Thorax part 3 Flashcards
The anterior inferior border of the lung is at what rib?
6th costal cartilage?
The lateral inferior border of the lung is at what rib?
8th rib
The posterior inferior border of the lung is at what rib?
10th rib
Anterior line of pleural reflection is at what rib?
8th costal cartilage
Lateral line of pleural reflection is at what rib?
10th rib
Posterior line of pleural reflection is at what rib?
12th rib
What is the space between the inferior border or the lung and the line of pleural reflection?
Costodiaphragmatic recess
Where is the lungs most vulnerable to neck damage?
at the apex of the lung (above the first rib)
Anteriorly, where would you draw fluid for a thoracocentesis?
6th-8th costal cartilage
Lateraly, where would you draw fluid for a thoracocentesis?
8th- 10th rib
Posteriorly, where would you draw fluid for a thoracocentesis?
10th-12th rib
The air in the chest tends to accumulate between what 2 layers?
Parietal and visceral pleura
Spontaneous pneumothorax tend to happen in what kind of patient?
tall and lanky teenage boys
Closed (spontaneous) pneumothorax is caused by ??
weak spot in the lungs that pops and collapses the space
Open pneumothorax is caused by ??
Something has traumatized the lungs, hole in the lungs
Tension pneumothorax is caused by ??
trauma, hole in the lung but there is flap over the hole. pressure builds
What is a flail chest?
trauma to the thorax detaches the ribs
when you breath in, the chest caves inward (instead of out)
True/ False: The right and left lymph of the lungs can cross over
TRUE
Name some ways that could cause visceral pain to an organ
stretching or deprive of oxygen
How does the GI system respond to a sympathetic stimulation?
constricts smooth muscle and decreases blood flow to the GI tract/abdominal/pelvic organs
In a sympathetic response, the pupil with ____
dilate
Why are the lungs not always open to max diameter?
because the wider the airway, increases the chances of pathogens getting into the lungs
What is the parasympathetic response in the bladder?
increases detrusor muscles and relaxes smooth muscle of the sphincter
Where are the Sympathetic pre-ganglionic cell bodies located?
in intermediolateral (IML) cell column of T1-L2 spinal cord
Where do Sympathetic pre-ganglionic axons exit the spinal cord?
Anterior roots
**What is the Sympathetic pathway?
exit through anterior root -> spinal nerve -> white rami communicans -> paravertebral ganglia
The white rami communicans are (heavily/slightly) myelinated
Slightly (that is why they are white)
What 4 things can happen to a pre-ganglionic sympathetic axon once it arrives in the paravertebral ganglia?
- Synapse and exit the paravertebral chain
- Ascend, synapse and exit the pvc
- Descend, synapse and exit the pvc
- exit without synapse (abdomen and pelvis)
If the axon is going to the back or limbs (somatic target) what pathway does it take?
pre-ganglionic axon synapses in the paravertebral ganglion -> exits by gray ramus -> travels in anterior and posterior rami -> Sweat glands, Arrector pili (pilomotor), Precapillary sphincter (vasomotor)
Sudomotor is going ??
Sweat glands
Pilomotor is going ?
Arrector pili
Vasomotor is going ?
precapillary sphincter
In hyperhidrosis the _____ are grey rami that travel from the C8- T1 and inferior cervical ganglion to the brachial plexus.
In severe cases they are ____
Nerve of Kuntz
Surgically resected (or cut)
In the head sympathetic pathway, what levels?* ASK HIM ABOUT THIS ONE
T1-3 IML
exit through anterior root -> spinal nerve -> white rami communicans -> synpase in the INFERIOR/MIDDLE/ SUPERIOR cervical ganglion then go to the head and face
Post- gangionlic sympathetic cells in the INFERIOR and MIDDLE send axons through ??
gray rami communicans
Post- gangionlic sympathetic cells in the SUPERIOR cervical send axons through ??
Where is there final destination?
carotid arteries
the eye and innervated the radial fibers of the iris (eye will cause the iris to dilate and allows might light into the retina)
What is Horner’s Syndrome caused by ?
disruption of the sympathetic signals to the head
Unilateral and ipsilateral
Damage for these for things can lead to Horner’s syndome
-Sympathetic chain in the neck
-Superior cervical ganglion (less common)
-IML of the upper thoracic spinal cord (rare)
-Autonomic pathways from hypothalamus brainstem spinal cord
What are the common S/S of Horner’s Syndrome?
Ptosis
Anhydrosis
Meiosis- persistent constricted pupil
Flushing/warmness of the face on that side
What is the pathway for Sympathetic innervation of the Thoracic viscera?
exit through anterior root -> spinal nerve -> white rami communicans -> synapses in the paravertebral ganglion or ascends prior to synapse -> post- ganglionic axon exits as cardiopulmonary splanchnic nerve -> joins cardiopulmonary plexus -> reaches target by following branches of bronchi or coronary arteries
Sympathetic pathway for the thoracic viscera, where do the pre-ganglionic axon synapse?
paravertebral ganglion or ascends before synapsing
Sympathetic pathway for the thoracic viscera, where do the post- ganglionic axon exit?
exit ganglion as cardiopulmonary splanchnic nerve
define splanchnic nerve
any sympathetic/parasympathetic nerve that does NOT piggyback on anything else
Aka a solo traveler
The greater splanchnic nerve is at what levels?
T5-9
The lesser splanchnic nerve is at what levels?
T10-11
The least splanchnic nerve is at what levels?
T12
The parasympathetic nervous system has pre-ganglionic cell bodies in one of two places. What are they?
Cranial nerve nuclei and Sacral spinal cord
*Be able to draw these
Know this slide
Damage to the greater petrosal nerve or subsequent branches will cause _____ due to loss of parasympathetic innervation of lacrimal
dry eye
Damage to the lesser petrosal nerve can result in _____ since the parotid on the affected side would lose parasympathetic input.
dry mouth
In the thorax/abdomen and pelvis where are the post-ganglion cell bodies located?
in the wall of the organ
Pre-ganglionic parasympathetics to thoracic organs originate from the ______
dorsal vagal motor nuclei
What is the thorax parasympathetic pathway?
Pre-ganglionic para orginiate in the dorsal vagal motor nuclei -> descend in the vagus nerve -> axons to the heart join in the cardiopulmonary plexus -> post-ganglionic cell bodies are located in the wall of the heart and bronchi -> very short post-ganglionc axons extend to nearby myocardium, smooth muscle or glands
Parasympathetic of the thorax: Pre-ganglionic parasympathetic axons descend _____
in the vagus nerves
Parasympathetic of the thorax: the axons to the heart join the _____
cardiopulmonary plexus
Parasympathetic of the thorax: Axons synapse with post-ganglionic parasympathetic cell ???
bodies in the wall of the heart and bronchi
Parasympathetic of the thorax: Very short post-ganglionic axons extend to _____, ______ and ______.
nearby myocardium, smooth muscle, or glands
Label
Sympathetic chain
Label. Sym or Para
Vagus nerve
Para
Label. Sym or Para
Cardiopulmonary splanchnic
Para
Label. Sym or Para
Pre-ganglion parasympathic cell bodies
Visceral non-pain stimuli (reflexes) follow the ______ nerves backwards to reach the central nervous system.
parasympathetic
The solitary nucleus is part of what system?
cardiorespiratory center
The _____ nerve carries these inputs to the caudal region of the solitary nucleus – the cardiorespiratory center.
vagus
The cardiorespiratory center just happens to be next to the _____ and this complex is the control center for heartbeat and respiration.
dorsal vagal motor nucleus
______ controls the rate of peristalsis and secretion in the foregut and midgut
dorsal vagal motor nucleus
In the thorax, abdomen and upper pelvis, visceral pain stimuli travel to the spinal cord backwards along the _____ nerves that supply each organ
sympathetic
What is the pathway backwards for visceral pain to the spinal cord?
Cardiopulmonary plexus -> Cardiopulmonary splanchnic nerve -> Thoracic and cervical paravertebral ganglia -> White ramus -> Spinal nerve -> POSTERIOR root (cell body in the posterior root ganglion) -> Posterior horn of the spinal cord
What is the basis for referred pain?
Organs will jump on the somatic afferent to the VPL and since those have assigned areas of the brain, the brain thinks the pain is coming from that specific area of the body when its actually coming from the visceral afferent-> Call referred pain
What is the referred pain from the heart?
T1-5 sympathetics with cervical connections
The gray rami communicans carry what kind of nerve?
post-ganglion sympathetic to the body
The posterior rami carry what kind of nerve?
Post- ganglion sympathetic to muscle and skin to the back
The Greater thoracic splanchnic nerve carry what kind of nerve?
Sympathetic to the abdominal organs
The Vagus nerve carry what kind of nerve?
Parasympathetic
Sweating is (Sympathetic/Parasympathetic)
Parasympathetic
Paired ________ in the mesoderm fuse into a single tube
Endocardial tubes
Mesoderm around the tube enlarges to form the ______ and starts beating ~22 days.
myocardial mantle
What are the 4 steps to the development of a 4 chambered heart
What is a patent foramen ovale?
persistence of foramen ovale after birth, may open during increased right heart pressure, can allow clots to enter the arterial circulation (Stroke)
The primitive ventricle and bulbis cordis are initially separated by the ????
muscular portion of inter-ventricular septum.
????? also helps to separate the atrioventricular canal into a right and left canal.
muscular portion of inter-ventricular septum.
____ is the most common CHD lesion
Ventricular Septal Defect (VSD)
_____ cause LEFT to RIGHT ventricle shunting.
What is the most common type?
Ventricular Septal Defect (VSD)
Perimembranous
The closure of the primitive atrium is separated from the primitive ventricle by two _____
endocardial cushions
______ contribute to pulmonary and aortic valves
Endocardial cushions
______ form the membranous portion of the interventricular septum and fully separate the two ventricles
Endocardial cushions
What causes the common atrioventricular canals to form into left and right atrioventricular canals?
Expansion of the endocardial cushions
The closure of the primitive atrium is separated from the primitive ventricle by ______?
Endocardial cushions
During prenatal screenings, a cross is formed by what 3 features?
atrioventricular valves
atrial septum
ventricular septum
Atrioventricular canal defects are also known as ?
They can be ____ or _____
Endocardial cushion defect
partial or complete
What does a partial atrioventricular canal defect present as ?
a severe low ASD or high VSD with the AV valves affected but present
What does a complete atrioventricular canal defect present as ?
the AV valves are not developed and all four chambers of the heart are contiguous
When the mesenchyme below the AV valves hollow out, what 3 things does it leave behind?
valves
chordae tendinae
papillary muscles
What are the four components of the tetrology of fallot?
- Pulmonary stenosis
- RIGHT ventricular hypertrophy
- Overriding aorta
- VSD
The primitive ventricle forms the ?
left ventricle
the bulbus cordis forms the ?
right ventricle
the conus cordis and truncus arteriosus form what two structures?
proximal aorta and pulmonary artery
The conus cordis and truncus arteriosus form ___ that leads where ?
a single tube that leads to the aortic sac
The conus cordis and truncus arteriosus are subdivided by ?
spiral conotruncal ridges
The conotruncal ridges spiral as they pass through the _____ and _______ and meet the membranous portion of the ______.
conus cordis
truncus arteriosus
interventricular septum.
The spiraling of the left ventricle results in the ____
aortic channel
The spiraling of the right ventricle results in the ____
pulmonary channel
During the transposition of great arteries what is happening?
wrong ventricles are connected to the wrong vessels
During truncus arteriosus what is happening?
it results in one giant ventricle and the blood is mixed oxy and deoxygenated
The 3rd aortic arch gives rise to ?
the common carotid
the 4th aortic arch gives rise to ?
Right subclavian artery
the 6th aortic arch gives rise to ?
the proximal trunk
During a double aortic arch what is happening?
the right dorsal aorta remains intact below the 7th intersegmental artery and the esophagus gets squeezed making it hard to swallow
During a subclavian sling, what is happening?
The right dorsal aorta remains intact below the 7th inter-segmental artery but disappears more superiorly. Does NOT compress trachea and esophagus as severely.
What is a coarctation of the aorta?
when the aorta is narrow/compressed usually happens right below the origin of the ductus arteriosus
Initially, where do all veins empty?
into the sinus venosus
the vitelline veins carry (deoxy/oxy) from where?
deoxygenated
the yolk sac
the cardinal veins carry (deoxy/oxy) blood from ?
deoxygenated
the embryo itself
umbilical veins carry ____ blood from where?
OXYGENATED from the placenta
Malformations of the cardinal veins result in ???
abnormal venous drainage
Total anomalous pulmonary venous return results from ???
all four pulmonary veins are connected to the superior vena cava
mixing of blood in the right atrium due to an atrial septal defect
The ______ lined by endoderm, extends off the gut tube & invades surrounding mesoderm
respiratory diverticulum
The respiratory diverticulum, lined by ______, extends off the gut tube & invades surrounding ______.
endoderm
mesoderm
The respiratory diverticulum extends inferiorly through the _____ and is separated from the foregut by _________.
laryngeal orifice
tracheoesophageal ridges
The epithelium near the base of the tongue overgrows and closes the ______. It later is re-canalized, leaving the ______ and _____ as remnants
Laryngeal orifice
false laryngeal fold
laryngeal ventricle
What is laryngomalacia? How does it present? What position is it worse in?
floppiness of the larynx
inspiratory stridor and/or stertor within the first few weeks of life
Worse in supine versus prone
What is subglottic stenosis?
Congenital lesion results from incomplete recanalization of the laryngotracheal tube during the 3rd month of gestation
3rd most common laryngeal anomaly
Tracheoesophageal fistulas happen when ?
the esophagus does not connect to the stomach, instead it connects with the trachae
_____ is a slit like opening between the posterior larynx and esophagus
laryngeal cleft
_____ is often present with recurrent aspiration, immediate regurtitation or cyanotic spells with feeding
laryngeal cleft
laryngeal clefts happen due to the developmental failure of ??
primitive tracheoesophageal septum
At week 5-26, respiratory diverticulum enter ____, branches then does what?
mesoderm
associates with vessels
At week 27-> birth, _____ cells flatten and form ____ in much closer contact with vessels
epithelial
blind sacs
birth to 10 years -> Branches become _____, cells ____ to create _____.
finer
flatten
more surface area
insufficient surfactant can cause _____, which results in _____
atelectasis
collapse of the alveoli and respiratory distress syndrome
Spaces (______ ) develop in ______
Intraembryonic coelom
lateral plate mesoderm
the intraembryonic coelom fuse and expand – eventually they enlarge and separate the ______ into what 2 layers?
lateral plate mesoderm
Somatic layer and visceral layer
The ____ and ____ layers separate and fold anteriorly
visceral and parietal
The visceral layer and endoderm fold to form _____ and ______.
gut tube and mesentery
What three layers fold to completely surround the gut tube?
parietal layer
ectoderm
amniotic cavity
As what layer approach each other anteriorly, do they fuse and create the intraembryonic cavity?
somatic layers of lateral plate mesoderm
The intramebryonic cavity produces what three other cavities?
pericardial, pleural and peritoneal cavities
Thoracic wall defects results in ?
ectopia cordis
In ectopia cordis the ___ and ____ do not fuse on the midline. What happens to the heart?
ribcage and sternum
heart develops normally outside of the body
Gastroscisis develops as a result of ?
abdominal wall defects
incomplete closure of the abdominal wall which causes protrusion of the viscera
Pelvic wall defects result in ?
bladder/cloacal exstrophy
What layer does the bladder and external genitalia originate from?
somatic layer of lateral plate mesoderm
The horseshoe-shaped intraembryonic cavity splits into _____ and ____ cavities by the developing diaphragm.
pericardial & peritoneal
How do the pericardial and peritoneal cavities communicate?
through left and right pericardioperitoneal canals
Pericardioperitoneal canals close as two _____ folds extend from the lateral body wall to fuse with the _____ and ______.
pleuroperitoneal
septum transversum
esophageal mesentery
Congenital diaphragm hernia results in ?
the intestine are found in the top cavity coming through the diaphragm
______ manifests similarly to a mild congenital diaphragmatic hernia but pushes weakened diaphragm into the thoracic cavity. What nerve is this due to ?
Eventration of the diaphragm
Flaccid paralysis of the splenic nerve
Name 2 additional hernias the also result in herniation from the abdomen into the thorax?
parasternal and esophageal hernias
The heart grows into the ______ before the lungs.
embryonic pericardial cavity
As the lungs take up more space, they push two _____ folds ahead of them. What nerves do they contain?
pleuropericardial
phrenic nerves
When the pleuropericardial folds fuse to each other, what two cavities do they separate?
pleural cavity from the pericardial cavity
The lungs “sculpt” their _____ out of the body wall as they expand lateral to the heart’s _____.
pleural cavities
pericardial cavity
