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AIM 2.1 > 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

5th intercostal space in midclavicular line

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7
Q

thoracic cage expands/contracts, thus inc/dec

A

intrathoracic pressure

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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 rub 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. & anterior intercostals?

A

branches of internal thoracic a. and v.

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

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25
Q

phrenic n.

A

C3, 4, 5
motor innervation of diaphragm
sensory innervation of diaphragm, pleura, pericardium, inferior vena cava, and peritoneum

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26
Q

Diaphragm during inspiration

A

during quiet inspration, diaphragmflattens as it contracts –> increases height of thoracic cavity

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27
Q

External intercostal muscles during deep inspiration

A

contract during deep inspiration to raise the ribs –> inc circumference of thoracic cavity

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28
Q

accessory m. of respiration that add extra increase in volume

A 
scalenes
sternocleidomastoids
pec. major/minor
serratus anterior
obliques
transversus thoracis
transversus abdominus
rectus abdominus
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29
Q

tripod position

A

pts w/ advanced lung disease –> leaning forward, hands on knees to optimize respiratory mechanics

30
Q

bucket-handle movement

A

external intercostal muscles contract and elevate rib cage, expands laterally

31
Q

pump-handle movement

A

raising and lowering of sternal end of rib

32
Q

quiet expiration

A 
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
Q

forced expiration

A

use muscles of anterior and wall to compress viscera up under diaphragm

34
Q

intercostal n.

A

ventral primary rami of spinal n. T1-T12
travel between internal intercostals and innermost intercostals

motor innervation to muscles of intercostal space

35
Q

severe coarctation of aorta

A

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
Q

2 terminal branches of internal thoracic artery

A

musculophrenic artery

superior epigastric artery

37
Q

ligaments attaching ribs to vertebral body

A

costovertebral ligaments

38
Q

ligaments rib-transverse process vertebrae

A

costotransverse ligaments

39
Q

costochondritis

A

comm cause of chest pain in children and adolescents

inflammation of sternocostal ligaments (synovial ligaments)

40
Q

Thoracocentesis

A

in midaxillary line to avoid intercostal n. and collateral branch

41
Q

anterior intercostal veins drain into

A

internal thoracic veins

42
Q

posterior intercostal veins drain into

A

azygous system of veins

43
Q

Compartments of thoracic cavity

A

2 pulmonary cavities (lungs and pleurae)

central compartment - mediastinum (heart, great vessels, trachea, esophagus)

44
Q

R lung

A

3 lobes
horizontal fissure
oblique fissure

45
Q

L lung

A

oblique fissure
cardiac notch
lingula

46
Q

parietal pleurae lines the

A

thoracic cavity

47
Q

visceral pleurae

A

covers surface of lungs

48
Q

pain from mediastinal and diaphragmatic pleurae may be referred to shoulder dermatome (C3, C4) because of innervation by….

A

phrenic nerve

49
Q

pleurisy

A

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
Q

first place pleural effusion will occur

A

buildup of fluid particularly in costodiaphragmatic recess

51
Q

lungs extend ot ribs … during quiet respiration, pleural reflections to ribs…

A

lungs to ribs 6, 8, 10

pleural reflections to ribs 8, 10, 12

52
Q

types of fluid that can accumulate in pleural space

A 
serous fluid (hydrothorax, pleural effusion) 
blood (hemothorax)
lymph (chyle - chylothorax)
pus (prothorax or empyema)
air (pneumothorax)
53
Q

pleural effusion

costodiaphragmatic angle on affected vs. unaffected side

A

sharp on unaffected side

blunt on affected side

54
Q

common cause of spontaneous pneumothorax in young children and adults

A

pulmonary blebs (weakened out-pouching in lung, can rupture)

other causes: chest injury, lung disease (pneumonia, COPD)

55
Q

tension pneumothorax

A

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
Q

pneumothorax

A

injury to parietal or visceral pleurae or lung –> air into pleural cavity

57
Q

mucosa covering carina is innervated by sensory fibers that trigger…

A

cough reflex

58
Q

R and L pulmonary a. divide into ______, then _______ (usu 10 in each lung).

A

R and L pulmonary a. –> lobar a. –> segmental a. (10 each lung)

59
Q

pulmonary veins enter into

A

LA

60
Q

bronchial a.

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
Q

lung root

A

sheath of parietal pleura, conjoins the pericardium, and encloses pulmonary a., v., main bronchus, lymph nodes, and autonomic nerves

62
Q

pulmonary embolism sx/clinical signs/tx

A

difficulty breathing, chest pain upon inspiration

low oxygen levels, cyanosis, rapid breathing, rapid heart rate

anticoagulants and thrombolytics

63
Q

pulmonary plexus

A

supplies smooth muscles, glands in lungs/airways w/ autonomic innervation

R/L vagus n. (CN X)
R/L sympathetic chain

64
Q

cardiopulmonary splanchnic n.

A

carry POSTGANGLIONIC SYMPATHETIC fibers to heart/lung/esophagus

via IML cell column

65
Q

vagus n. (CN X)

A

parasympathetic
in pulmonary plexus

constricts smc in bronchi

secretion of mucous glands

relaxes blood vessels

66
Q

sympathetic fibers of pulmonary plexus

A

relax smooth muscle in bronchi (bronchodilator)

inhibit secretion of mucous

constrict blood vessels

exp. albuterol

67
Q

Right main-stem bronchus (eparetial bronchus) is found superior to the…

A

pulmonary artery

bronchopulmonary (hilarious) lymph nodes can often be seen here, and on rare occasion also small bronchial arteries

68
Q

left pulmonary a. lies above…

A

left main stem bronchus

69
Q

esophagus

A

long tube from C6 (cricopharynxgeus m.) to T10)

70
Q

landmark for IVC

A

T8

71
Q

landmark for esophageal hiatus

A

T10

72
Q

landmark for thoracic aorta becoming abdominal

A

T12

AIM 2.1 (23 decks)

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