Thorax Clinical Supplement Flashcards
“a depression of the sternum; ““funnel chest”” associated with exercise intolerance, dyspnea, chest pain”
“Pectus Excavatum<div><br></br></div><div><img></img></div>”
“an anterior protrusion of the sternum; ““pigeon chest”” associated with dyspnea, frequent respiratory tract infections; commonly found with scoliosis”
“pectus carinatum<div><br></br></div><div><img></img></div>”
the union of the manubrium and body of the sternum; <br></br>–associated with the sternal end of the 2nd rib<br></br>–arch of the aorta <br></br>–bifurcation of the trachea <br></br>–projects posteriorly to TV4 and approximates the superior border of the middle mediastinum
“sternal angle (of louis)<div><br></br></div><div><img></img></div>”
an important site of red bone marrow, but a biopsy can result in a sternal fracture, pneumonediastinum, pneumothorax, or cardiac tamponade
“sternal biopsy (risks and purpose)<div><br></br></div><div><img></img></div>”
causes: <br></br>–bony issues: cervical rib, hypoplastic first rib; <br></br>–soft tissue changes: hypertrophic/spastic muscles (ant/mid scalene), fibrous CT band; <br></br>–other: trauma, tumors<br></br><br></br>signs and symptoms: compression of C8-T1 roots of brachial plexus, vascular compression of subclavian a. (cold fingers, color changes in hands, claudication, pain)
“thoracic outlet syndrome<div><br></br></div><div><img></img></div>”
rib fractures can lead to:
flail chest, pneumo or hemothorax, spleen/liver injury, lacerations to the aorta/great vessels
intercostal nerve block should be administered where?
between internal and innermost intercostal muscles
whats at risk for iatrogenic injury with intercostal nerve block?
intercostal n.
metastasis of cancer cells from a primary tumor can occur by 3 mechanisms:
local spread, lymphatic channels, blood vessels (usually veins)
the majority of the lymph from the breasts is directed towards the _________ nodes
“axillary<div><br></br></div><div><img></img></div>”
secondary lymph drainage for the breast is directed to the _______________ nodes (medial quadrants)or ___________ nodes (lower quadrants) (provides a route for spread to the liver)
parasternal, inferior phrenic
60% of malignant breast tumors arise from the ___________ ________ quadrant
superior lateral
“signs and symptoms of _______________:<br></br>-breast mass<br></br>-axillary lump<br></br>-skin dimpling <br></br>-impaired lymphatic drainage (peau d’orange)<br></br>-nipple inversion, retraction, or bloody discharge<br></br>-skin ulceration <br></br>-metastasis”
“breast cancer<div><br></br></div><div><img></img></div>”
metastasis from the breast can get to the brain and intervertebral column through ____________ __________
“batson’s plexus<div><br></br></div><div><img></img></div>”
accumulation of fluid in the pleural sac
pleural effusion
______________________<br></br><b>rupture of visceral pleura</b>, air enters the pleural cavity<br></br> <br></br>risk factors: <b>Marfan or Ehlers-Danlos syndrome</b>, tall, thin stature, young (20-30s), smoking <br></br><br></br>S/S: acute onset chest/shoulder pain (worse with inspiration), shortness of breath<br></br> <br></br>Chest x-rays: line of visceral pleura (collapsed lung), <b>mediastinal shift away from affected lung</b>, reduces size of pulmonary cavity on contralateral side, impaired pulmonary function, venous return, diniminishes atrial filling and <b>reduces CO</b>
spontaneous pneumothorax (Traumatic Pneumothorax would result in (at least) the same S/S and imagining)
_____________ <br></br><b>rupture of visceral pleura</b>, air enters the pleural cavity through a <b>flap like tear</b><br></br>- more air enters with each successive breath<br></br>-increased interpleural pressure can lead to <b>compression of SVC</b><br></br>—-hypotension, hypoxia, jugulovenous distention, tachycardia, anxiety, fatigue<br></br>—-need thoractomy @ 2nd intercostal space and then chest tube
tension pneumothorax
air and fluid in the interplural space
hydropneumothorax
blood in the interplural space
hemopneumothorax
lymph in the interplural space (injury to the thoracic duct)
chylothorax
pus and air in the interplural space
pyopneumothorax
pus <b>without</b> air in the interplural space (from infection, bacterial pneumonia or abscess)
empyma
inflammation of the pleura
“pleurisy<div><br></br></div><div><img></img></div>”
which ribs does the oblique fissure run along (scapular line, midaxillary line, midclavicular line)?
“4, 5, 6<div><br></br></div><div><img></img></div>”
which ribs does the horizontal fissure run along (midaxillary line, midclavicular line)?
“4, 4<div><br></br></div><div><img></img></div>”
to listen for lung sounds from the superior lobe of the right lung, place the stethescope anteriorly _________?
above 3rd rib
to listen for lung sounds from the superior lobe of the left lung, place the stethescope anteriorly _________?
above the 5th rib
to listen for lung sounds from the middle lobe of the right lung, place the stethescope anteriorly _________?
below 4th rib
to listen for lung sounds from the lower lobe of the right or left lung, place the stethescope posteriorly _________?
below the 5th rib
inferior border of parietal pleura (midclavicular –> scapular)
8,10,12
inferior border of visceral pleura (midclavicular –> scapular)
6,8,10
where is thoracocentesis usually performed?
8th or 9th intercostal space (midaxillary line)
where are chest tubes usually placed?
4th or 5th intercostal space (midaxillary line)
the parietal pleura is GSA duel innervated by _________ n.s for the costal and peripheral diaphragmatic and ________ n.s for the central diaphragmatic and mediastinal
“intercostal, phrenic<div><br></br></div><div><img></img></div>”
the _________ pleura has no pain innervation
visceral
most common sites for metastasis of lung cancer (through venous system): (4)
CNS (brainstem & cerebellum), <br></br>bone (vertebrae),<br></br>liver, <br></br>adrenal gland,
inferior left lung lobe lymphatic drainage path: _________ -> __________ ->_________ -> __________
L pulmonary, L bronchiopulmonary, Carinal, R paratracheal
inferior right lung lobe lymphatic drainage path: _________ -> __________ ->_________ -> __________
R pulmonary, R bronchiopulmonary, R tracheobronchial (and carinal), R paratracheal
lung cancer in the lower lobe of the left lung, if metastasis occurs through the lymphatic drainage, can cause displacement of _________
carina (due to enlarged carinal nodes)
aspirated foreign objects are more likely to lodge in the ___________ main bronchus because it is shorter, wider, and more vertical than the other one
right
cough reflex: sensory by _______ and motor by __________
CN X, CN X (phrenic and intercostal)
______________ collapse of lung or lobe resulting from blockage of the airway<br></br><br></br>most common to occur in the ___ __________ lobe, because its entrance is the most narrow
“Atelectasis, R middle<div><br></br></div><div><img></img></div>”
tumor of the lung apex =_______________
“pancoast tumor<div><br></br></div><div><img></img></div>”
2 possible effects of pancoast tumor: ____________ + ____________
“klumpke palsy (lower trunk of brachial plexus), horner syndrome (cervical sympathetic chain)<div><br></br></div><div><img></img></div>”
____________ is a blockage of a branch of the <b>pulmonary artery</b> with a blood clot (DVT), fat droplet or air bubble; often from DVT of lower extremity
“pulmonary embolism<div><br></br></div><div><img></img></div>”
_______ = difficulty breathing
dyspnea
a thymic tumor may compress: (4)
“esophagus (dysphagia), trachea or recurrent laryngeal n. (hoarseness), great veins (cyanosis)<div><br></br></div><div><img></img></div>”
space behind aorta and pulmonary trunk = ______________
“transverse pericardial sinus<div><br></br></div><div><img></img></div>”
______________- inflammation of the pericardium, characterized by pericardial friction rub
“pericarditis<div><br></br></div><div><img></img></div>”
______________- accumulation of fluid in the pericardial space
“pericardial effusion<div><br></br></div><div><img></img></div>”
pericardial effusion can lead to ________ _________
cardiac tamponade
cardiac tamponade is associated with what othe symptoms _______ _______
“beck’s triad (rapid heartbeat and muffled heart sounds, distended neck veins, hypotension/weak pulses)”
innervation of the pericardium is by the ________ n. and ________ n. and sympathetics
vagus, phrenic
where is the needle placed during pericardiocentesis?
“left xiphisternal angle<div><br></br></div><div><img></img></div>”
heart dominance is determined by which coronary artery gives off the _______________
Posterior interventricular artery (aka - PDA post. descending a.)
the SA and AV nodes receive arterial blood from the _______
RCA (60% for SA and 85% for AV)
the anterior-superior 2/3s of the interventricular septum is supplied by the _________.
LCA (posterior-inferior 1/3 is supplied by RCA)
which heart will have better collateral circulation? (left dom. or right dom.)
“right dom.<div><br></br></div><div><img></img></div>”
two anastomoses of the heart circulation
RCA - circumflex <br></br>LAD - PDA (within IV septum)
3 most common sites of occlusion in the coronary vessels
LAD, RCA, Circumflex
GVA innervation to the heart arises from spinal cord levels _______. (pseudounipolar cell bodies in the PRG)<br></br>Pain from MI is perceived on these dermatomes on the left
T1-T4
GVA innervation from body organs converges on relay neurons that also receive input from the GSA neurons from the body wall. these neurons are trained to interpret signal from that relay neuron as GSA from the body wall so when they receive pain input from the GVA, they misinterpret that information as pain from the body wall<br></br><br></br>this phenomenon is known as ___________
“referred pain<div><br></br></div><div><img></img></div>”
chest pain from the heart resulting from insufficient supply of oxygen to cardiac muscle
angina pectoris
dissociation between the atrial and ventricular contractions can occur due to a _______________________
“complete bundle block<div><br></br></div><div><img></img></div>”
auscultation of the heart valves is done by listening to the rush of blood through the valve.<br></br><br></br>Acronym to remember placement _______
“APTM (first two are 2nd intercostal space, last 2 are at 5th intercostal space)<div><br></br></div><div><img></img></div>”
three points at which the aorta is fixed? (these three are most susceptible to deceleration trauma)
aortic valve, ligamentum arteriosum, aortic hiatus
coarctation is more common in males or females with _____________
turner syndrome
______________________<br></br>-hypertension in UL<br></br>-weak pulses in LL<br></br>-rib notching due to enlarged collateral circulation<br></br>-defect is opposite ductus arteriosus, distal to great arteries
“coarctation of the aorta<div><br></br></div><div><img></img></div>”
____________________<br></br>can compress the left recurrent laryngeal nerve and cause: hoarseness > dysphagia > dyspnea
“aortic aneurysm<div><br></br></div><div><img></img></div>”
___________________<br></br>-creation of space within the wall of the aorta due to the tearing of the tunica intima and subsequent accumulation of blood volume in the wall of the vessel<br></br>-can result in strokes and/or infarcts
aortic dissection
congenital risk factors for aortic dissection: (4)
Marfans, Ehlers danlos, turner, osteogenesis imperfecta
acquired risk factors for aortic dissection: (3)
syphilis, trauma, cocaine use
medial rib fracture on ribs 6-9 or dislocation of those ribs can impinge or lacerate the aorta leading to __________
exsanguination
SVC syndrome is usually caused by _________
mediastinal malignancy
4 important anastomoses for SVC
thoracioepigastric v., internal thoracic v. (internal mammary v.), vertebral plexus, azygos system (TIVA)
___________ - idiopathic sympathetic disregulaion of the vasculature of the UL<br></br>- can be fixed by surgical destruction of the ___________ _________ at the root of the neck which would result in vasodilation of arterioles in the ipsilateral upper extremity
raynaud syndrome, sympathetic chain
high spinal anesthesia may produce temporary ___________ due to the impaired sympathetic relay
vasodilation
muscle distribution of the esophagus: ____, ___, ____
5% skeletal, 35% mixed, 60% smooth
the muscle of the esophagus is innervated by the _______ n.
vagus
the cervical portion of the esophagus is drained of lymph by _____________ nodes
deep cervical, paratracheal
the thoracic portion of the esophagus is drained of lymph by _____________ nodes
posterior mediastinal
the abdominal portion of the esophagus is drained of lymph by _____________ nodes
left gastric, celiac
3 places esophageal cancer usually spreads
liver, lungs, vertebrae
preganglionic sympathetic neurons are found in the ______
IML
preganglionic parasympathetic neurons are found in the ______
dorsal vagal nucleus
postganglionic sympathetic neurons are found in the _______
sympathetic chain
postganglionic parasympathetic neurons are found in the ______
intramural (organ wall)
CNS level of the sympathetic heart
T1-T4
CNS level of the sympathetic lungs
T2-T7
CNS level of the sympathetic upper esophagus
T1-T4
CNS level of the sympathetic lower esophagus
T2-T7
CNS level of the <b>parasympathetic</b> heart, lungs, upper esophagus
Medulla
When you inspire the cracked ribs to inward. When you expire, the cracked ribs go outward. What is this called?
Flail chest
