Thoracic Contents Flashcards
1
Q
Superior thoracic aperture
A
- T1
- 1st ribs and costal cartilages
- superior manubrium
- borders
2
Q
Inferior thoracic aperture
A
- T12
- ribs 11 and 12
- costal cartilages 7-10
- Xiphisternal joint
3
Q
Pleural sac
A
- Visceral: around the organ
- parietal: around the cavity
4
Q
Lobes of the lung
and what seperates them
A
- right lung as 3 lobes while left has 2
- horizontal fissue: seperates middle lobe and superior lobe on the right
- Oblique fissue: seperates the middle and inferior on the right and the superior and inferior on the left
5
Q
bony landmarks
Right lung
A
- upper lobe: adjacent to ribs 1-4 anteriorly
- middle lobe: extends inferiorly and laterally between ribs 4-6
- lower lobe: largest, posteriorly extends from T4-T10
6
Q
bony landmarks
left lung
A
- Upper lobes: sits within ribs 1-6
- lingual lobe: area corresonding to the middle lobe
- lower lobe: same as right lower lobe
7
Q
Mediastinum
A
- area between the lungs containing the following structures
- heart
- roots of great vessels (ascending aorta, pulmonary trunk, superior and inferior vena cava)
8
Q
Structure of the heart
A
- 4 chambers
- AV vales: mitral and bicuspid
- semilunar vales: aortic and pulmonic
9
Q
blood flow through the heart
A
- superior vena cava/inferior vena cava
- right artium
- tricuspid valve
- right ventricle
- pulmonary valve
- pulmonary arteries
- pulmonary veins
- left atrium
- mitral valve
- left ventricle
- aortic valve
- aorta
10
Q
Heart auscultations
A
- aortic valve: right 2nd intercostal space next to sternum
- pulmonic valve: left 2nd intercostal space next to sternum
- tricuspid: left 5th intercostal space close to sternum
- mitral: left 5th intercostal space at midclavicular line
11
Q
RIb fracture
causes:
A
- direct trauma to the area
- repetitive motions such as golf swing, or rowing
- coughing hard or long periods of time
12
Q
rib fracture
clinical presentation
A
- pain with any of the following: deep breathing, bending/twisting, palpation on the injured area
- if there are double fractures to 3+ ribs can present with flail chest
13
Q
rib fracture
complications:
A
- tear of aorta: usually from a break in one of the 1st 3 ribs
- tear in the lungs: punctured lung causing it to cave in
- ripped spleen, liver, kidneys: caused from a break in on eof the lower ribs
- TOS - usually with 1st rib
- excessive use of acessory muscles can also cause TOS
14
Q
rib fracture
Diagnostic tools
A
- good history
- physical exam
- imaging is not needed unless multple rib fractures are suspected with underlying organ damage
- if imaging is used CT is gold standard for rib fx
15
Q
Pancaust tumor
A
- apical region of the lung
- can cause entrpament and disruption of structures in this area
16
Q
rib fx
PT treatment
A
- pain control is super important with these patients
- this will allow early respiratory care to prevent pulmonary complications
- examples: effective coughing, diaphragmatic breathing, intercostal nerve blockss, muscle relaxants
17
Q
Costochondritis
A
- inflammation of the cartilage that connexts the ribs to the sternum
- has no clear cause but can be connected to trauma, illess or severe strain
18
Q
Costochondritis
symptoms
A
- pain that is sharp or aching like
- affects more than one rib
- pain that can radiate to shoulders and arms
- symptoms will worsen with coughing, sneezing, or taking a deep breath
- can be exacerbated during pregnancy due to diaphragm being unable to descending causing ribs to move more
19
Q
Costochondritis
diagnostic tools
A
- tests are used to rule out other possible diagnosis
- lab tests: cardiac enzymes and troponin levels, sed rate, C-reactive test (CRP)
- imaging: X-ray to check for pneumonia
- diagnostic procedure: ECG
20
Q
Costochondritis
Treatment
A
- medications: cortisone injection/lidocain patch, asprin, non-steroidal, anti-inflammatory, analgescis
- cryotherapy
- taping to support ribs of costal cartailges
21
Q
Heart referral patterns
A
- chest
- left shoulder
- left neck and jaw
- left back
- can be right just unusual
22
Q
Lungs referred pain
A
- neck
- back
- both shoulders
- ribs
23
Q
Intercostal nerves
A
- 11 intercostal nerves
- innervate intercostal muscles
- provide sensory information from overlying skin and outer wall of the pleura
24
Q
Pathway of intercostal nerves
A
- from the anterior rami of that thoracic nerves T-T11
- enter between the posterior intercostal membrane and outer wall of pleura
- goes into the subcostal groove of its repective rib
- lies posteriorly to the rib
- first 6 nerves have branches and end in their intercostal space
- the 7-11th nerves leave the space and go into the abdominal wall
25
# Intercostal neuralgia
presentation
- pain and symptoms within the distribution of the intercostal nerves
- burning, sharp and or stabbing pain
- numbness and tinglinging within the distribtuion
- pain may be constant of intermittent
- severe cases may affect the intercostal muscles
26
# Intercostal neuralgia
causes
- damage from thoracotomy
- shinges
- trauma
- iatrogenic
- pregnancy
- inflammatory infections
- neoplasms
- aberrant or no motion of thoracic vertebrae
27
# Intercostal neuralgia
Treatment
- intercostal nerve blocks
- meds: NSAIDs, anticonulsants, topical meds
- chroninc conditions = SSRIs, SNRIs, tricyclic antidepressants can be used
- antiviral
- thoracic joint mobs if caused by lack of movement
- surgery: neurectomy, dorsal rhizotomy or sensory ganglionectomy
28
# The vagus nerve
functions
- parasympathetic control of heart rate and respiratory rate
- digestion
- immune response
- involved in swallowing and coughing
- innervates muscles of the soft palate, pharynx,larynx
29
# The vagus nerve
simplified pathway
- begins in the medulla
- exist skull through jugular foramen
- travels through the carotid sheath into thoracic cavity
- continues as pharyngeal, laryngeal, bronchia, esophageal and gastric branches and superior cardiac nerve
30
# The vagus nerve
injury: causes
- upper cervical instability: AA-C1-C3
- post-concussion syndrome
- whiplash
- cervical spine laminectomy
- injury to the chest
- poor posture
- injury to the ascending pharyngeal artery
- infection
31
# The vagus nerve
injury: signs and symptoms
- abdominal pain
- acid reflux
- change in HR or BP
- dysphagia
- dizziness or fainting
- hoarse voice
- nausea and vomiting
- uvular deviation to contralateral side
