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Module Two > Thoracic Cavity & Breathing > Flashcards

Thoracic Cavity & Breathing Flashcards

1
Q

Name the five structures of the sternum

A

Jugular notch, manubrium, sternal angle, body, xiphoid process

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2
Q

How many true ribs are there?

A

7

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3
Q

Which are the floating ribs?

A

11-12

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4
Q

Which are the false ribs?

A

8-10

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5
Q

Between what vertebral levels would you describe the thoracic cavity as being?

A

T1-T12

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6
Q

What are the major structures that exit the superior thoracic aperature?

A

Left and right carotid, left and right subclavian, left and right internal and external jugular veins, oesophagus, trachea, recurrent laryngeal nerves, left and right vagus and phrenic nerves.

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7
Q

What perforates the diaphragm at T8 vertebral level, leaving the inferior thoracic aperature?

A

IVC

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8
Q

What vertebral level does the oesophagus perforate the diaphragm?

A

T10

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9
Q

What structures make up the scapula?

A

Acromion, coracoid process, glenoid fossa, subscapular fossa

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10
Q

How many lobes does the right lung have?

A

3

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11
Q

Which lung has two lobes?

A

Left

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12
Q

How many fissures does the left lung have?

A

1

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13
Q

How many fissures does the right lung have?

A

2

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14
Q

What are the two types of pleura that surround the lungs?

A

Visceral and parietal

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15
Q

Which pleura adheres tightly to the surface of the lungs?

A

Visceral

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16
Q

What two structures lie directly posterior and anterior to the thoracic plane?

A

Disc between T4-T5 and the sternal angle

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17
Q

What landmarks might you find in the thoracic plane?

A

Carina, start and end of aortic arch, perforation of the SVC into the heart, terminal end of pulmonary trunk

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18
Q

Between which vertebral levels would you describe the superior mediastinum?

A

T1-T4

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19
Q

The inferior mediastinum consists of what three sections?

A

Anterior, middle, posterior

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20
Q

What structures may be mentioned to describe the position of the Hilum in the lungs?

A

Posterior to the cardiac impression, vertebral level T5-T7

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21
Q

Name the main structures that are found in the posterior mediastinum

A

Oesophagus, IVC, descending thoracic aorta, thoracic duct, azygous veins, thoracic splanchnic nerves.

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22
Q

What vertebral level is the xiphoid process?

A

T10

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23
Q

The typical ribs have what parts?

A

Head with two facets, neck, tubercle, costal angle, costal groove.

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24
Q

Which ribs only articulate with one vertebrae?

A

1, 10, 11, 12

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25
Q

The 1st rib is what shape?

A

Sickle shaped and flat

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26
Q

Which ribs have no costal cartilages?

A

11 and 12

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27
Q

The costal margin is shared cartilage among which ribs?

A

8-10

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28
Q

What marks the boundaries of the inferior thoracic aperture?

A

T12, costal margin and xiphoid process

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29
Q

Name the three layers of intercostal muscle

A

External, internal, innermost

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30
Q

What nerves innervate the intercostal muscles?

A

Ventral rami of the thoracic spinal nerves

31
Q

Where does the neurovascular bundle of each intercostal space run?

A

In the costal groove of each rib

32
Q

What are the functions of the three layers of intercostal muscle?

A

External- elevate during forced inspiration. Internal and innermost- depression during forced expiration

33
Q

What happens to the diameter of the thorax during elevation of the upper ribs?

A

Increase in anterior-posterior diameter, known as the “pump-handle” movement

34
Q

What happens to the diameter of the thorax during elevation of the low ribs?

A

Increase in transverse diameter, known as the “bucket-handle” movement

35
Q

What are the accessory inspiratory muscles?

A

sternocleidomastoid, scalenus anterior/medius/posterior, pectoralis major/minor, serratus anterior and latissimus dorsi

36
Q

What are the accessory expiratory muscles?

A

rectus abdominis, external/internal oblique and transversus abdominus

37
Q

What part of the pleura can sense pain?

A

Parietal

38
Q

What part of the pleura does the phrenic nerve innervate?

A

Mediastinal and diaphragmatic parietal pleura

39
Q

Which nerve supply the apical and costal parietal pleura?

A

Intercostal nerves

40
Q

What arteries supply the parietal pleura?

A

Intercostal arteries

41
Q

What arteries supply the visceral pleura?

A

Bronchial arteries

42
Q

Where do pleural effusions collect?

A

Costo-diaphragmatic recess

43
Q

On a plain x-ray, how would you discern a pleural effusion?

A

“blunting” or decrease of the costophrenic angle

44
Q

What is thoracocentesis?

A

Pleural tap, a procedure performed to drain the excess fluid in the costo-diaphragmatic recess

45
Q

What part of the pulmonary plexus innervates 75% of the lungs?

A

Posterior

46
Q

How does a pneumothorax occur?

A

Air or gas within the pleural space removes the surface tension of the serous fluid and results in the collapse of the lung.

47
Q

What is a tension pneumothorax?

A

Air enters the pleural cavity and cannot escape. The pressure causes a mediastinal shift which impairs venous return to the heart and cause haemodynamic compromise, as well as flattening the diaphragm, deviating the trachea to the contralateral side and reducing the function of the contralateral lung.

48
Q

Where is a chest drain inserted in a pneumothorax or pleural effusion?

A

5th or 6th intercostal space, mid-axillary line

49
Q

Which costal cartilage aligns with the xiphisternal joint?

A

6th

50
Q

Where is the cardiac notch of the pleura?

A

4th-6th costal cartilage

51
Q

What costal cartilage does the sternal angle align with?

A

2nd

52
Q

What ribs does the costo-diaphramatic recess sit between?

A

10th and 12th

53
Q

Which costal cartilage will you find the horizontal fissure on the right side?

A

4th

54
Q

What is the angle of the right main bronchus?

A

25 degrees

55
Q

What is the angle of the left main bronchus?

A

45 degrees

56
Q

Name the layers of tissue, from external to internal, you would encounter during a standard chest drain insertion for pneumothorax?

A

Skin, superficial fascia, external intercostal muscle, internal intercostal muscle, innermost intercostal muscle, endothoracic fascia, parietal pleura, visceral pleura, lung

57
Q

Where would a chest drain usually be inserted?

A

5th intercostal space, midaxillary line.

58
Q

Describe what happens during the inspiratory phase of the cough reflex

A

Irritation of cough receptors cause vocal cords to abduct, external intercostals and diaphragm contract, thoracic cavity size increases, decreasing pressure, air moves into thorax.

59
Q

The epiglottis and vocal cords close, trapping air within the lungs. What stage of the cough reflex is this?

A

Compression

60
Q

What muscles are involved in the expiratory phase of the cough reflex?

A

Internal intercostals and abdominal muscles

61
Q

What affect on the cough reflex can ACE inhibitors have?

A

Side effect of persistent dry cough. Caused by the accumulation of bradykinin which releases pro-inflammatory peptides that irritate the c-fibres, resulting in hyperstimulation of the cough reflex.

62
Q

Irritation of what nerve causes sneezing?

A

Trigeminal (V)

63
Q

How are larger particles prevented from entering the respiratory system?

A

Trapped in the mucus secretion in conducting zone and swept upwards towards the nose and mouth via the mucociliary escalator

64
Q

What partial pressure of oxygen would you find in venous blood?

A

~40mmHg

65
Q

What partial pressure of C02 would you find in arterial blood?

A

~40mmHg

66
Q

The partial pressure gradient between the air and the tissues is smaller in CO2, what ensures that equal amounts of exchange happen?

A

CO2 is 20x more soluble that O2.

67
Q

Explain Fick’s law.

A

Rate of diffusion is proportional to the surface area of the tissue, the pressure gradient and the gas constant. It is inversely proportional to tissue thickness.

68
Q

What is the gas constant?

A

Gas solubility / sqrt(gas molecular weight)

69
Q

Use Fick’s law to describe why gas exchange is reduced in pathological disease, such as pneumonia.

A

Alveolar air is blocked by infectious fluid, creating a thicker diffusion pathway, increasing rate of diffusion across the membrane. The surface area is also reduced due to inflammatory consolidation, reducing the rate of diffusion across the membrane.

70
Q

What is VQ matching?

A

the changes in bronchiolar constriction/dilation (V) and arteriolar constriction/dilation (Q) happening at each gas exchange surface in the lungs to maximise coupling.

71
Q

What do the V and Q stand for in VQ?

A

Ventilation and perfusion

72
Q

What is the ideal VQ ratio?

A

0.8-1

73
Q

What happens in the arterioles in the lungs when there is a low PaO2 (hypoxia)?

A

Vasoconstriction, decreasing blood flow and redirecting it to better perfused areas

74
Q

A high VQ ratio would indicate what cause of respiratory distress?

A

High VQ=Low Q= Low perfusion= Reduced blood flow/blocked vessel (i.e. pulmonary embolism)

Module Two (9 decks)

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