Thorax Clinical Correlates Flashcards
An imaginary line drawn posteriorly from the ________ ________ through the intervertebral disc between T4 and T5 divides the central thorax into superior and inferior mediastinal regions.
sternal angle
An accessory cervical rib (1% of population) may articulate with the ____
vertebra and potentially contribute to what?
C7
thoracic outlet syndrome
What is thoracic outlet syndrome?
pressure is placed on the subclavian artery or lower brachial plexus trunk or both
Symptoms of thoracic outlet syndrome include:
1) numbness
2) tingling in C7–C8 nerve root distribution
3) pain
4) temperature changes in the upper limb
What is a general rule for main intercostal muscle function?
it is opposite of muscle name!
External intercostal muscles are most active during…..
inspiration (remember EX-IN)
Internal intercostal muscles are most active during….
expiration (remember IN-EX)
____, _____, _____ keep the diaphragm alive!
C3, C4, C5
The pleural sac can be visualized like a fist pushed into an inflated balloon, where your fist is representing the….
lung
In the “balloon analogy,” the outer surface of the balloon not touching your fist represents the…..
parietal pleura
The surface of the balloon in contact with your fist is the _____ ______, and the air/space between these two surfaces represents the _______ _______
visceral pleura, pleural cavity.
In the balloon analogy, your wrist represents the root of the _____, where these two layers are_______
lung, continuous
What tool is used to auscultate lung (breath) sounds across all anterior and posterior lung fields?
A stethoscope
Breath sounds vary depending on what?
airway diameter
Percussion of the thorax is performed to determine what?
whether underlying lung tissue is air-filled, fluid-filled, or solid, producing a resonate, dull, or flat sound, respectively
Left superior pulmonary vein drains….
left superior lobe
Left inferior pulmonary vein drains….
left inferior lobe
Right superior pulmonary vein drains….
right superior and middle lobes
Right inferior pulmonary vein drains….
right inferior lobe
What is an alveolus?
a thin-walled, polyhedron-shaped chamber that is continuous with the alveolar duct.
Alveolus is surrounded by what? Why?
a network of capillaries that brings blood in close proximity to the air so that gas exchange between the blood and air can occur
Surfactant is composed of….
1) Dipalmitoylphosphatidylcholine, which is the strongest-acting surfactant lipid molecule
2) Phosphatidylcholine, phosphatidylglycerol, neutral lipids, and
cholesterol
3) SPs A, B, C, D
Surfactant reduces what, by doing what?
reduces the elastance or collapsing force in the lung by reducing the surface attraction between opposing alveolar walls
What does “lub” refer to?
closure of the tricuspid and bicuspid valves at the start of ventricular systole (contraction)
What does “dub” refer to?
closure of the pulmonary and aortic valves at the end of ventricular systole
lub is what heart sound?
first heart sound and often referred to as S1
dub is what heart sound?
second heart sound and often referred to as S2
At the apex of the heart, ________ and ________ IV arteries anastomose
posterior and anterior
Deoxygenated blood from the head, neck, and thoracic cage enters the ______ ______ through the SVC, while blood from the abdomen, pelvis, and lower limbs enters through the ______
right atrium, IVC
Deoxygenated blood from the heart primarily enters the right atrium through the…..
coronary sinus
Blood is expelled from the ______ atrium through the _____ valve to the right ventricle.
right, tricuspid
Blood is expelled from the left atrium through the _____valve to the _____ ventricle.
bicuspid (mitral), left
Oxygenated blood is expelled from the left ventricle through the aortic valve to the _______ ______ and distributed to the head, neck, and body by way of aortic branches.
ascending aorta
Fracture of the rib typically occurs at the what? By the result of what?
costal angle as a result of crushing or traumatic injury
Visceral pleura and lungs are at risk of
injury from…..
exposed fractured rib end, which can result in pneumothorax
If indicated, surgical intervention (rib plating) involves stabilizing fractures with hardware to limit deformity and improve…..
respiratory function
During procedures like thoracentesis and intercostal nerve blocks, care must be taken to avoid damaging the ______ ________ ________ (in costal groove) and ________ ________ ________ within the intercostal space.
main neurovascular bundle, smaller collateral bundle
What is thoracentesis?
removal of fluid from pleural cavity
For thoracentesis, needle placement should occur just superior to the superior rib border and extend into the ________ ______ in the pleural cavity.
costodiaphragmatic recess
Needle placement should be low in the ______ intercostal space to access the costodiaphragmatic recess to avoid the neuromuscular bundle
9th
Needle placement should be high in the intercostal space to target the……
intercostal nerve
The Tanner stages of breast development are guidelines in assessing…..
whether a female adolescent is
developing normally
List the Tanner stages of breast development
Stage I: Breasts have papillae elevations only.
Stage II: Breasts have palpable buds and the areolae enlarge.
Stage III: Breasts show elevation of contours and the areolae enlarge.
Stage IV: Breasts form secondary areolar mounds.
Stage V: Breasts show an adult breast contour, the areolae recess to the general contour of the breast, and the nipples project.
The nipple may occasionally remain what?
depressed (called an inverted nipple)
Supernumerary ______ (called polythelia) or supernumerary ______ (called polymastia) may form along the line of the mammary ridge.
nipples, breasts
Carcinoma of the breast typically arises from the ______ cells of the mammary gland lactiferous ductal system (adenocarcinomas)
epithelial
What type of cancer is adenocarcinoma? Where can it metastasize?
malignant and can metastasize through the lymphatic system (most common), venous system, and by direct invasion of adjacent tissue
Lymphatic metastasis typically occurs through….
axillary lymph nodes, which drain ~75% of lymph from the breast
Breast cancer most often metastasizes to where?
bone, lungs, brain, or liver
Common signs of breast cancer include:
1) acute asymmetry
2) skin dimpling
3) pitting edema (peau d’orange sign)
4) abnormal breast contours
5) nipple inversion
6) redness
7) nipple discharge (blood; milk when not pregnant/breastfeeding)
8) palpable mass in breast or axilla
What is a mammogram? What is it most often used for?
radiographic examination of breast tissue
used to detect abnormal masses in the breast
If cancer is suspected, a _______ may be performed to determine whether cancer is present and to what extent.
biopsy
What are the treatment options for breast cancer?
radiation, chemotherapy, and mastectomy, which involves surgical excision of affected tissue
What is a radical mastectomy?
removal of the pectoral muscles, fascia, adipose, breast tissue, and adjacent lymph nodes
Care should be taken during a
mastectomy to avoid damaging the ______ ______ nerve, which runs along the lateral border of the breast in the midaxillary line.
long thoracic
What is pleural effusion caused by?
an accumulation of excess fluid within the pleural space, thus between the parietal and visceral pleurae
Pleural effusions can be categorized as…..
transudative or exudative in origin
Transudative effusions are most commonly caused by what?
heart failure
Exudative effusions are commonly caused by what?
1) vascular or lymphatic blockage
2) lung trauma
3) inflammation
4) tumor
T/F:
Chest x-ray or computed tomography scan may confirm effusion.
true
What is the treatment for pleural effusion?
thoracentesis to remove excess fluid and implementation of preventive measures based on the principle cause of effusion
What is a pneumothorax? When does that occur?
(collapsed lung) occurs when the parietal pleura is compromised, and air is allowed into the pleural cavity
T/F:
The normal air pressure that is present within the pleural cavity is increased, thereby causing the air-filled lung tissue to recede in size.
false, its DECREASED
What are the symptoms of pneumothorax?
significant difficulty breathing and chest pain
What are the symptoms of pneumothorax?
significant difficulty breathing and chest pain
What is the treatment for pneumothorax?
involves placement of a chest tube to remove excess air
Surgery may also be an option in the event that the chest tube does not fix the
problem completely
What is foreign body aspiration (FBA)?
fatal event due to potential airway obstruction and is a common cause of morbidity and mortality in children
Due to its vertical orientation and wider diameter, aspirated objects most often lodge in the _____ _______ _______ or one of its branches
right primary bronchus
If a bronchoscopy is warranted to assess the position of the foreign body, the _____ is visualized as an
important anatomical landmark.
carina
Obstructive lung diseases are characterized by what?
elevated airway resistance, primarily during expiration, due to airway narrowing.
Airway narrowing may be caused by what?
hint: 3 things
1) smooth muscle hypertrophy in airway walls
2) increase luminal mucus secretions
3) diseased lung tissue surrounding airway branches
Examples of obstructive lung disease include:
1) chronic bronchitis
2) asthma
3) cystic fibrosis
4) emphysema
Chronic obstructive pulmonary disease (COPD) involves a combination of _______ and _______
chronic bronchitis and emphysema
Restrictive lung diseases are characterized by what?
restriction in lung expansion during inhalation; therefore, the lung is described as being “stiff”
What is limited in restrictive lung diseases?
total lung capacity (TLC)
Examples of conditions that cause restrictive lung disease include….
1) pulmonary fibrosis
2) asbestosis
3) sarcoidosis
4) significant scoliosis
5) select neuromuscular diseases, such as amyotrophic lateral sclerosis (ALS) and muscular dystrophy
Lung diseases are commonly diagnosed by….
1) radiologic studies
2) pulmonary function testing
3) bronchoscopy
4) biopsies
What are two common symptoms for both types of lung disease (obstructive and restrictive)?
Difficulty breathing and a chronic cough
Pulmonary embolism refers to what?
the blockage of a pulmonary artery and its branches by a blood clot (embolus) that has traveled to the lung(s) from a deep vein thrombosis (DVT) in the lower limb or pelvis
Blocked vessels ______ blood oxygen levels and can be life-threatening.
decrease
Severity depends on the size of the embolus, with larger emboli blocking main vessels—potentially fatal—and small emboli leading to _______ _______ over time.
pulmonary hypertension
Sedentary or bedridden patients are typically at higher risk for developing ______ and must be monitored closely
DVTs
________ therapies may help to break up the clot, and ______ (“blood thinners”) therapy may help to prevent future clot development.
Thrombolytic, anticoagulant
In both men and women, _____ cancer is the leading cause of death, accounting for ~25% of all annual cancer deaths
lung
Lung cancer can be classified as either….
non–small-cell carcinoma (84%) or small-cell carcinoma (13%).
Non–small-cell carcinoma can be further divided into…..
1) adenocarcinoma (most common in women)
2) squamous cell carcinoma (poor prognosis)
3) large-cell carcinoma
Small cell carcinoma occurs almost always in ______, they have the worst prognosis, and often metastasizes early.
smokers
Signs and symptoms of small cell carcinoma typically do not present until later stages, but patients commonly describe what?
1) a chronic cough
2) shortness of breath
3) angina
4) recurrent bouts of pneumonia or bronchitis
Lung tumor growth into surrounding structures can lead to what issues?
1) Horner syndrome (cervical sympathetic ganglia involvement)
2) superior vena cava syndrome
3) dysphagia (esophagus involvement)
4) voice hoarseness (vagus nerve/recurrent branch involvement)
5) diaphragm paralysis (phrenic nerve involvement)
Structural or positional changes in the ______ during bronchoscopy are indicative of tumor growth around the tracheal bifurcation.
carina
What are the treatment options for lung carcinoma?
radiotherapy, chemotherapy, surgery, and palliative care
Primary lung cancer most commonly metastasizes to the….
brain, liver, and bone
Cardiac tamponade is described as….
compression on the heart in the
pericardial sac
Symptoms of cardiac tamponade include:
1) significant drop in blood pressure
2) difficulty breathing
3) lightheadedness
Cardiac tamponade may occur as a result of what?
fluid buildup between the heart and the unyielding fibrous pericardial sac
The increase in pressure on the heart is potentially fatal and must be decompressed by ________(fluid drainage) to avoid organ damage and ultimately failure in cardiac tampnade
pericardiocentesis
What does a pericardiocentesis involve?
inserting a needle into the pericardial cavity at the level of the fifth or sixth
intercostal space adjacent to the sternum, or at the left subcostal angle
Cardiac tamponade should be considered an _______ and treated
_______
emergency, immediately
Myocardial infarct (MI), or “heart attack,” occurs when what happens?
the heart is deprived of blood and oxygen, often because of a blocked coronary artery
Death of heart tissue can cause referred pain in the….
1) chest
2) shoulder
3) mid-thoracic back
4) the arm—the left arm in particular.
Additional symptoms besides pain w/ heart attack include:
1) diaphoresis (excessive sweating)
2) nausea
3) vomiting
4) shortness of breath
5) fatigue
An MI should be treated immediately, as it can lead to _______ tissue damage and possibly death.
irreversible
What is a common treatment for blocked coronary arteries? What about for more complex cases)
common= angioplasty with placement of a single or multiple stents
complex cases= a coronary artery bypass graft (CABG), in which an intact vessel (often the internal thoracic artery) is used to bypass the blocked vessel
Obstructions most commonly occur at the LAD (left anterior descending artery) > RC (right coronary artery) > _________ artery
circumflex
EMBRYO-
What is a congenital diaphragmatic hernia?
herniation of abdominal contents into the pleural cavity caused by a failure of the pleuroperitoneal membrane to develop or fuse with the other components of the diaphragm
EMBRYO-
A congenital diaphragmatic hernia is
most commonly found on the….
left posterolateral side
A congenital diaphragmatic hernia found on the left posterolateral side is usually life threatening. Why?
abdominal contents compress the lung buds, causing pulmonary hypoplasia
EMBRYO-
Clinical features of a congenital diaphragmatic hernia in the newborn
include….
1) unusually flat abdomen
2) breathlessness
3) severe dyspnea
4) peristaltic bowel sounds over the left chest
5) cyanosis
EMBRYO-
A congenital diaphragmatic hernia can be detected prenatally using what?
ultrasonography
EMBRYO-
What is tracheoesophageal fistula?
an abnormal communication between
the trachea and esophagus that results from improper division of foregut by the tracheoesophageal septum
EMBRYO-
What is tracheoesophageal fistula generally associated w?
esophageal atresia, which will then result in polyhydramnios
EMBRYO-
The most common type of tracheoesophageal fistula is…..
an esophageal atresia with a tracheoesophageal fistula at the distal third end of the trachea
EMBRYO-
What does an esophageal
atresia mean?
the esophagus ends as a blind tube and does not connect w/ the stomach
EMBRYO-
Fistula establishes an abnormal connection between the _____ and ______
trachea and esophagus
EMBRYO-
Neonatal respiratory distress syndrome is caused by what?
a deficiency of surfactant
EMBRYO-
Neonatal respiratory distress syndrome is caused by a deficiency of surfactant. This may occur due to what?
1) prolonged intrauterine asphyxia
2) maternofetal hemorrhage
3) in premature infants
4) in infants of diabetic mothers
5) in multiple-birth infants
EMBRYO-
In neonatal respiratory distress syndrome, a deficiency of surfactant
prevents the newborn from….
inflating the lungs with air
EMBRYO-
What are the patho findings for neonatal resp. distress syndrome?
1) hemorrhagic edema within the lung
2) atelectasis (collapse of alveoli)
3) widely dilated air spaces
4) hyaline membrane disease characterized by eosinophilic material consisting of proteinaceous fluid (fibrin, plasma) and necrotic cells
EMBRYO-
What is pulmonary hypoplasia (PH)?
a poorly developed bronchial tree
with abnormal histology
EMBRYO-
Pulmonary hypoplasia (PH) classically involves what?
the right lung in association with right-sided obstructive congenital heart defects
EMBRYO-
Pulmonary hypoplasia (PH) can also be found in association with ______ ______ ______ (i.e., herniation of abdominal contents into the thorax), which compresses the developing lung.
congenital diaphragmatic hernia
EMBRYO-
Pulmonary hypoplasia (PH) can also be found in association with bilateral renal agenesis, or _______ _______, which causes an insufficient amount of amniotic fluid (oligohydramnios) to be produced, which, in turn, increases pressure on the fetal thorax.
Potter syndrome
EMBRYO-
Cystic fibrosis (CF) is caused by what?
production of abnormally thick mucus
by seromucous glands and goblet cells lining the respiratory tract
EMBRYO-
Cystic fibrosis (CF) results clinically in what?
obstruction of airways and recurrent bacterial infections
EMBRYO-
CF is an autosomal _______ genetic disorder.
recessive
