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Respiratory > Thoracic cage and mechanics of breathing > Flashcards

Thoracic cage and mechanics of breathing Flashcards

1
Q

sternoclavicular joint

A

synovial joint between clavicle and manubrium of the sternum

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2
Q

sternocostal joints

whats the exception

A

synovial joints of costal cartilages of the true ribs with the sternum ( only exception is first rib (synchondrosis joint since the cartilage is directly united with the sternum)

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3
Q

costochondral joint

A

each of your ribs is connected to your breastbone by a piece of cartilage - the point where your rib connects to this cartilage is know as the costochondral joint

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4
Q

manubriosternal joint

A

symphysis joint ( 2nd cartilage joint) formed by manubrium and the sternal body

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5
Q

xiphisternal joint

A

where the sternum and xiphoid process meet

structurally it is synchondrosis and function synarthrosis

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6
Q

interchondral joints

A

articulations formed by the costal cartilages between the 6th to 10th rib

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7
Q

why can’t you palpate the first rib

A

its covered by the clavicle

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8
Q

what is a false rib

A

said to be false if it does not attach to the sternum but attach via costal cartilages

11th to 12th rib have no ventral attachment to anchor them so are floating

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9
Q

suprasternal notch/jugular notch

A

between the clavicle and above the manubrium

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10
Q

what rib is at the level of the sternal angle

A

2nd rib

Counting ribs from the sternal angle
Counting vertebrae from the C7 spinous process

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11
Q

what is the vertebra felt at the vertebral prominence at the level of the suprasternal notch

A

C7

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12
Q

at what vertebral level does the suprasternal notch correspond to

A

T2/3

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13
Q

at what vertebral level does the sternal angle of louis correspond to

A

T4/5

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14
Q

at what vertebral level does the inferior angle of the scapula

A

T8

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15
Q

at what vertebral level does the xiphisternum

A

T9

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16
Q

at what vertebral level does the lowest part of costal margin 10th rib

A

L3

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17
Q

what is the costal margin and what structure attaches here

A

medial margin formed by the cartilages of the 7th-10th ribs

diaphragm (Nipples are the height are where diaphragm is)-abdomen starts below nipples

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18
Q

what is the costal angle

A

is the angle between the left and right total margins where they join the sternum

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19
Q

do the costochondral junctions fully cover the heart

A

no - some of the heart is left exposed

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20
Q

midline thoracotomy

A

used in cardiothoracic surgery - split sternum in half with saw - often done to read lung cancer - need to access plural space of the thorax
or to put an artificial pacemaker in

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21
Q

where is the weakest point of the rib

A

the angle of the rib - mostly likely to be fractures

1 and 2 hardly break as protected by clavicle
11 and 12 can spring out the way

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22
Q

true rib

what ribs

A

attach to sternum via own costal cartilages 1-7

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23
Q

false ribs

what ribs

A

connected to sternum indirectly via cartilage from the rib above 8-10

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24
Q

floating ribs

what ribs

A

cartilage of these ribs ends in the abdominal musculature 11-12

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25
Q

what is a typical rib and what ribs are typical ribs

A

head contains two articular facets, neck, tubercle and body ( contains costal groove and joins with costal cartilage
3-9

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26
Q

what is an atypical rib and what ribs are atypical ribs

A

1,2,10,11,12
1st- widest and shortest - contains two grooves subclavian vessels
2nd- two facets and roughed surface
10-12- one facet

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27
Q

which rib contains grooves for the subclavian vessels

A

1st rib

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28
Q

external intercostals

A

elevate ribs

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29
Q

internal intercostals

A

depress ribs

30
Q

why are chest fractures in children rare

A

chest wall is elastic

31
Q

thoracic outlet syndrome

what would be associated with these injuries

A

disorder where blood vessels or/and nerves in the space between the clavicle and first rib are compressed ( brachial plexus problem, subclavian arteries and veins)
if vein going to have arm turn blue
if artery could be paler and colder intolerance
C8-T1- tingling of nerve - work out ulna)
sports that require competitive movements

32
Q

the pain of TOS can be confused with what clinical condition and how are they distinguished

A

confused with pain with angina( chest pain due to an inadequate supply of oxygen to the heart muscle)
distinguished because the pain of TOS does not occur or increase when walking

pain of TOS increase when raising affected arm which does not occur in angina

33
Q

how could the superior thoracic aperture could be obstructed

A 
extra ribs ( cervical rib) above the first rib 
abnormal tilt band connecting the spine to the ribs
34
Q

how many thoracic vertebrae

and what is there main function

A

12

articulation with the ribs

35
Q

the costal facet of thoracic vertebrae is on the transverse process which articulate with the tubercle of the rib. which vertebrae are not included in this

A

T11-12

36
Q

the spinous processes start inferiorly and anteriorly what are they protecting

A

the spine

37
Q

shingles is when the virus sits in the sensory cell bodies of spinal nerve roots - what is a classic symptom of this

A

pain go along the intercostal nerves - classic transverse pain ( nothing else does this) this is before spots come along

good to ask for chicken pocks

38
Q

resting ATP is 760mmHg

the intrapleural pressure is 756mmHg what is the alveolar pressure

A

760mmHg

39
Q

During inhalation diaphragm lowers increasing size of cavity and air comes in and diaphragm drops - flattened the ATP obviously stays the same the intrapleural pressure drops to 754mmHg what does the alveolar pressure drop to

A

758mmHg

40
Q

which side of the diaphragm is higher due to the liver

A

right side

Right hemidiaphragm at level of 5th rib anteriorly and T9 posteriorly at end of respiration

41
Q

chylothorax

A

rare condition where lymphatic fluid leaks into the space between the lung and chest wall - lymphatic flow disorder

42
Q

when the diaphragm contracts during inspiration it causes it to flattens and moves downwards leading to an increase in vertical diameter of the thoracic cavity –> what nerve innervates the diaphragm

A

Phrenic nerve C3-5

43
Q

in quiet breathing what muscles are used

A

diaphragm

external intercostals stabilise the rib cage

44
Q

when you increase effort during inspiration what muscles are used

A

diaphragm
external intercostals lift and expand ribs
accessory muscles
neck- SCM, SA,SM ( pull the rib cage up
shoulder Girdle muscles ( pec minor0, lat dorsi)

45
Q

sternoclaidomastoid in breahting

A

elevate sternum

46
Q

saclenus major and minor muscles

A

elevate first two ribs and the sternum

47
Q

pec minor ( when scapula stabilised) and lat doris

A

pull ribcage outwards - seen in acute asthma and patients in respiratory distress

( 3-5th ribs)

48
Q

oblique,transversus and rectus abdominaux muscles

A

pull ribcage downwards

49
Q

what are the accessory muscles of inspiration that need to be identified with patients with COPD on forced inspiration and expiration

A

sternocleidomastoid

anterior, middle and posterior scalenes and pec minor(major) and serratus anterior

50
Q

in quiet expiration breathing what muscles are used

A

none just elastic recoil of tissues ( chest wall and lungs) - normal exhalation is a passive process

internal and innermost intercostals

51
Q

what muscles are used in increasing effort expiration

A

active process so involves

internal intercostals and abdominal wall muscles

52
Q

What are the accessory muscles of expiration

A

rectus abdominus
transverse abdominus
these fix costal margin and increase intra-abdominal pressure

external internal obliques

53
Q

the mechanisms of breathing are described using 2 analogies - what are they

A

Pump handle movement

Bucket handle movement

54
Q

what is the pump handle movement

A

increase the anterograde-posterior AP diameter of the thoracic cavity

upwards movement of the upper ribs over sternum and out

most active muscle group being the intercostals

55
Q

what is the bucket handle movement

A

Increases the Transverse Diameter of the Thoracic Cavity.

upwards and outward movement of the middle and lower ribs increase the transverse or lateral diameter of the thoracic cavity

56
Q

what is poland syndrome

A

no pec major or rib

can be anything to do with missing structures in the pectoral girdle

57
Q

if you are going to anethastise go below the rib but if you want to do a chest drain where do you go

A

above the rib

apical pneumothorax, placement of a chest tube in the 2nd intercostal space should be considered.

58
Q

what nerves supply the intercostal muscles

A

segmental thoracic nerves

59
Q

what muscles are like having your hands in your pockets?

A

intercostals

60
Q

C2 lesion would patient need to be on ventilator

A

yes

Diaphragm is C3,4,5 therefore with a C2 lesion it wont work so patient will need to be on artificial ventilator

61
Q

C5 lesion would they need to be on ventilator

A

no- can breath as C3,4 nerve roots are working - wont be able to exercise much as everything below that

62
Q

T2 lesion

A

diaphragm will work and allplus with work and can use expiratory muscles and sternocleidomastoid ( 11th cranial nerve) , serratu
Wont be able to use intercostal muscles below that level

63
Q

L1 lesion or nerve block

A

everything above - intercostal will work but they will be paraplegic from below even if they increase respiration rate

64
Q

through what hole does the spinal cord pass through in thoracic vertebrae

A

vertebral foramen

65
Q

laminectomy

A

type of surgery in which a surgeon removes part or all of the vertebral bone( lamina) - this eases pressure on the spinal cord or the nerve root that may because by injury, herniated disk, narrowing of the canal ( spinal stenosis ) or tumours.

66
Q

Name the nerve that innervates the majority of the muscles associated with this structure in this region of the neck.

A

recurrent laryngeal nerve - innervates most of the intrinsic muscles of the neck except the cricothyroid

67
Q

recurrent laryngeal nerve palsy can causes what symptoms

A

Hoarseness/voice change

Vocal Cord Palsy which leads to hoarseness/voice change- persistent new onset hoarseness is therefore a ‘red flag’ symptom requiring investigation.

68
Q

what level is hyoid bone

A

C3

69
Q

what level is the upper border of the thyroid cartilage

A

C4

70
Q

what level is the cricoid cartilage

A

C6

71
Q

what level Is the junction of the pharynx and oesophagus

A

C6

Respiratory (22 decks)

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