Thorax and Lung

Question 1

Flail Chest

Answer 1

A loss of stability of the thoracic cage that occurs when a segment of the anterior or lateral thoracic wall moves freely because of multiple rib fractures.

This allows the loose segment to move inward on inspiration and outward on expiration

Question 2

Rib fractures

Answer 2

Fracture of the first rib may injure the brachial plexus and subclavian vessels. The middle ribs are most commonly fractured and usually result from direct blows or crushing injuries. Fractures of the lower ribs may tear the diaphragm, resulting in a diaphragmatic hernia.

Question 3

Thoracic outlet syndrome

Answer 3

A compression of neurovascular structures in the thoracic outlet causing a combination of pain, numbness, tingling or weakness and fatigue in the upper limb caused by pressure on the brachial plexus (lower trunk-C8 and T1 nerve roots) by a CERVICAL RIB

Question 4

Diaphragmatic ventilation

Answer 4

Young children and elderly persons with reduced thoracic compliance tend to breath diaphragmatically. Also, horn and wind instrument players and vocalists develop greater control over diaphragmatic and abdominal musculature.

Question 5

Costal ventilation

Answer 5

Obese people and women in pregnancy cannot effectively contract the diaphragm and therefore favor the abdominal musculature.

Question 6

Nerve T4 (dermatome contains landmark)

Answer 6

Nerve T4 supplies the dermatome that contains the nipple

Question 7

Nerve T10 (landmark)

Answer 7

T10 supplies the dermatome containing the umbilicus

Question 8

Intercostal nerve block

Answer 8

Accomplished by injecting an anesthetic immediately beneath the inferior edge of a rib, posteriorly

Question 9

Thoracentesis (needle placement)

Answer 9

If a needle or cathether is inserted into the pleural space, for example, to perform a thoracentesis, it should be placed just above the inferior rib in the intercostal space (rather than just below the rib above the intercostal space) to avoid the main neurovascular bundle WHICH TRAVELS IN A GROOVE IN THE INFERIOR EDGE OF THE RIB ABOVE THE INTERCOSTAL SPACE

Question 10

costodiaphragmatic recess

Answer 10

The lungs do not completely fill the pleural cavities and in certain areas parietal pleura comes into potential contact with another layer of parietal pleura with no lung tissue between (e.g. costodiaphragmatic recess). Should a collection of pleural effusion/blood form within the pleural cavity, it will tend to collect in the recess and may be drawn off with a syringe for examination.

Question 11

cupola

Answer 11

A small portion of the parietal pleura (called the cervical pleura I believe) extends superiorly in the neck region to be higher than the first rib. This area is called the “cupola”. Surgical incisions or knife wounds in this area may cause the collapse of the lung due to introduction of air into the pleural cavity.

Question 12

Pleurisy

Answer 12

Inflammation of the pleurae with exudation into its cavity, causing the pleural surfaces to be roughened. This roughening produces friction and a pleural rub can be heard with the stethoscope on respiration. The exudate forms dense adhesions between the visceral and parietal pleurae forming pleural adhesions. Symptoms are a chill, followed by fever and dry cough.

Question 13

Small objects lodge in which bronchus?

Answer 13

The diameter of the right bronchus is usually larger than the left. The angle for the left is usually more acute and the length of the left is usually longer than the right. As a result of these factors, small objects which may be swallowed and pass into the trachea proper usually lodge in the right bronchus.

(Right bronchus has three branches)

(Left bronchus has two branches)

Question 14

Pulmonary embolism

Answer 14

A blockage of the pulmonary artery or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream. PE most commonly results from DVT

Question 15

Auscultation (2nd intercostal space)

Answer 15

Left 2nd intercostal space: pulmonary artery (pulmonic valve?)

Right 2nd intercostal space: aorta (aortic valve)

Question 16

Auscultation (5th intercostal space)

Answer 16

left 5th intercostal space in mid-clavicular line: mitral valve

middle-left 5th intercostal space: tricuspid valve

Question 17

Costochondritis

Answer 17

Common cause of chest pain in children and adolescents

Inflammation of the cartilage connecting the anterior aspect of the ribs (1-7: the true ribs) with the sternum

Question 18

pectus excavatum

Answer 18

“funnel chest”

Question 19

Pectus carinatum

Answer 19

pigeon chest

Question 20

Kyphoscoliosis

Answer 20

Not sure of the details. Looks like a triangle cut out of ribs

Question 21

Shingles (Herpes zoster)

Answer 21

A viral disease characterized by a painful skin rash with blisters in a limited area on one side of the body, often in a dermatonal pattern

Virus affects dorsal root ganglia and travels down nerve axons to cause viral infection of the skin in the region of the nerve

The initial infection with varicella zoster virus causes the acute illness chickenpox.

Question 22

Aortic coarctation

Answer 22

In severe coarctation of the aorta, collateral circulation involving internal thoracic and intercostal arteries occurs-may result in enlargement of the intercostals and “rib notching” (seen on x-rays)

Question 23

Pleural effusion (x-ray)

Answer 23

Many times blunting of the costodiaphragmatic angle can be noted on the affected side

Question 24

Pulmonary blebs

Answer 24

Common cause of spontaneous pneumothorax in young children and adults. Blebs are weakened outpouchings in the lung, which can rupture, causing pneumothorax