Thoracic Deep and Respiratory System

Question 1

Insertion of a chest drain (tube) is a commonly performed procedure and is indicated in the presence of pneumothorax, malignant pleural effusion, empyema, hemopneumothorax and postoperatively after thoracic surgery.
The position of the chest drain (tube) is determined by the “safe triangle.” This triangle is formed by the anterior border of the latissimus dorsi, the lateral border of the pectoralis major muscle, (the area superior to a line horizontal to the level of the nipple) and the apex below the axilla. The position of the ribs in this region should be clearly marked. Anesthetic should be applied to the superior border of the rib and the inferior aspect of the intercostal space. The neurovascular bundle runs in the neurovascular plane, which lies in the superior aspect of the intercostal space, hence the reason for positioning of the tube on the superior border of a rib (i.e., at the lowest position in the intercostal space).

Answer 1

Safe TriangleChest drain (tube) insertion

Question 2

Safe Triangle

Answer 2

1.Mid-axillary line / boarder of latissimus dorsi.

2. Lateral boarder of pectoral major.
3. Imaginary horizontal line from the nipple.

Question 3

Respiratory System Consists of :

Answer 3

1. Conducting zone
2. Respiratory zone

Question 4

Provides rigid conduits for air to reach the sites of gas exchange
Includes all other respiratory structures (e.g., nose, nasal cavity, pharynx, larynx, trachea.

Answer 4

Conducting zone (upper respiratory)

Question 5

Site of gas exchange
Consists of bronchioles, alveolar ducts, and alveoli

Answer 5

Respiratory zone (lower respiratory)

Question 6

Respiratory muscles:

Answer 6

1. Diaphragm- promote inhalation
2. Internal intercostals - promote exhalation
3. External intercostals- promote inhalation

Question 7

Diaphragm and external intercostals

Answer 7

promote inhalation

Question 8

Internal intercostals

Answer 8

promote exhalation

Question 9

Major Functions of the Respiratory System

Answer 9

To supply the body with oxygen and dispose of carbon dioxide
Respiration – four distinct processes must happen
1. Pulmonary ventilation – moving air into and out of the lungs
2. External respiration – gas exchange between the lungs and the blood
3.Transport – transport of oxygen and carbon dioxide between the lungs and tissues
4. Internal respiration – gas exchange between systemic blood vessels and tissues

5. Cellular Respiration- takes place in the cell in the mitochondria and produces energy.
   O2 + GLUCOSE= ATP+CO2+H20+HEAT

Question 10

moving air into and out of the lungs

Answer 10

Pulmonary ventilation

Question 11

gas exchange between the lungs and the blood

Answer 11

External respiration

Question 12

transport of oxygen and carbon dioxide between the lungs and tissues

Answer 12

Transport

Question 13

gas exchange between systemic blood vessels and tissues

Answer 13

Internal respiration

Question 14

passes through the central tendon at approximately vertebral level TVIII

Answer 14

The inferior vena cava

Question 15

passes through the muscular part of the diaphragm, just to the left of midline, approximately at vertebral level TX

Answer 15

The esophagus

Question 16

pass through the diaphragm with the esophagus

Answer 16

The vagus nerves

Question 17

passes behind the posterior attachment of the diaphragm at vertebral level TXII

Answer 17

The aorta

Question 18

passes behind the diaphragm with the aorta

Answer 18

The thoracic duct

Question 19

may also pass through the aortic hiatus or through the crura of the diaphragm.

Answer 19

The azygos and hemiazygos veins

Question 20

Because the anterior ends of the ribs are inferior to the posterior ends, when the ribs are elevated, they move the sternum upward and forward. Also, the angle between the body of the sternum and the manubrium may become slightly less acute. When the ribs are depressed, the sternum moves downward and backward. This “pump handle” movement changes the dimensions of the thorax in the antero-posterior direction and allows for more air to enter the lungs inferiorly.

Answer 20

Pump Handle

Question 21

As well as the anterior ends of the ribs being lower than the posterior ends, the middles of the shafts tend to be lower than the two ends. When the shafts are elevated, the middles of the shafts move laterally. This “bucket handle” movement increases the lateral dimensions of the thorax increasing area for lung inflation.

Answer 21

Bucket Handle

Question 22

Although the visceral pleura is innervated by visceral afferent nerves that accompany bronchial vessels, pain is generally not elicited from this tissue.
The lungs do not completely fill the anterior or posterior inferior regions of the pleural cavities. This results in recesses in which two layers of parietal pleura become opposed. Expansion of the lungs into these spaces usually occurs only during forced inspiration; the recesses also provide potential spaces in which fluids can collect and from which fluids can be aspirated.

Answer 22

Visceral pleura

Question 23

The parietal pleural is innervated by somatic afferent fibers. The costal pleura is innervated by branches from the intercostal nerves and pain would be felt in relation to the thoracic wall.
The diaphragmatic pleura and the mediastinal pleura are innervated mainly by the phrenic nerves (originating at spinal cord levels C3, C4 and C5).
Referred Pain from these areas would refer to the C3, C4 and C5 dermatomes (lateral neck and the supraclavicular region of the shoulder).

Answer 23

Parietal pleura

Question 24

The two lungs are organs of respiration and lie on either side of the mediastinum surrounded by the right and left pleural cavities. Air enters and leaves the lungs via main bronchi, which are branches of the trachea.
The pulmonary arteries deliver deoxygenated blood to the lungs from the right ventricle of the heart. Oxygenated blood returns to the left atrium via the pulmonary veins.
The right lung is normally a little larger than the left lung because the middle mediastinum, containing the heart, bulges more to the left than to the right.
Each lung has a half-cone shape, with a base, apex, two surfaces, and three borders (Fig. 3.39).
▪The base sits on the diaphragm.
▪The apex projects above rib I and into the root of the neck.
▪The two surfaces—the costal surface lies immediately adjacent to the ribs and intercostal spaces of the thoracic wall. The mediastinal surface lies against the mediastinum anteriorly and the vertebral column posteriorly and contains the comma-shaped hilum of the lung through which structures enter and leave.
▪The three borders—the inferior border of the lung is sharp and separates the base from the costal surface. The anterior and posterior borders separate the costal surface from the medial surface. Unlike the anterior and inferior borders, which are sharp, the posterior border is smooth and rounded.

Answer 24

Lungs

Question 25

PET is a nuclear medicine medical imaging technique that produces a 3-D image of functional processes in the body. A PET scan uses a small amount of a radioactive drug, or tracer, to show differences between healthy tissue and diseased tissue. The most commonly used tracer is called FDG (fluorodeoxyglucose), so the test is sometimes called an FDG-PET scan. Before the PET scan, a small amount of FDG is injected into the patient. Because cancer grows at a faster rate than healthy tissue, cancer cells absorb more of the FDG. The PET scanner detects the radiation given off by the FDG and produces color-coded images of the body that show both normal and cancerous tissue.

Currently, many PET scanners also include a conventional computed tomography (CT) scanner. This allows images of both anatomy (CT) and function (PET) to be taken during the same examination.

Example of uses: PET scans can be used to view, monitor, or diagnose
Tumors
Blood flow to the heart
Brain disorders

Answer 25

FDG PET Scan

Question 26

Nasal cavity has bumps

Answer 26

conchae

Question 27

Olfactory Nerve (cranial nerve 1)

Answer 27

Top of nasal cavity

Question 28

Nasal Pharynx

Answer 28

runs from nasal cavity to uvula

Question 29

Oral Pharynx

Answer 29

Runs from Uvula to Epiglottis

Question 30

Laryngeal Pharynx

Answer 30

Epiglottis to larynx

Question 31

Anabolic activity

Answer 31

Energy

Question 32

Catabolic

Answer 32

Break down

Question 33

where the trachea splits

Answer 33

Carina

Question 34

Auditory tube

Answer 34

middle ear

Question 35

Goes up to vocal cords allowing speech

Answer 35

Recurrent Laryngeal Nerve

Question 36

96-100

Answer 36

Normal

Question 37

92-95

Answer 37

Respiratory problems

Question 38

85-89

Answer 38

Moderate COPD

Question 39

90-91

Answer 39

Mild COPD

Question 40

< 84

Answer 40

Severe COPD