pleural cavity
Chylothorax
Lymph in pleural cavity
Empyema (pyothorax)
Purulent fluid (pus)
Costal lung surface
Faces ribs and costal parietal pleura
Mediastinal lung surface
Faces mediastinum and mediastinal parietal pleura
Hilum of lung
Roots of lung
What surface of lung is the hilum on
Mediastinal
Diaphragmatic surface of lungs
Faces diaphragm and diaphragmatic parietal pleura
Base of lung
What all is at the superor thoracic apeture
Trachea
Esophagus
Vessels
Nerves
R/L pleural cavities
Inferior thoracic apeture
Enclosed by diaphragm
Where does the IVC pass through diaphragm
T8
Where does the esophagus pass through the diaphragm
T10
Where does the thoracic aorta pass through the diaphragm
T12
Diaphragmatic apetures
Caval
Aortic
Esophageal
Where is and what goes through caval hiatus
T8
IVC goes through diaphragm
Right phrenic nerve
Lymphatic vessels
Where is and what goes through esophageal hiatus
T10
Esophagus
Anterior vagal trunk
Posterior vagal trunk
Esophageal branches of left gastric vessels
Lymphatic vessels
Where is and what goes through aortic hiatus
T12
Descending aorta
Azygos vein
Thoracic duct
Central tendon
Central aponeurosis
Fused to inferior surface of fibrous pericardium
Right lung fissures
Oblique separates RUL and RML from RLL
Horizontal separates RUL from RML
Left lung fissures
Oblique separates LUL and LLL
Mediastinal structures on surface of right lung
Heart
IVC
SVC
Azygos vein
Esohagus
Subclavian arteries and veins
Mediastinal structures on surface of left lung
Heart
Aortic arch
Thoracic aorta
Esophagus
Subcalvian arteries and veins
How to tell which lung you’re looking at
Position of pulmonary artery compared to bronchiole
Right Anterior
Left Superior
Bronchial arteries
Come from thoracic aorta and give blood supply to lung tissue, visceral pleura, and root structures.
Much smaller than pulmonary arteries but sometimes seen in hilum
Where do the bronchial veins drain
Azygos vein
Indications for intercostal nerve blocks
Thoracic surgery
Upper abdominal surgery
Breast surgeryy
Rib fractures
Chest tube placement
Absolute contraindication of intercostal nerve block
Local infection
Relative contrainidications of intercostal nerve block
Coagulation disorders
Where to do intercostal nerve block
Posterior to midaxillary line
Complications of intercostal nerve block
Pneumothorax (not much room for error)
Bleeding (hitting vessel)
Where does the lateral cutaneous branch come off intercostal
Midaxillary line
Transudative pleural effusion
Pleural effusion with increased hydrostatic pressure or decreased oncotic pressure.
CHF
Hypoproteinemia
Exudative pleural effusion
Pleural effusion with thick stuff with cells.
Parapneumonic
Infectious
Malignant
Connective tissue disease
Chylothorax
Thoracentesis/pleural effusion signs and symtpms
Dyspnea
Cough
Respirophasic chest pain
Dullness to percussion
Absent or decreased breath sounds
Pleural fiction rubs
Chest tube procedure
Local anesthesia, intercostal nerve block, or IV sedation
Inserted at 4th or 5th intercostal space mid-axillary line
Emergent needle decompession
Done at second intercostal space midcalvicular line for tension pneumothorax.
Tension pneumothorax signs
Absence of breath sounds
Tracheal deviation to contralateral side
JVD
Give emergent needle decompression
land mark for 4/5th intercostal space midclavicular line
Nipple
When does the patient feel the most pain in thoracic procedure
Breaking through the parietal pleura
Should the patient inhlale or exhale for most radiographs
Inhale
Should the patient inhale or exhale for pneumothorax radiograph
Exhale
Best test to diagnose PE
CTPA/CTPE
When is D dimer not reliable for PE test
Hospital setting
What does a clot look like on CT
Hypodensity within vessel
