Witwer Thorax & Respiratory Flashcards
The sternal angle is also called ____. Being an important landmark the 2nd ____ insterts here at the thoracic level of __-__.
Manubriosternal, rib, T4-T5
What landmark is at the top of the manubrium? This is at level __-__?
suprasternal notch, T2-3
The superior and inferior mediastinum is separated transversely by?
Plane of the sternal angle
The sternal angle is very important landmark as it also notes the?
- Superior limit of pericardium
- Beginning of aortic arch
- superior vena cava enters right atrium
- tracheal bifurcation
- superior limit of pulmonary trunk
Where is central venous pressure determined?
Where superior vena cava enters atrium at level of sternal angle
What are the contents of the anterior mediastinum?
thymus, internal mammary vessels, lymph nodes, loose connective tissue
What gland is located behind the manubrium
Thymus
What are the contents of the middle mediastinum?
Pericardia (fibrous and serous), heart, great vessels (aorta, SVC, IVC, pulmonary aa vv), nerves (vagus, sympathetics, phrenics), trachea
What are the contents of the posterior mediastinum?
descending aorta, esophagus, intercostal aa/vv, thoracic duct, azygos and hemiazygos vv
What are the contents of the superior mediastinum?
Thymus, brachiocephalic vv, SVC, aortic arch and branches (R brachiocephalic, L common carotid and L sublcavian), trachea, esophagus, phrenic and vagus nn, L recurrent laryngeal n, thoracic duct
The phrenic nerve follows ____ through the ____ ____.
vasculature, middle mediastinum
Right phrenic n. follows ____ (three of them).
Veins = SVC, IVC, RA
Left phrenic n. follows ____ ____ (two of them).
arterial vessels = pulmonary artery (PA) and left ventricle (LV)
The vagus n. follows the ____ route through the _____ mediastinum, and the ____ route through the ____ mediastinum.
arterial, superior, food, posterior
The right vagus n. takes the ____ route through the ____ mediastinum then the ____ route through the ____ mediastinum.
air (next to trachea), superior, food, posterior
superior intercostal aa branches off to form the ____ and ____ ____ ____ aa
1st and 2nd posterior intercostal
The descending aorta branches off lower 9 ___ ___ aa
posterior intercostal
The 6th rib is a landmark sigifiying?
Internal mammary aa bifurcation
The internal mammary vv anastomose w/ which two veins?
lateral thoracic vv and superior epigastric vv
What causes caput medusae?
portal HTN distends superior and inferior epigastric vv and this extends into the thoraco-epigastric anastomosis (collateral) «_space;are these the lateral thoracic and superior epigastric???
For a refresher, the vagus n. causes ____ of bronchioles while the sympathetic trunk ____.
constricts, dilates
The R&L parasternal lymphatics serves as a site of?
Metastasis
The thoracic lymphatic duct descends anterior to the vertebral column, passing behind the diaphragm and dilates into a larger collecting duct called?
Cisterna chyli (Witty loves these crazy anatomy names)
what are the primary muscles of inspiration?
Diaphragm (75% of baseline inspiration), external intercostals (externals Elevate) moving ribs up and out (T1-11), Interchondral portion of the intercostals (T1-11)
What are the accessory muscles of breathing (i.e. forced breathing of exercise or pathology)
-Sternocleidomastoids (C
N XI)
-A/P/M scalenes (C3-8)
If you want to be super annoying about the accessory inspiratory muscles some authors also include?
- serratus A/P
- Pectoralis maj/min
- latissimus dorsi
- traperzius
- erector spinae
- quadratus lumborum
- transverse thoracis
- subcostals and subclavius
What is responsible for the passive aspect of expiration
Essentially the passive elastic recoil of lungs
Muscles of active exhalation?
- Internal intercostals (move ribs down and inward)
- Abdominal muscles (abdominus rectus/transversus, ext/int obliques) **slide 13 pic
What is the inspiratory center of the brain?
Medulla (not active during normal breathing, but is during active exhalation)
The inspiratory center (medulla) receives sensory input from ____ and ____ receptors.
-chemo and mechano
What nerves carry chemo receptors input to medulla?
Glossopharyngeal and vagus
What nerve carries mechanoreceptor input to the medulla for inspiration?
Pulmonary mechanoreceptors via Vagus nerve.
What is the predominant receptor responsible for normal breathing and where is it located?
Chemoreceptors in medulla responding to change in pH of CSF.
What is the most sensitive peripheral mechanism affecting breathing?
Peripheral carotid and aortic chemoreceptors for PaO2 (<60mmHg stimulates these receptors to increase inspiratory rate)
What center causes prolonged inspiration?
Apneustic center of pons or medulla?
What center turns off inspiration?
Pneumotaxic
Lung compliance will decrease (stiffer) in which type of lung dz?
Restrictive. Makes sense because harder for lungs to expand
The hilum contains which vessels (4) and are they located superior inferior posterior?
- Pulmonary aa superior
- Pulmonary vv inferior
- Main stem bronchi posterior
- Bronchial arteries from aorta (location not noted)
Bronchial arteries branch from the ____ and supply the ____ and pulmonary ____.
aorta, bronchi (duh), stroma
There are two great nerves that pass anterior and posterior to the hilar roots. Which are they and where do they travel (A/P?)
Vagus = posterior Phrenic = anterior
Which lung contains the lingular segments?
Left. Superior and inferior lingular segments
The Angle of Louis is located at which costal cartilage level?
2nd
The lower border of the lung is located around which ribs and locations?
- Anteriorly = Midclavicular 6/7
- Laterally = rib 8 mid axillary
- Posteriorly = infrascapular line rib 10
- Lateral to vertebral column rib 11
Between deep inspirations and exhalations the lung borders will move __ ribs.
2
What rib is located just below the inferior angle of the scapula?
Rib 8 (usually)
The two exiting motor nerves of the brachial plexus that innervate the trunk are which two and what muscles do they innervate?
- Long thoracic n. = serratus anterior m
- Thoracodorsal n. = latissimus dorsi
Brachial plexus motor nerves (5) to the shoulder and muscles innervated?
-Axillary n = deltoid
Brachial plexus motor nerves (5) to the shoulder and muscles innervated?
- Axillary n = deltoid and teres minor m
- Suprascapular n = supraspinatus, infraspinatus m
- Inferior subscapular n = subscapularis, teres major m
- dorsal scapular n = rhomboid m
- Medial and lateral pectoral n = pectoralis major and minor m
Brachial plexus motor nerves to the arm (2) and muscles innervated.
- Musculocutaneous n = all muscles in anterior compartment of the arm
- Radial n = all muscles in posterior compartment of the arm and forearm
Brachial plexus motor nerves to the forearm (3) and muscles innervated.
- Median n = most of mm to anterior compartment of forearm
- Ulnar n = most intrinsic mm of the hand
- Radial n = all muscles in the posterior compartment on the arm and forearm
Brachial plexus motor nerves to the forearm (3) and muscles innervated.
- Median n = most of mm to anterior compartment of forearm
- Ulnar n = most intrinsic mm of the hand
- Radial n = all muscles in the posterior compartment on the arm and forearm
During breast surgery which nerve can be compromised and what does it cause?
Long thoracic nerve. Serratus anterior loses function of “forward shoulder thrust” and causes winging of scapula
What muscle is known as the “solitary muscle”
Subscapularis b/c only muscle to insert on lesser tuberosity of scapula
What innervates the latissimus dorsi m?
Thoracodorsal nerve
What muscles make up the rotator cuff?
SITS muscles Supraspinatus Infraspinatum Teres Minor Subscapularis
Sensory innvervation of brachial plexus:
- Axillary n
- Medial cutaneous n of arm
- Musclulocutaneous n
- Radial n
- Ulnar n
- Median n
- Axillary n = skin over lateral portion of upper arm
- Medial cutaneous n of arm = medial upper arm
- Musculocutaneous n = lateral forearm
- Radial n= posterior arm and forearm, lower lateral arm, dorsolateral hand
- Median n= lateral palmar 3 1/2 digits, palm and middle of wrist
- Ulnar n= medial palmer 1 1/2 digits, palm and wrist, medial dorsal 1 1/2 fingers
What are the branches of the 3 parts of the axillary artery?
First part = 1 branch > sup thoracic a.
Second part = 2 branches > thoracoacromial and lateral thoracic aa
Third = 3 branches > subscapular, posterior circumflex humeral, anterior circumflex humeral aa
Anastomoses around the should are formed via ______ branches.
thoracoacromial
What are the branches of the thoracoacromial artery that forms anastomoses around shoulder? (6)
- Clavicular
- Acromial
- Deltoid
- Thoracic
- Lateral thoracic a. anastomoses with T4-10 intercostal aa
- Superior thoracic a. anastomoses with T1-2 intercostal branches of interanal mammary a.
T/F: There are copious anterior anastomoses b/w anterior thoracic and anterior abdominal wall aa.
True
Inferior and medial to Coracobrachialis muscle landmark (6)
Axillary vein Axillary artery Median nerve Ulnar nerve Radial nerve Medial cutaneous nerves of forearm and arm
What nerve is involved in the “Saturday night palsy” nerve or “Nerve d’ amour”
Causes radial neuropathy from pressure on back or medial axillary area
wrist drop is characterized by…
Numbness on back of hand and wrist. Pt cannot straighten fingers (extensors)
