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Anatomy > Thoracic cage and mechanics of breathing > Flashcards

Thoracic cage and mechanics of breathing Flashcards

1
Q

what level is the suprasternal notch?

A

T2/3

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2
Q

what level is the sternal angle of Louis?

A

T4/5

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3
Q

what level is the inferior angle of scapula?

A

T8

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4
Q

what level is xiphisternum

A

T9

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5
Q

what level is the lowest part of costal margin, 10th rib?

A

L3

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6
Q

what are false ribs?

A

free ribs - 11 and 12

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7
Q

what are true ribs?

A

7,8,9

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8
Q

which ribs are most likely to fracture?

A

7-10

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9
Q

which ribs are least likely to fracture?

A

1 and 2 and 11 and 12

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10
Q

where is the weakest part of the rib?

A

middle/ side

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11
Q

fracture caused by coughing

A

pathological fracture

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12
Q

rib fractures in children

A

rare because bones are elastic and flexible

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13
Q

what do the lower ribs protect?

A

liver, spleen, diaphragm, abdominal viscera

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14
Q

thoracic outlet syndrome

A

C8 and T1 become compressed in the thoracic outlet, affecting the ulnar nerve . Unable to do fine movements of hand and flexion at wrist . Causes tingling in hands, white/ pale arms if subclavian artery compressed or blue arm if subclavian vein compressed

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15
Q

where is the apex of the lung?

A

comes out above clavicle

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16
Q

what could obstruct the superior thoracic aperture?

A 
extra ribs (cervical) above 1st rib
abnormal tight band connecting the spine to the ribs
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17
Q

anatomy of thoracic vertebrae

A

12 thoracic vertebrae
medium sized
main function - to articulate with the ribs
each thoracic vertebra has 2 demi facets
costal facet is on the transverse process except T11 and 12 which articulate with the tubercle of the rib

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18
Q

Pressures at rest

A

atmospheric = 760mmHg
Alveolar pressure = 760mmHg
Intrapleural pressure = 756mmHg

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19
Q

pressures during inhalation

A 
atmospheric = 760mmHg
Alveolar = 758mmHg
Intrapleural = 754mmHg
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20
Q

level of diaphragm

A

T9 posteriorly
anteriorly level of 5th rib
higher on left due to the liver

21
Q

diaphragmatic movement

A

increases vertical diameter of thoracic cavity .
contraction during inspiration causes it to flatten and moves downward leading to increase in the vertical diameter of thoracic cavity .

22
Q

what are the most active muscle group in breathing?

A

diaphragm/ skirt

23
Q

Inspiratory muscles during quiet breathing

A

diaphragm

external intercostals stabilise rib cage and move ribs up and out to increase diameter of thorax .

24
Q

Inspiratory muscles during increasing effort

A

diaphragm
external intercostals move the ribcage up and out
neck muscles pull ribcage upwards
sternocleidomastoid elevate sternum and scalenus major and minor muscles elevate first 2 ribs and sternum
shoulder muscles will pull rib cage outwards > pecs and lat dorsi

25
Q

what are the muscles of inspiration?

A 
diaphragm
external intercostals
accessory muscles= sternocleidomastoid, anterior, middle and posterior scalenes 
pectoralis major and minor 
serratus anterior
26
Q

expiratory muscles in quiet breathing

A

elastic recoil of tissues - chest wall and lungs. Normal exhalation is a passive process

27
Q

expiratory muscles in increasing effort

A

becomes an active process and involves internal intercostals and abdominal wall muscles

28
Q

what muscles are involved in expiration

A

internal and innermost intercostals

accessory muscles = rectus abdominis and transversus abdominis, external and internal oblique

29
Q

what do the internal and innermost intercostals do in expiration

A

internal = depress interosseus parts of ribs during forced expiration
elevate interchondral parts of ribs during forced expiration

30
Q

what do the accessory muscles of expiration do in expiration?

A

fix costal margin and increase intra-abdominal pressure

31
Q

mechanics of movement

A

pump handle movement - increases the antero-posterior diameter of thoracic cavity. Upward movement of the upper ribs move the sternum upward and outward and increases the antero-posterior diameter of thoracic cavity .
bucket handle movement = increases the transverse diameter of the thoracic cavity . Upward and outward movements of the middle and lower ribs increase the transverse or lateral diameter of thoracic cavity .

32
Q

what are the most active muscle groups in the pump handle movement?

A

intercostals

33
Q

what are the most active muscle groups in the bucket handle movement?

A

intercostals

34
Q

what innervates the diaphragm?

A

phrenic nerves

35
Q

what innervates the intercostal muscles?

A

segmental thoracic nerves

36
Q

what is the nerve root of the phrenic nerve?

A

C3,4,5

37
Q

upper and lower surfaces of ribs

A 
upper = blunt
lower = sharp
38
Q

fractured rib from coughing

A

pathological rib fracture

39
Q

cervical pleura

A

above first rib

40
Q

structure of pleura

A

cervical pleura above first rib
space for root of lung
pleura named based on what it is touching

41
Q

what goes through the diaphragm?

A

inferior vena cava
oesophagus
aorta

42
Q

Azygos system

A

veins that drain the thoracic wall and upper lumbar region via the lumbar veins and posterior intercostal veins

43
Q

what type of muscle is the diaphragm?

A

fast twitch

44
Q

not exercising with a respiratory condition

A

may use all the breathing muscles despite not exercising .

45
Q

thoracic interventions

A

go above rib for pleural fluid
insert chest drain above rib to avoid the artery and vein
at anaesthetise the rib insert needle below the rib to hit the nerve

46
Q

phrenic nerve palsy

A

causes hemidiaphragm, one side raises up

47
Q

Injury to C5

A

patient will still be able to breathe but not move anything else

48
Q

Injury to C2

A

no movement

patient will have to be on ventilator

Anatomy (16 decks)

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