Thorax

Question 1

Segmental innervation

Answer 1

Innervates the piece of skin at that level, all the way to the back. T1 is responsible for sensation on your medial forearm - last nerve root that will move along UE. T2 can sometimes do medial arm.

Question 2

The umbilicus has which nerve root?

Answer 2

T10

Question 3

If someone has a transection at T4 then

Answer 3

You can move your head, neck, and all UE. Will also have sensation from T4 and up, and can breathe on your own because the diaphragm was already innervated. But you will be a community ambulator, can’t walk or sit up straight or have sensation below T4

Question 4

External intercostals run

Answer 4

downward and forward (more lateral)

Question 5

Internal intercostals run

Answer 5

downward and backward (more medial)

Question 6

All the intercostal muscles will

Answer 6

bring the ribs closer together. They are muscles of ventilation - process of getting air in and out of the lungs

Question 7

Innermost intercostals run

Answer 7

straight up and down

Question 8

Transversus thoracis

Answer 8

Comes from the body of the sternum and inserts onto ribs 3,4,5,6
Will pull the ribs down so we use it for forceful exhaling.
Inconsistant muscle

Question 9

Diaphragm

Answer 9

Main muscle of respiration.
Separates thoracic cavity from abdominal cavity. Lies completely over your liver, spleen, pancreas, stomach, and lines the under surface of the rib cage and goes all the way to the posterior abdominal wall. Untapped muscle for stability, should be incorporated

Question 10

Pelvic floor muscles have

Answer 10

Poor recruitment patterns, poor firing patterns during pain (delayed), called an adaptive change - someone’s in pain the muscle doesn’t fire appropriately. If it doesn’t go away after pain is gone then we have a maladaptive pattern

Question 11

What works best to treat chronic lower back pain?

Answer 11

Pain education, myopyschosocial behavior counseling, and aerobic exercise

Question 12

What works best to treat hypermobility problems?

Answer 12

Stabilization exercises

Question 13

Lungs are where we

Answer 13

Exchange our gases

Question 14

In the front they run down to…

In the back they run down to…

Answer 14

Rib 8

Rib 10

Question 15

Lungs have two layers of tissue between them and the chest wall called

Answer 15

Parietal pleura which covers the entire thoracic cavity.

Visceral pleura which is a thin lining around the lungs only.

Question 16

Mediastinum

Answer 16

Area between the lungs.
4 areas: superior, anterior, middle, posterior
Hypothetical line at T4 to separate superior mediastinum on top from the other three ones below

Question 17

Superior mediastinum structures

Answer 17

Thymus gland
Superior vena cava
Brachiocephalic veins and arteries
Internal jugular veins 
Common carotid arteries
Subclavian veins and arteries
Trachea and esophagus 
Phrenic nerves and vagus nerves

Question 18

Patients who have serious cervical spine trauma like whiplash from an MVA can have structural damage to the

Answer 18

Sympathetic chain ganglion - In your thoracic spine (lateral to spinal cord between T1-T3).
Can only be associated with superior mediastinum.
Going to present with clinical symptoms like nausea, vomiting, increased sweating. Research that a single upper thoracic spine thrust manipulation can send a mechanical input to the system that will change the neurophysiological output

Question 19

Anterior mediastinum structures

Answer 19

Space between the front of the lungs and the sternum, no big structures

Question 20

Middle mediastinum structures

Answer 20

Pericardium and the heart

Question 21

Posterior mediastinum structures

Answer 21

2 vagus nerves, 2 phrenic nerves, esophagus, trachea

Question 22

The superior vena cava is formed by

Answer 22

Both brachiocephalic veins

Question 23

Each brachiocephalic vein is formed from the

Answer 23

Internal jugular vein and the subclavian vein

Question 24

Great veins are…. to the great arteries

Answer 24

anterior

Question 25

Trachea begins at the

Answer 25

cricoid cartilage

Question 26

Trachea runs down and splits at the

Answer 26

carina to form the right and left main stem bronchus, which will give us the right and left lungs

Question 27

How many lobes do the right and left lungs have?

Answer 27

Right has 3 lobes: upper middle and lower

Left has 2 lobes: upper and lower, and another piece called the lingula

Question 28

3 primary coronary arteries

Answer 28

Left anterior descending
Right anterior descending
Circumflex
They will supply the heart and myocardium with blood rich in oxygen

Question 29

6-way bypass surgery

Answer 29

Have signs like being out of breath after only 3 stairs, squeezing tightness etc. Coronary artery bypass graft x6, 6 vessels were blocked so they bypass those vessels and take new grafts from the veins in your legs and they reroute your blood supply. Need to restore oxygenated blood to the heart. Discharge from hospital is 2 days. These people are in their 40s and 50s.

Question 30

Blood enters the heart via 3 ways

Answer 30

Superior vena cava - which will dump blood from the UE and the head.
Inferior vena cava - which will dump blood from the LE, hepatic circulation.
Cardiac circulation itself - blood will flow through the coronary sinus.

Question 31

Blood flow through the heart

Answer 31

Blood will enter the right atrium after going through the thespian valve. Blood in the right atrium travels to the right ventricle through the tricuspid valve. This valve called the atrioventricular valve will have papillary muscles and chordae tendinae. These structures on the valve will prevent the valve from being blown open backwards and prevent backflow of blood. From the right ventricle blood passes thru the pulmonic semilunar valve and enters the pulmonary artery. This is the only artery that will carry deoxygenated blood to the lungs to become oxygenated. Blood will then enter the pulmonary vein (which is the only vein that carries oxygenated blood) and it will then enter the left atrium. Oxygenated blood passes from left atrium to left ventricle through the bicuspid / mitral valve, another AV valve. Once in the left ventricle blood will pass through the aortic semilunar valve to the entire circulation – cardiac output 5L per minute

Question 32

In diastole

Answer 32

The atria are contracting and the AV valves are open, semilunar valves are closed

Question 33

In systole

Answer 33

The ventricles are contracting and the AV valves are closed preventing backflow of blood while the semilunar valves are open

Question 34

Automaticity

Answer 34

Heart will beat by itself

Question 35

Intercalated discs

Answer 35

In cardiac muscle. Will break up the cardiac muscle into clumps which will allow parts of the cardiac muscle to depolarize all at once in sections

Question 36

SA node

Answer 36

Located in the right atrium
Controls the cardiac cycle
Heart’s implanted pacemaker which will set the beat between 60-100bpm (endocrine system)

Question 37

When the SA node depolarizes

Answer 37

The atria contract first, and the impulse will travel to the AV node

Question 38

When the AV node depolarizes

Answer 38

The ventricles will begin to contract

Question 39

The AV node is located at the

Answer 39

Top of the interventricular septum. As the impulse travels down the walls of the ventricles and up the sides the purkinjie fibers will begin to contract to finish depolarization of the heart

Question 40

Aortic valve auscultation point

Answer 40

To the right of the sternum in the 2nd intercostal space

Question 41

Pulmonary valve auscultation point

Answer 41

To the left of the sternum in the 2nd intercostal space more laterally

Question 42

Bicuspid valve auscultation point

Answer 42

To the left of the sternum much more laterally in the 5th intercostal space

Question 43

Tricuspid valve auscultation point

Answer 43

To the left of the sternum in the 5th intercostal space medially right off the sternum

Question 44

EKG

Answer 44

Only as good as the second you take it, not going to predict any pathology