Thorax Flashcards
During radical mastectomy what nerve can be lesioned during ligation of the lateral thoracic artery?
*Long thoracic nerve (serratus anterior muscle)
- winged scapula, weakness in abduction of the arm
+another nerve - thoracodorsal nerve (latissimus dorsi muscle)
- weakness in extension and medial rotation of the arm
What is the consequence of the mal formation of the tracheoesophageal septum? What other conditions are associated?
Tracheoesophageal fistula
- esophageal atresia and polyhidramnios, regurgitation, gagging and cyanosis after feeding, abdominal distention after crying, reflux of gastric contents into lungs ▶️ pneumonitis
Congenital causes of pulmonary hypoplasia
- congenital diaphragmatic hernia
- bilateral renal agenesis ▶️ oligohydramnios ▶️ potter’s sequence (one the features bilateral hypoplasia)
What is the consequence of a tumor in the breast shape, why does it occur?
- dimpling of the skin (orange-peel appearance)
- tumor distort cooper ligaments
What is the cause of respiratory distress syndrome and with what conditions is related?
- deficiency of surfactant (type II neumocytes)
- premature infants, infants of diabetic mothers, prolongued intrauterine asphyxia
- tx: thyroxine and cortisol ⬆️ surfactant
Cause of hyaline membrane disease, what findings can you get histologically?
- surfactant deficiency - repeated gasping inhalation damage alveolar lining
- collapsed alveoli (atelectasis) and eosinophilic fluid covering the alveoli
Why does the lung collapse during a pneumothorax?
- air into the pleural cavity
- loss of negative pressure of the pleural cavity
Why does the tension pneumothorax occur?
- piece of tissue forms a flap over the wound ▶️ during expiration the air can’t escape from the wound ▶️ pressure ⬆️ ▶️ shift of the mediastinum and lung compression ⬆️
What structure occupy the costomediastinal recess?
Lingula of the left lung during inspiration
Where is the most commonly enter when aspiration of a foreign body?
Right primary bronchus (shorter, wider, more vertical than left)
*often can fall into the posterior basal segment of right inferior lobe
Where do the thoracic duct and the right lymphatic duct drain at the blood venous system?
Junction of the internal jugular and subclavian veins on their respective sides
How can a metastasis arise from the lower lobe of the left lung?
The lymphatic drainage from it also drains across the midline into the right bronchomediastinal lymphatic nodes and trunk ▶️ right lymphatic duct
Trachea and bronchi have pseudostratified columnar as their epithelial lining, where is the other only place that have this epithelia?
Male reproductive tract
What is the cause of the kartagener syndrome and what is the consequence?
- lacking dynein ▶️ immotile cilia
- many respiratory problems (can’t move the mucus where the bacteria is)
- males immotile sperm ▶️ infertility
What is the origin of bronchial metastatic tumor?
Kulchitsky cells - pulmonary neuroendocrine cell
What type of cells have defective the chloride transport in cystic fibrosis?
Clara cells
Until what portion of the airway are present the globet cells?
Until the proximal bronchioles, they are not at the terminal bronchioles
Where is the Clara cell, and what are its functions?
- serous solution similar surfactant
- detoxification of airborne toxins
- stem cells for cilliated cells and themselves
Why the children of diabetic mothers have higher risk of respiratory distress syndrome?
If the mothers have insulin resistance diabetes ▶️ ⬆️ insulin antagonizes effect of corticosteroids in inducing surfactant production
Which are the components of the blood-gas barrier?
Surfactant, pneumocyte type I, shared basal lamina, capillary endothelium
What are the pores of Kohn and their function?
Opening in the wall of most alveoli - important in collateral ventilation
Which are the three shunts that allow bypass the liver and pulmonary circulation during fetal life?
- foramen ovale
- ductus venosus
- ductus arteriosus
What allow maintain the fetal shunts
- ⬆️ right atrial pressure due to large bolus of blood directed into the right atrium from the placenta
- ⬆️ pulmonary resistance
Structurally what is the foramen ovale?
Opening between septum primum and foramen secundum
What type of shunts are cyanotic and non-cyanotic?
- right to left shunt ▶️ cyanotic condition
- left to right shunt ▶️ non-cyanotic condition
What type of shunt results in a atrial septal defect?
- left to right shunt ▶️ non-cyanotic condition
Why a pain arising from the diaphragm (ex subphrenic access) is referred to shoulder region?
sensory and motor diaphragm innervation is primarily from C3 - C5 spinal nerves ▶️ pain is referred to these dermatomes in shoulder region
What is the cause of the congenital diaphragmatic hernia? What does it cause?
Failure of the pleuroperitoneal membranes to develop properly ▶️ herniation of abdominal content into pleural cavity
*causes pulmonary hypoplasia
What is the cause of esophageal hiatal hernia? What does it render in esophagus?
Abnormally large esophageal hiatus to the diaphragm ▶️ herniation of stomach to pleural cavity
*renders esophagogastric sphincter incompetent because reflux I to esophagus
Which is the most common cause of cyanosis presenting immediately AFTER BIRTH?
Tetralogy is the most common cyanotic defect, but a newborn is not always cyanotic at birth. Transposition of the great arteries always presents with cyanosis at birth.
What structure is at risk of lesion when removing thymoma?
Left Brachiocepahlic vein
*lies immediately posterior to the thymus
What are the five birds of the mediastinum?
“The va-goose, the esopha-goose, the azy-goose, the hemiazy-goose, and the thoracic duck”
Presentation of the “Pancoast tumor” of the apex of the lung
lung cancer of the apex of the upper left lobe ▶️ hoarseness ▶️ the tumor invades the left recurrent laryngeal nerve
Which embryonic dilatations does not form a septum during heart development?
Sinus venosus becomes incorporated into the right atrium during heart development
During fetal life, in which structure will the oxygen saturation level of fetal blood be the lowest?
Ductus arteriosus
