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THORAX / HEART FINAL Flashcards

1
Q

anesthesia injection

A

-anesthesia of any particular area of skin usually requires injection of two adjacent nerves
-ex. anesthesia for broken rib requires injection of anesthetic agent into region of intercostal nerves superior and inferior to rib, proximal to site of fracture

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2
Q

muscles use during breathing

A

-forced:
-inspiration- external intercostal muscles
-expiration- internal intercostal muscle and rectus abdominus sheath
-dyspnea:
-recruitment of neck muscles
-sternocleidomastoid, pecs, upper trapezius, scalene muscles
-normal expiration is governed by elastic recoil pulmonary

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3
Q

atelectasis

A

-pleural cavity (normally potential space) becomes real space
-intercostal space narrowing
-displacement of mediastinum toward affected side
-when air enters pleural cavity visceral and parietal layers detach -> elastic recoil
-perfusion no ventilation
-more common on right side
-not taking deep breathes
-alveoli fill with junk
-subsegmental collapse of lung due to mucus plugging
- bronchial breath sounds heard in periphery (instead of vesicular)

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4
Q

lymph in lungs

A

-carry phagocytes
-ingest carbon particles from inspired air
-smokers -> mottled gray

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5
Q

subclavian artery compression

A

-apex of lung
-scalene muscles
-supernumerary C7 rib
-thoracic outlet syndrome -> costoclavicular syndrome

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6
Q

lesser diaphragmatic apertures

A

-2 in right crus of diaphragm- transmit greater and lesser right splanchnic nerves
-3 in the left crus of diaphragm- transmit greater and lesser left splanchnic nerves as well as hemiazygos vein
-under the medial arcuate ligament- usually transmit sympathetic trunks
-under lateral arcuate ligament- subcostal nerve and vessels
-left phrenic nerve pierces dome of the left hemidiaphragm
-internal mammary artery thorough sternal costal gaps

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7
Q

rib movement / percussion

A

-water pump
-increase/decrease anterior posterior diameter of lungs according to diaphragm
-percuss it posteriorly to measure -> diaphragmatic migration
-phrenic nerve pace maker for diaphragm paralysis
-C 3, 4, 5 keep the diaphragm alive

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8
Q

numbing of spinal nerves

A

-numb posterior region around spine when pt has significant nerve pain
-allows patient to breathe deeply -> prevents pneumonia and atelectasis
-catheter two fingers away from midline that infuses fluid with LONG acting anesthetic
-ancupump (grenade)

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9
Q

dead space

A

area of lung ventilating but not perfused -> no gas exchange

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10
Q

shunting

A

area of perfusion but no ventilating -> blood is passing by with no gas exchange

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11
Q

VQ

A

-interface between alveoli and capillary
-VQ ventilation perfusion
-areas of lung that are ventilating need to be perfused -> gas exchange
-gas exchange doesnt happen until level of bronchial

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12
Q

left internal thoracic artery

A

-internal mammary artery
-used for bypass conoid
-comes off the left subclavian

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13
Q

blood supply to lungs

A

-pulmonary and bronchial supply
-rarely infarct!

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14
Q

thorax imaging

A

-costophrenic angle -> blunt -> pleural effusion
-costocardiac angle
-costocardiac triangle -> where IVC enters RA -> area can become cystic -> pericardial cysts
-costophrenic- sharp angle
-left costophrenic angle is lower due to heart weighing it down
-blunt angle -> pleural effusion
-Ds method- circle aortic knob -> 45 degree angle -> midline -> carina

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15
Q

kehrs sign

A

-pt laying down with legs elevated
-referred pain to tip of left shoulder
-sign of fluid / blood in cavity
-often spleen damage
-this is bc diaphragm is innervated by superior nerves

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16
Q

left upper lobe pneumonia

A

-heart loses silhouette due to obscured by left UPPER lobe pneumonia involving the lingula lobe
-left low lobe pneumonia -> density in back of heart -> Still can see cardiac border
-lower lobe lesion is located retrocardiac

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17
Q

tension pneumothorax

A

-tear in parenchyma -> pleura leaks
-air collects -> pneumothorax
-pressure increases so high -> shifts to contralateral side -> displaces mediastinum -> kink off vena cava -> decrease return -> no blood to heart -> tension pneumothorax
-heart shifts to unaffected side
-no breath sounds on that side
-clinical diagnosis
-bleb pops can cause
-FIRST decompress with thoracocentesis (midclavicular 2nd space) -> simple pneumothorax
-then chest tube

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18
Q

pneumothorax + pleural effusion x-ray

A

-would show has a flat line of fluid collection on imaging
-meniscus line suggests just pleural effusion

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19
Q

right lower lobe pneumonia

A

-mimics appendicitis due to T10 dermatome

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20
Q

T4

A

nipple line

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21
Q

T7/T6

A

xiphoid process

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22
Q

tension pneumothorax vs atelectasis

A

-pneumothorax pushes away
-atelectasis- pushes towards

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23
Q

pancoast tumor

A

starts at apex of lung

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24
Q

Paradoxical Embolism (PDE)

A

-occurs when a thrombus crosses an intracardiac defect into the systemic circulation.

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25
oblique pericardial sinus
-within pericardium -blind recess posterior to the heart -potential space -cant completely pass through- pocket -reflects around pulmonary veins, IVC, and esophagus -oblique and transverse sinus created by folding of fetal primordial heart tube
26
VAN to pericardium
ARTERIAL -pericardiophrenic artery (branch of internal thoracic artery) -smaller branches of: -musculophrenic artery (terminal branch of internal thoracic artery) -bronchial -esophageal -superior phrenic arteries -coronary arteries supply the visceral layer (muscle wall, epicardium) VENOUS -pericardiacophrenic veins (tributaries of the brachiocephlic) -tributaries of the azygos venous system NERVES -sensory- phrenic -pain referred to the skin of ipsilateral shoulder -vagus nerve (CN X) -sympathetic trunks- vasomotor contribution
27
cardiac tamponade
-pericardial effusion large enough -> reduce ability of blood fill and leave heart -> cardiac tamponade -fluid, pus, blood -> injury or perforation of weak area after MI -blood drained to allow proper filling and ventricular contraction -cardiac collapse when ventricles cant contract properly -between fibrous pericardium and visceral layer -BECKS TRIAD: -1. decreased APP- hypotension -2. venous distention- jugular neck veins -3. muffled heart sounds
28
heart auscultation
-mitral valve- 5th intercostal space -best heard at apex -> mitral regurgitation -tricuspid- 4th-5th intercostal space regurgitation or VSD -aortic- 2nd intercostal space -> on the right bc of aortic arch- aortic stenosis -pulmonic- left 2nd intercostal space- pulmonic stenosis -left sternal border- aortic/ pulmonic regurgitation
29
sinus venarum
smooth walled posterior wall on which SVC, IVC and CS open
30
PFO
-patent foramen ovale -paradoxical embolism -enlarges right atrium, ventricle, and pulmonary trunk -stroke
31
right ventricle features
-septal, anterior, posterior papillary muscle -supraventricular crest- thick muscular ridge separates muscular inflow part from smooth wall of outflow -outflow is conus arteriosus (infundibulum) -septomarginal trabeculae- moderator band that carries right AV bundle branches to anterior papillary muscle -> conduction
32
VSD
-ventricular septal defect -hole in the membranous part of interventricular septum (upper part) -decrease CO -venous supply goes into systemic -increases pulmonary blood flow -causes pulmonary disease -may cause cardiac failure
33
atrial fibrillation
-atrial systole -> dissipation of electrical signal and contraction -abnormal p wave (beat) -chaotic electrical activity -quivering behavior -increase likelihood of stroke, ischemic bowel event, ischemic limb etc -> bc blood clot can form in atrial auricle-> systemic circulation -fluttering
34
aortic vestibule
-smooth part before aortic valve -no resistance -analogous to conus arteriosus
35
supply to coronary sinus
-aortic sinuses- spaces at the origin of the ascending aorta between wall and cusp -3 cusps (right, left and non-coronary posterior -backflow of blood due to recoil of elastic aorta -> causes filling of R&L coronary arteries -during diastole -> blood back flows and pools in cusps -> supplies the right and left coronary arteries -posterior cusp is non coronary
36
coronary artery supply
-myocardium -right marginal artery- RV and apex -left coronary- LA, LV, septum, AV bundle -left anterior descending -> RV, LV and septum -left circumflex- LA and LV -left marginal artery- comes off left circumflex -> supplies LV -posterior interventricular artery- supplies RV and LV and septum
37
venous drainage
-coronary sinus -one of 3 things emptying into RA -great cardiac vein contributes -middle cardiac vein, small cardiac vein -place a pacemaker wire into the coronary sinus and track this out to lateral wall and leaving pacemaker wires in the coronary sinus extended out into smaller vein -> Allows for pacing of LV -wire in RA, RV, and coronary vein -> biventricular pacing (pacing of both ventricles simultaneously)
38
lymph drainage of heart
-subepicardial lymphatic plexus -follow the coronary arteries -inferior drainage from tracheobronchial lymph nodes on the right side
39
RA / RV surgery
-AV node will pass from RA into RV -valvular disease or surgery here (especially tricuspid) -> interrupt cardiac skeleton -> conduction system disease -> may need pacing
40
pericarditis
-exacerbated by cough -edema -rustle of silk auscultation -chronic -> calcify -> decrease efficiency -pericardial effusion can develop with inflammatory diseases -> cardiac tamponade
41
stenosis
-increase pressure -requires more force to pump blood past
42
symptoms of heart failure
-rapid thready pulse -murmur -abnormal location of auscultation -enlarged heart -swollen and cyanotic legs and feet -bloated stomach -fluid around the lungs- LV -> LA -> lungs (backup) -when laying down ORTHOPNEA -> blood regurgitates from LV -> LA -> lungs -more volume going to heart when laying down (retributed from legs) -even more SOB laying down
43
pericardiocentesis
-left sternocostal angle -5th-6th intercostal space -possible due to cardiac notch of left lung -can also be done by xiphocostal angle -> superoposteriorly
44
most common sites of myocardial infarction
-LAD -right coronary artery -circumflex branch -necrosis = MI -MC cause of ischemic heart disease is coronary artery insufficiency from atherosclerosis
45
coronary bypass graft
-coronary artery obstruction of severe angina -great saphenous vein is preferred -1. diameter is > or equal to coronary -2. easily dissected from lower limb -3. lengthy portions without valves/branching -if valve is present flip it upside down -radial artery is also common -surgical anastomosing internal thoracic artery with coronary artery
46
coronary angioplasty
-percutaneous transluminal coronary angioplasty -> balloon inflates -Percutaneous coronary intervention (PCI) -stretch artery -thrombokinase- enzyme that dissolves -rigid/semirigid mesh stents put in after dilation -> balloon inflates
47
echocardiogram
-detects fluid -doppler echocardiogram- demonstrates flow through heart -> valve stenosis, regurgitation, septal defects
48
cardiac referred pain
-ischemia and accumulation of metabolic products stimulate pain (nothing else) -noxious stimuli in the heart -> refers to -superficial part of body -> Ex. skin on medial aspect of left upper limb -cardiac sensory nerves enter at T1-T4/T5 especially on left side -referred pain to structures innervated at this same level
49
AV and SA node supply
-most common cause of conducting system damage -> CAD -LAD supplies AV bundle -RCA branches supply SA and AV nodes -damage to AV bundle/node -> heart block -> excitation doesnt reach ventricles -when both bundles are blocked -> ventricles beat independently (slowly) -if only one branch is blocked -> 1 ventricle beats asynchronously
50
aneurysm of ascending aorta
-not protected by pericardium (beginning part is) -blood rush hits hard here due to lack of support from pericardium -localized dilation -chest pain that radiates to back -can compress traches, esophagus, recurrent laryngeal nerve -> difficulty breathing and swallowing
51
coarctation of aorta
-stenosis -narrowing -obstructs blood flow to inferior body -common site- ligamentum arteriosum -coarctation below ligamentum arteriosum (postductal coarctation) -> circulation is still ok bc of intercostal and internal thoracic arteries
52
53
percussion of heart
-density of size of the heart -3,4,5 intercostal spaces -from right to left axillary line -resonance to dullness
54
CVA / stroke
-cerebrovascular accident -occlusion of cerebral artery -usually from clots formed in LA
55
stenosis
-valve cant open fully -narrowing -slows blood flow -requires more force to pump past -> increase pressure
56
regurgitation / valve insufficiency
-valve cant close fully -nodule formation and scarring prevents
57
turbulence
-restriction of flow (stenosis) and blood flow through narrow opening into larger space produce turbulence -creates eddies (small whirlpools) -> produce vibrations -> murmurs. -Superficial vibrations -> thrills -> may be felt on the skin over area of turbulence
58
prolapsed mitral valve
-leaflets are enlarged, redundant or floppy -extending back into LA during systole -blood regurgitates into LA when LV contracts -murmur
59
aortic valve stenosis
-MC -left ventricular hypertrophy -MC results from degenerative calcification
60
pulmonary valve stenosis
-valve cusps are fused -narrow central opening -infundibular pulmonary stenosis- conus arteriosus underdeveloped -> restriction of right ventricular outflow -degree of hypertrophy of RV is variable.
61
ischemia vs infarction
-infarction -> tombstone -ischemia -> depression -ischemia can lead to infarction

Anatomy (34 decks)

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