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Emma III > Thoracic wall and lung > Flashcards

Thoracic wall and lung Flashcards

1
Q

anterior axillary line

A

vertical line through anterior axillary fold

lat edge of pectoralis major

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2
Q

posterior axillary line

A

vertical line through posterior axillary fold

ant edge of latissimus dorsi

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3
Q

aortic valve auscultation site

A

2nd intercostal space just to right of sternum

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4
Q

pulmonary valve auscultation site

A

2nd intercostal space just to left of sternum

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5
Q

tricuspid valve auscultation site

A

5th intercostal space just L to sternum

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6
Q

mitral valve auscultation site

A

left 5th intercostal space in midclavicular line

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7
Q

thoracic cage expands/contracts, thus inc/dec

A

intrathoracic pressure

inhale –> intercostal m. and diaphragm contract to expand chest cavity. diaphragm flattens and moves downwards and intercostal m. move rib cage up and out

inc in size –> dec internal air pressure, air from outside (now at higher P than inside thorax) rushes into lungs to equalize pressures

Exhale –> diaphragm and intercostal m. relax, reduces size of thoracic cavity thus increasing pressure and forcing air out of lungs

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8
Q

external intercostal muscles are replaced anteriorly by…

A

external intercostal membrane

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9
Q

internal intercostal muscles are replaced posteriorly by…

A

internal intercostal membrane

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10
Q

internal thoracic vessels are lateral to …

A

sternum

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11
Q

true ribs

A

(1-7) attach directly to sternum

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12
Q

false ribs

A

8-10 attach to costal cartilage above

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13
Q

floating ribs

A

11, 12 no cartilage

no necks or tubercles

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14
Q

paravertebral line

A

runs down transverse processes

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15
Q

scapular line

A

runs vertically down scapula

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16
Q

right semi-diaphragm is where during expiration

A

at about the 4th intercostal space

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17
Q

7th rib articulates with …

A

7th vertebral body
6th vertebral body above
intervertebral disc

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18
Q

flail chest

effects on inspiration/expiration

A

multiple rib fractures –> section of rib cage becomes detached from rest of the chest wall

inspiration –> intapleural pressure becomes increasingly negative, flail segment and underlying tissue sucked inward, lung collapses on affected side, mediastinum shifted toward unaffected side

expiration –> intrapleural pressure becomes less negative, flail segment and underlying tissue are pushed outward, mediastinum shifts to affected side

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19
Q

cervical rib may compress…

A

…subclavian/brachial artery between anterior scalene m. and cervical rib –> loss of pulse when arm is aBducted

…lower trunk of brachial plexus –> weakness in muscles of hand, pain, numbness in medial side of forearm and hand

^cause form of THORACIC OUTLET SYNDROME

(cervical rib=extra rib, usually arises from 7th cervical vertebra)

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20
Q

pectus excavatum

A

funnel chest

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21
Q

pectus carinatum

A

pigeon chest

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22
Q

kyphoscoliosis

A

lat bending

xs curvature

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23
Q

external intercostal m. action

A

elevate rib below during inspiration, expand vol of thoracic cavity which decreases inter thoracic pressure below atmospheric pressure and draws air into lungs

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24
Q

which arteries/veins run between transversus thoracis m.?

A

branches of internal thoracic a. and v.

internal thoracic a. arises from first part of subclavian a.

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25
phrenic n.
C3, 4, 5 motor innervation of diaphragm sensory innervation of diaphragm, pleura, pericardium, inferior vena cava, and peritoneum
26
Diaphragm during inspiration
during quiet inspration, diaphragmflattens as it contracts --> increases height of thoracic cavity
27
External intercostal muscles during deep inspiration
contract during deep inspiration to raise the ribs --> inc circumference of thoracic cavity
28
accessory m. of respiration that add extra increase in volume
``` scalenes sternocleidomastoids pec. major/minor serratus anterior obliques transversus thoracis transversus abdominus rectus abdominus ```
29
tripod position
pts w/ advanced lung disease --> leaning forward, hands on knees to optimize respiratory mechanics
30
bucket-handle movement
external intercostal muscles contract and elevate rib cage, expands laterally
31
pump-handle movement
raising and lowering of sternal end of rib
32
quiet expiration
``` passive inspiratory muscles relax rib cage drops under force of gravity relaxing diaphragm moves up elastic fibers in lung recoil volumes of thorax and lungs decrease simultaneously, increasing the pressure air forced out ```
33
forced expiration
use muscles of anterior and wall to compress viscera up under diaphragm
34
intercostal n.
ventral primary rami of spinal n. T1-T12 travel between internal intercostals and innermost intercostals motor innervation to muscles of intercostal space
35
severe coarctation of aorta
collateral circulation involving internal thoracic and intercostal arteries occurs may result in enlargement of intercostals and "rib notching" on inferior edge of upper rib figure 3 sign --> formed by dilatation of the aortic arch and
36
2 terminal branches of internal thoracic artery
musculophrenic artery | superior epigastric artery
37
ligaments attaching ribs to vertebrae
costovertebral ligaments
38
ligaments rib-rib
costotransverse ligaments
39
costochondritis
comm cause of chest pain in children and adolescents inflammation of sternocostal ligaments (synovial ligaments)
40
Thoracocentesis
in midaxillary line to avoid intercostal n. and collateral branch
41
anterior intercostal veins drain into
internal thoracic veins
42
posterior intercostal veins drain into
azygous system of veins
43
Compartments of thoracic cavity
2 pulmonary cavities (lungs and pleurae) central compartment - mediastinum (heart, great vessels, trachea, esophagus)
44
R lung
3 lobes horizontal fissure oblique fissure
45
L lung
oblique fissure cardiac notch lingula
46
parietal pleurae lines the
thoracic cavity
47
visceral pleurae
covers surface of lungs
48
pain from mediastinal and diaphragmatic pleurae may be referred to shoulder dermatome (C3, C4) because of innervation by....
phrenic nerve
49
pleurisy
inflammation of pleura (parietal and visceral rub together) sharp pain during breathing, coughing, sneezing causes: viral/bacterial infections (pneumonia, TB), pneumothorax, palm embolism, lung cancer can cause pleural effusion
50
first place pleural effusion will occur
buildup of fluid particularly in costodiaphragmatic recess
51
lungs extend ot ribs ... during quiet respiration, pleural reflections to ribs...
lungs to ribs 6, 8, 10 pleural reflections to ribs 8, 10, 12
52
types of fluid that can accumulate in pleural space
``` serous fluid (hydrothorax, pleural effusion) blood (hemothorax) lymph (chyle - chylothorax) pus (prothorax or empyema) air (pneumothorax) ```
53
pleural effusion costodiaphragmatic angle on affected vs. unaffected side
sharp on unaffected side blunt on affected side
54
common cause of spontaneous pneumothorax in young children and adults
pulmonary blebs (weakened out-pouching in lung, can rupture) other causes: chest injury, lung disease (pneumonia, COPD)
55
tension pneumothorax
air enters pleural cavity during inspiration but not expelled during exhalation L side tension pneumothorax causes increased volume of air within pleural space can cause MEDIASTINUM SHIFT to R side. inc pressure within chest cavity --> dec systemic venous return --> dec systemic venous return to heart --> dec cardiac output findings: chest pain, respirator distress, tachycardia, tachypnea (in initial stages)
56
pneumothorax
injury to parietal or visceral pleurae or lung --> air into pleural cavity
57
mucosa covering carina is innervated by sensory fibers that trigger...
cough reflex
58
R and L pulmonary a. divide into ______, then _______ (usu 10 in each lung).
R and L pulmonary a. --> lobar a. --> segmental a. (10 each lung)
59
pulmonary veins enter into
LA
60
bronchial a.
usually branches of posterior intercostal a. or from aorta itself carry oxygenated blood, travel along bronchi and pulmonary a. to provide blood to bronchi/tissue
61
lung root
sheath of parietal pleura, conjoins the pericardium, and encloses pulmonary a., v., main bronchus, lymph nodes, and autonomic nerves
62
pulmonary embolism sx/clinical signs/tx
difficulty breathing, chest pain upon inspiration low oxygen levels, cyanosis, rapid breathing, rapid heart rate anticoagulants and thrombolytics
63
pulmonary plexus
supplies smooth muscles, glands in lungs/airways w/ autonomic innervation R/L vagus n. (CN X) R/L sympathetic chain
64
cardiopulmonary splanchnic n.
carry POSTGANGLIONIC SYMPATHETIC fibers to heart/lung/esophagus via IML cell column
65
vagus n. (CN X)
parasympathetic in pulmonary plexus constricts smc in bronchi secretion of mucous glands relaxes blood vessels
66
sympathetic fibers of pulmonary plexus
relax smooth muscle in bronchi (bronchodilator) inhibit secretion of mucous constrict blood vessels exp. albuterol
67
Right main-stem bronchus (eparetial bronchus) is found superior to the...
pulmonary artery bronchopulmonary (hilarious) lymph nodes can often be seen here, and on rare occasion also small bronchial arteries
68
left pulmonary a. lies above...
left main stem bronchus
69
R lung hilum vs. L lung hilum
RALS R A (anterior pulmonary a.) L S (superior pulmonary a.)
70
Where does lymph from L lower load drain into?
Lymphatics on R side
71
superior thoracic aperture
aka thoracic outlet | Between T1 and manubrium
72
inferior thoracic aperture
bound by costal margin and lower ribs

Emma III (28 decks)

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