Thorax Clinical Correlates Flashcards
(125 cards)
1
Q
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.
A
sternal angle
2
Q
An accessory cervical rib (1% of population) may articulate with the ____
vertebra and potentially contribute to what?
A
C7
thoracic outlet syndrome
3
Q
What is thoracic outlet syndrome?
A
pressure is placed on the subclavian artery or lower brachial plexus trunk or both
4
Q
Symptoms of thoracic outlet syndrome include:
A
1) numbness
2) tingling in C7–C8 nerve root distribution
3) pain
4) temperature changes in the upper limb
5
Q
What is a general rule for main intercostal muscle function?
A
it is opposite of muscle name!
6
Q
External intercostal muscles are most active during…..
A
inspiration (remember EX-IN)
7
Q
Internal intercostal muscles are most active during….
A
expiration (remember IN-EX)
8
Q
____, _____, _____ keep the diaphragm alive!
A
C3, C4, C5
9
Q
The pleural sac can be visualized like a fist pushed into an inflated balloon, where your fist is representing the….
A
lung
10
Q
In the “balloon analogy,” the outer surface of the balloon not touching your fist represents the…..
A
parietal pleura
11
Q
The surface of the balloon in contact with your fist is the _____ ______, and the air/space between these two surfaces represents the _______ _______
A
visceral pleura, pleural cavity.
12
Q
In the balloon analogy, your wrist represents the root of the _____, where these two layers are_______
A
lung, continuous
13
Q
What tool is used to auscultate lung (breath) sounds across all anterior and posterior lung fields?
A
A stethoscope
14
Q
Breath sounds vary depending on what?
A
airway diameter
15
Q
Percussion of the thorax is performed to determine what?
A
whether underlying lung tissue is air-filled, fluid-filled, or solid, producing a resonate, dull, or flat sound, respectively
16
Q
Left superior pulmonary vein drains….
A
left superior lobe
17
Q
Left inferior pulmonary vein drains….
A
left inferior lobe
18
Q
Right superior pulmonary vein drains….
A
right superior and middle lobes
19
Q
Right inferior pulmonary vein drains….
A
right inferior lobe
20
Q
What is an alveolus?
A
a thin-walled, polyhedron-shaped chamber that is continuous with the alveolar duct.
21
Q
Alveolus is surrounded by what? Why?
A
a network of capillaries that brings blood in close proximity to the air so that gas exchange between the blood and air can occur
22
Q
Surfactant is composed of….
A
1) Dipalmitoylphosphatidylcholine, which is the strongest-acting surfactant lipid molecule
2) Phosphatidylcholine, phosphatidylglycerol, neutral lipids, and
cholesterol
3) SPs A, B, C, D
23
Q
Surfactant reduces what, by doing what?
A
reduces the elastance or collapsing force in the lung by reducing the surface attraction between opposing alveolar walls
24
Q
What does “lub” refer to?
A
closure of the tricuspid and bicuspid valves at the start of ventricular systole (contraction)
25
What does "dub" refer to?
closure of the pulmonary and aortic valves at the end of ventricular systole
26
lub is what heart sound?
first heart sound and often referred to as S1
27
dub is what heart sound?
second heart sound and often referred to as S2
28
At the apex of the heart, ________ and ________ IV arteries anastomose
posterior and anterior
29
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
30
Deoxygenated blood from the heart primarily enters the right atrium through the.....
coronary sinus
31
Blood is expelled from the ______ atrium through the _____ valve to the right ventricle.
right, tricuspid
32
Blood is expelled from the left atrium through the _____valve to the _____ ventricle.
bicuspid (mitral), left
33
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
34
Fracture of the rib typically occurs at the what? By the result of what?
costal angle as a result of crushing or traumatic injury
35
Visceral pleura and lungs are at risk of
injury from.....
exposed fractured rib end, which can result in pneumothorax
36
If indicated, surgical intervention (rib plating) involves stabilizing fractures with hardware to limit deformity and improve.....
respiratory function
37
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
38
What is thoracentesis?
removal of fluid from pleural cavity
39
For thoracentesis, needle placement should occur just superior to the superior rib border and extend into the ________ ______ in the pleural cavity.
costodiaphragmatic recess
40
Needle placement should be low in the ______ intercostal space to access the costodiaphragmatic recess to avoid the neuromuscular bundle
9th
41
Needle placement should be high in the intercostal space to target the......
intercostal nerve
42
The Tanner stages of breast development are guidelines in assessing.....
whether a female adolescent is
developing normally
43
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.
44
The nipple may occasionally remain what?
depressed (called an inverted nipple)
45
Supernumerary ______ (called polythelia) or supernumerary ______ (called polymastia) may form along the line of the mammary ridge.
nipples, breasts
46
Carcinoma of the breast typically arises from the ______ cells of the mammary gland lactiferous ductal system (adenocarcinomas)
epithelial
47
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
48
Lymphatic metastasis typically occurs through....
axillary lymph nodes, which drain ~75% of lymph from the breast
49
Breast cancer most often metastasizes to where?
bone, lungs, brain, or liver
50
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
51
What is a mammogram? What is it most often used for?
radiographic examination of breast tissue
used to detect abnormal masses in the breast
52
If cancer is suspected, a _______ may be performed to determine whether cancer is present and to what extent.
biopsy
53
What are the treatment options for breast cancer?
radiation, chemotherapy, and mastectomy, which involves surgical excision of affected tissue
54
What is a radical mastectomy?
removal of the pectoral muscles, fascia, adipose, breast tissue, and adjacent lymph nodes
55
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
56
What is pleural effusion caused by?
an accumulation of excess fluid within the pleural space, thus between the parietal and visceral pleurae
57
Pleural effusions can be categorized as.....
transudative or exudative in origin
58
Transudative effusions are most commonly caused by what?
heart failure
59
Exudative effusions are commonly caused by what?
1) vascular or lymphatic blockage
2) lung trauma
3) inflammation
4) tumor
60
T/F:
Chest x-ray or computed tomography scan may confirm effusion.
true
61
What is the treatment for pleural effusion?
thoracentesis to remove excess fluid and implementation of preventive measures based on the principle cause of effusion
62
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
63
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
64
What are the symptoms of pneumothorax?
significant difficulty breathing and chest pain
65
What are the symptoms of pneumothorax?
significant difficulty breathing and chest pain
66
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
67
What is foreign body aspiration (FBA)?
fatal event due to potential airway obstruction and is a common cause of morbidity and mortality in children
68
Due to its vertical orientation and wider diameter, aspirated objects most often lodge in the _____ _______ _______ or one of its branches
right primary bronchus
69
If a bronchoscopy is warranted to assess the position of the foreign body, the _____ is visualized as an
important anatomical landmark.
carina
70
Obstructive lung diseases are characterized by what?
elevated airway resistance, primarily during expiration, due to airway narrowing.
71
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
72
Examples of obstructive lung disease include:
1) chronic bronchitis
2) asthma
3) cystic fibrosis
4) emphysema
73
Chronic obstructive pulmonary disease (COPD) involves a combination of _______ and _______
chronic bronchitis and emphysema
74
Restrictive lung diseases are characterized by what?
restriction in lung expansion during inhalation; therefore, the lung is described as being “stiff"
75
What is limited in restrictive lung diseases?
total lung capacity (TLC)
76
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
77
Lung diseases are commonly diagnosed by....
1) radiologic studies
2) pulmonary function testing
3) bronchoscopy
4) biopsies
78
What are two common symptoms for both types of lung disease (obstructive and restrictive)?
Difficulty breathing and a chronic cough
79
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
80
Blocked vessels ______ blood oxygen levels and can be life-threatening.
decrease
81
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
82
Sedentary or bedridden patients are typically at higher risk for developing ______ and must be monitored closely
DVTs
83
________ therapies may help to break up the clot, and ______ (“blood thinners”) therapy may help to prevent future clot development.
Thrombolytic, anticoagulant
84
In both men and women, _____ cancer is the leading cause of death, accounting for ~25% of all annual cancer deaths
lung
85
Lung cancer can be classified as either....
non–small-cell carcinoma (84%) or small-cell carcinoma (13%).
86
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
87
Small cell carcinoma occurs almost always in ______, they have the worst prognosis, and often metastasizes early.
smokers
88
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
89
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)
90
Structural or positional changes in the ______ during bronchoscopy are indicative of tumor growth around the tracheal bifurcation.
carina
91
What are the treatment options for lung carcinoma?
radiotherapy, chemotherapy, surgery, and palliative care
92
Primary lung cancer most commonly metastasizes to the....
brain, liver, and bone
93
Cardiac tamponade is described as....
compression on the heart in the
pericardial sac
94
Symptoms of cardiac tamponade include:
1) significant drop in blood pressure
2) difficulty breathing
3) lightheadedness
95
Cardiac tamponade may occur as a result of what?
fluid buildup between the heart and the unyielding fibrous pericardial sac
96
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
97
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
98
Cardiac tamponade should be considered an _______ and treated
_______
emergency, immediately
99
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
100
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.
101
Additional symptoms besides pain w/ heart attack include:
1) diaphoresis (excessive sweating)
2) nausea
3) vomiting
4) shortness of breath
5) fatigue
102
An MI should be treated immediately, as it can lead to _______ tissue damage and possibly death.
irreversible
103
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
104
Obstructions most commonly occur at the LAD (left anterior descending artery) > RC (right coronary artery) > _________ artery
circumflex
105
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
106
EMBRYO-
A congenital diaphragmatic hernia is
most commonly found on the....
left posterolateral side
107
A congenital diaphragmatic hernia found on the left posterolateral side is usually life threatening. Why?
abdominal contents compress the lung buds, causing pulmonary hypoplasia
108
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
109
EMBRYO-
A congenital diaphragmatic hernia can be detected prenatally using what?
ultrasonography
110
EMBRYO-
What is tracheoesophageal fistula?
an abnormal communication between
the trachea and esophagus that results from improper division of foregut by the tracheoesophageal septum
111
EMBRYO-
What is tracheoesophageal fistula generally associated w?
esophageal atresia, which will then result in polyhydramnios
112
EMBRYO-
The most common type of tracheoesophageal fistula is.....
an esophageal atresia with a tracheoesophageal fistula at the distal third end of the trachea
113
EMBRYO-
What does an esophageal
atresia mean?
the esophagus ends as a blind tube and does not connect w/ the stomach
114
EMBRYO-
Fistula establishes an abnormal connection between the _____ and ______
trachea and esophagus
115
EMBRYO-
Neonatal respiratory distress syndrome is caused by what?
a deficiency of surfactant
116
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
117
EMBRYO-
In neonatal respiratory distress syndrome, a deficiency of surfactant
prevents the newborn from....
inflating the lungs with air
118
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
119
EMBRYO-
What is pulmonary hypoplasia (PH)?
a poorly developed bronchial tree
with abnormal histology
120
EMBRYO-
Pulmonary hypoplasia (PH) classically involves what?
the right lung in association with right-sided obstructive congenital heart defects
121
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
122
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
123
EMBRYO-
Cystic fibrosis (CF) is caused by what?
production of abnormally thick mucus
by seromucous glands and goblet cells lining the respiratory tract
124
EMBRYO-
Cystic fibrosis (CF) results clinically in what?
obstruction of airways and recurrent bacterial infections
125
EMBRYO-
CF is an autosomal _______ genetic disorder.
recessive
