Term
| function and structure of the thoracic cavity |
|
Definition
acts as a cage for breathing, support of upper arm and protection of the heart
12 T-vertebrae
12 ribs and coastal cartillage
1 sternum |
|
|
Term
| name the 3 parts of the sternum. Which ribs connect to which parts? |
|
Definition
| manubrium (1-1/2 of 2nd), body (other half of 2nd-7) and xiphoid process (none) |
|
|
Term
| Name the 3 kinds of ribs and how many of each we have |
|
Definition
True (1-7)attach to sternum
False (8-10) have costal cartillage but dont attach to sternum
Floating (11 & 12) lack costal cartillage |
|
|
Term
| which ribs are "typical" ribs? Name the four parts |
|
Definition
3-9
Head (articulates with body of correspoding vertebrae AND the vertebrae immediately superior to it
Tubercle: articulates with transverse process of corresponding vertebrae
Shaft or Body: most of the rib, curves anteriorly. Has a groove on its inferior surface to house the passage of intercostal vein, artery and nerve
angle of rib: lateral to tuburcle when reb first starts to turn anteriorly. Typical site of insertion for intercostal muscles, frequent site of rib fracture. |
|
|
Term
| name distinct feature of 1st rib |
|
Definition
| Prominent scalene tuburcule where anterior scalene muscle inserts on its superior surface. Subclavian artery is posterior to scalene muscle, subclavian vein is anterior |
|
|
Term
| which ribs attach to the scalene muscles? |
|
Definition
| 1 (anterior and middle) 2 (posterior) |
|
|
Term
| what is the sternal angle(of lewis)? |
|
Definition
the angle at which the second angle attaches to the sternum
also the intervertebral level at disc between T4& T5
nearly horizontal line
Divides mediastinum into superior and inferior
the bifurcation of the trachea
where the azygous ceins drains into the superior vena cava |
|
|
Term
| Where do ribs ususally break? |
|
Definition
|
|
Term
|
Definition
| if periosteum is left intact |
|
|
Term
what defines the thoracic apeture?
what important things go through here? (4) |
|
Definition
t1 vertebrae, 1st rib and superior border of the manubrium
trach, esophagus, brachial plexus, subclavian veins and arteries |
|
|
Term
| What creates a cervical rib? How many people have them? 2 complications of them. What do we call said complications |
|
Definition
elongation of the transverse process of C7
1/100-1/200 people
compression of the brachial plexus (c8-T1) or the subclavian artery
Atrial or Neurogenic Thoracic Outlet Syndrome
HANSON, swollen arm during concert |
|
|
Term
| name the 4 sternal abnormalities |
|
Definition
pectus excavatum (sunken seurnum)
pectus carinatum ((pigeon chest; ridge projects anteriorly)
premature sternal fusion (increased heart defects)
sternal fistula (holes in sternum) |
|
|
Term
| when does the xiphoid ossify with the sternal body? |
|
Definition
|
|
Term
| what is a costovertebral joint? |
|
Definition
| synovial joint between head of the rib and body of the verterbra at a facet or demifacets |
|
|
Term
| this is a joint in the T-spine. Name the 2 variations |
|
Definition
| costotransverse (curved for rotation T1-T7) (fairly flat joint allowing sliding T8-10) |
|
|
Term
| 3 kinds of joints between ribs and sternum |
|
Definition
cartilaginous (between 1st rib and manubrium)
synovial (ribs 2-7)
costrochondral joint (bone is directly attached to cartillage) synchondrosis |
|
|
Term
| Name the 3 divisions of the intercostal muscles |
|
Definition
exernal (run inferiorly and medially, like hands in pockets) replaced anteriorly by membrane. RAISE RIBS DURING INSPIRATION
Internal Intercostal Muscles (iferoposterially and replaste posteriorly by membrane near T-spine 90 degrees to external)
innermost intercostal muscle (lateral, forms transversus thoracic muscle anteriorly)--paralell to internal |
|
|
Term
| whats the function of intercostal muscles? |
|
Definition
| help keep intercostal space from bulging during respiration |
|
|
Term
| this muscle origins at sternum and inserts into ribs. Function? |
|
Definition
| transversus thoracic muscles, depress ribs, fast exhale |
|
|
Term
| these muscles originate from spinus processes and insert into ribs |
|
Definition
serratus posterior superior (c and t spine) INSPIRATION lifts ribs
and serratus posteiror inferior (T spine) EXPIRATION |
|
|
Term
| function of 3 scalene muscles. WHat helps them? |
|
Definition
help raise ribs during HEAVY inspiration.
sternocleidomastoid |
|
|
Term
|
Definition
| clavicular head, sternal head and costal head |
|
|
Term
|
Definition
| cephalic vein, drains TO the head |
|
|
Term
| function of serratus anterior |
|
Definition
| attaches from upper ribs to scapula to pull scapula forward |
|
|
Term
Crainal to caudal relationship of neurovascular bundle
where do they run? |
|
Definition
VAN
vein artery nerve
runs under rib groove (some run contralaterally, right off top of rib)
inbetween internal and innermost intercostal muscles |
|
|
Term
| if you had to inject nerve block in between ribs, where would you stick it? |
|
Definition
|
|
Term
| what happens if the aorta is coarctated? |
|
Definition
body can use internal thoacic (internal mamary artery) as a bypass system. Blood will flow through intercostal arteries
Causes grooving under surfaces of the ribs |
|
|
Term
| if shingles shows up, where would we look for them? |
|
Definition
vessiculation across a dermatome (diagnoally)
(singles live in the DRG) |
|
|
Term
| how does blood get into the intercostal arteries? |
|
Definition
| thoracic aorta AND internal thoracic artery |
|
|
Term
| 5 dermatomes that we need to know! |
|
Definition
C5=clavicle
T4=nipple (teat)
T7=xiphoid process
T10=umbilicus
L1=inguinal ligament |
|
|
Term
| how many lobes typically in breast? |
|
Definition
|
|
Term
| 2 muscles that the breast sits on |
|
Definition
| pec major (2/3) serratus anterior (1/3) |
|
|
Term
| what does the breast develop from? |
|
Definition
| skin (maybe a modified sweat gland?) |
|
|
Term
| what is the spaces of loos areaolar tissue that prevents the breast from movement with pec muscle? |
|
Definition
|
|
Term
| this is a breast vessel that is used in bypasses |
|
Definition
|
|
Term
| if BC is suspected, radioactive dye is injected near nodule. A geiger counter is used to locate where lymph has migrated do for disection. What is this procedure called? |
|
Definition
|
|
Term
| where do most breast cancers form? What type is the most common type? |
|
Definition
upper lateral kind
adenocarcinoma (lactiforous duct carcinoma) |
|
|
Term
| 4 signs of late breast cancer stages |
|
Definition
| skin dimpling, edema of the skin near nipple, nipple retraction and deviation, abnormal contours |
|
|
Term
extra nipples
extra breasts
where do these usually form? |
|
Definition
polytheilia
polymastia
along the milk line |
|
|
Term
this is the medial word for bob's bitch tits
when do these usually develop? |
|
Definition
gynecomastia
@ puberty in obese males due to increased estrogen levels |
|
|
Term
| how many cavities are in the thoracic cavity? |
|
Definition
| 2 pleaural cavities and 1 mediastinum |
|
|
Term
| what makes the R hemidiaphram higher than the L? |
|
Definition
| Liver (as high as 3rd intercostal space), heart (as high as 5th intercostal space) |
|
|
Term
| 2 things that diaphragm is derived from |
|
Definition
| septum transversum (from myoblast of 3rd 4th 5th cervical mytomes, pleuroperitoneal fold) |
|
|
Term
| Where is the diaphragm innervated? |
|
Definition
preneic nerve from C 3,4,5
C 3, 4, and 5 keep diaphragm alive |
|
|
Term
| name 3 major opeinings in diaphragm |
|
Definition
anterior T8 inferieor vena cava hiatus
t10 esophageal hiatus (and vagal trunks)
t12 aortic hiatus (also lets thoracic duct and azygous vein through) |
|
|
Term
| how does the blood supply get to diaphragm? |
|
Definition
| pericariaophrenic artery (also gets blood to pericardium) runs with phrenic nerve |
|
|
Term
|
Definition
| medial pectoral nerve innervates pec minor and pec major lateral pectoral nerve (medial to medial anatomically) and only innervates pec major |
|
|
Term
| describe the pleural cavity and it's 2 surfaces in relation to lungs |
|
Definition
"fist into a balloon"
visceral (next to lung) parietal (wall) |
|
|
Term
| what is the function of the fluid in the pleura? |
|
Definition
| keeps membranes together, but allows movement of the T-cage, diaphragm and lings in silence and with very little friction |
|
|
Term
| where is the visceral pleura continuous with the parietal pleura? |
|
Definition
|
|
Term
this is an inflamation of the pleaural membrane? What can cause this? 2 complications
sx(3)? |
|
Definition
pleurisy, bacteria or virus
rub or adhesions
localized chest pain, pain with inspriation, short breaths (because it hurts to breathe deep) |
|
|
Term
| name the subportions of the parietal pleura |
|
Definition
cervical pleura (goes above 1st rib)
costal pleura (outside)
diaphragmatic pleura (diaphragm)
mediastinal pleura (whats it next to?) |
|
|
Term
| where is fulid most likely to accumulate in the lungs? |
|
Definition
| costodiaphragmatic recess (most inf portion of pleural cavity when standing) |
|
|
Term
where do the pleural spaces and lungs end at? for Mid-clav line? Mid axill line? Medial edge of Scapula?
mid clavicular line?
mix axillary line?
medial edge of scapula? |
|
Definition
L: 6th rib, 8th Rib 10th rib
P: 8th, 10th 12th |
|
|
Term
| what keeps lungs inflated? |
|
Definition
| chest wall and negative pressure in pleural cavity |
|
|
Term
| what is the word for air in lungs? Blood? Water (or body fluids)? What happens with both of these? Sx? |
|
Definition
| pneumothorax, hemothorax, pleaural effusion Lungs collapse tachy, respiratory distress, chest pain |
|
|
Term
| how is pneumothorax diagnosed? |
|
Definition
| ascultation of the chest reveals decreased breath sounds over affected lung, confirmed by ultrasound or CT |
|
|
Term
| condition where pus and fluid accumulate in a body cavity? In chest? |
|
Definition
|
|
Term
| classification for minimal, moderate and massive hemothorax? |
|
Definition
| 350 ml > 350 to 1500 ml > 1501+ |
|
|
Term
| most common cause of hemothorax? |
|
Definition
| intercostal vein bleeding |
|
|
Term
| surgical procedure where we drain blood from pleural cavity |
|
Definition
|
|
Term
| tidal volume vs max inspiration |
|
Definition
0.5 liters of air
3-5 liters! |
|
|
Term
| this is an incision into the chest |
|
Definition
|
|
Term
| how many lobes in each lung? what divides them |
|
Definition
R (3) oblique fissure and horizontal fissure
L (2) only oblique fissure |
|
|
Term
| these are bits of the lungs that can be removed |
|
Definition
| bronchopulmonary segments (contain ariteries and veins) |
|
|
Term
| how many pulmonary arteries per lung? veins? |
|
Definition
|
|
Term
| R hilum cross section find R bronchus, R pulmonary arteries, R pulmonary veins |
|
Definition
Superior and posteiror
middle
andterir and inferior |
|
|
Term
| 2 important things to find on R lung |
|
Definition
grove for superior vena cava (down middle)
arch of azygous vein (around hilum) |
|
|
Term
| impressions on the L lung |
|
Definition
HUGE round cardiac impression
grouve for aorta arch |
|
|
Term
| L hilar vessel orientation |
|
Definition
bronchus posteiror
pulmonary veins anterior and inf
pulmonary artery (cranial-sort of sandwiched ALSO has cartillage) |
|
|
Term
| this divides the trachea, which bronchus is bigger? Why? |
|
Definition
carina, Right
heart pushes L side up AND L lung is smaller |
|
|
Term
| if you were looking for an inhaled foreign body, where would you look first? How? |
|
Definition
R inferior lobe of lung (R side is bigger)
ascultation |
|
|
Term
| where are most of the lymph nodes in the lung located? |
|
Definition
|
|
Term
where does sympathetic innervation of the lungs come from? What does it do?
ditto for parasympathetic |
|
Definition
T1-5. Produces relaxation of muscle inhibibs mucus secretion, induces pulmonary arterial vasoconstriction
Para: vagus nerve, bronchial constriction, mucus secretion and inhibits pulmonary vasoconstriction |
|
|
Term
| where does pleural pain come from? |
|
Definition
| parietal pleura (C3,4,5 neck and should pain too!) |
|
|
Term
FOR BREATHING:
describe lateral aspect increasing slightly
describe ribs rotating up and increasing anterior posterior dimension |
|
Definition
|
|
Term
| what muscles are invloved in passive inspiration vs passive expiration |
|
Definition
ins: diaphragm!
ex: NADA (elastic recoil) |
|
|
Term
| what muscles are involved in forced inspiration? forced expiration? |
|
Definition
ins: sternocleidomastoid, scalene, levator costarum, serratus posterior superior
ex: recuts abdominus, external and external oblique, internal intercostal, serratus posterior inferior AND transversus throacis |
|
|
Term
| this is the destruction of respiratory and or terminal bronchioles by fibrosis |
|
Definition
|
|
Term
| why does empysema result in barrel chest? |
|
Definition
| increase in amount of air drawn into the lungs in order for adequate gas exhcange |
|
|
Term
| how do the lungs develop? |
|
Definition
diverticulum off foregut
forms 3 buds on R, 2 on L then divides 23 times |
|
|
Term
| these are defects in the proper development of the esophagus and trachea What is the most common cause? 2nd? 2 rare forms.. |
|
Definition
Tracheoesophageal Fistula
Blind proximal esophagus, fistula @ distal end of esophagus @ just below bifurcation
isolated esophageal atresia / common communication of esophagus with trachea
proximal above bifurcation, split esophgagues with both ends fistula"ing" |
|
|
Term
| what causes hiccups? What is a severe way of treating them? |
|
Definition
spasmatic contraction of the diaphragm inturrupted by reflex closure of the glottis.
crush the phrenic nerve |
|
|
Term
where do PE's usually come from?
3 sx? They're VERY common in these patients |
|
Definition
DVTs through the pulmonary artery
dyspnea, tachy, lighthead
paraplegics |
|
|
Term
| how many extrapulmonary tumors metastases to the lungs? Why is this common? |
|
Definition
about 30%
if tumor cells leave via the blood, the lungs are the next cap bed that they go into!!!!! |
|
|
Term
|
Definition
median plane: (makes R&L)
sagittal plane: (paralell to median)
coronal plane: (front and back)
horizontal plane: (top and bottom)
oblique (section cut at any other angle) |
|
|
Term
| 2 other names for horizontal plane |
|
Definition
|
|
Term
| another term for superior vs inferior |
|
Definition
| crainal or cephalic vs caudal |
|
|
Term
this means same side of the body
this means opposite side of the body |
|
Definition
|
|
Term
| what are the 3 layers of the umbilical cord? |
|
Definition
medain (innermost)
medial (middle)
lateral (outermost) |
|
|
Term
|
Definition
| flexsion decreases the angle between body parts |
|
|
Term
|
Definition
AB moving away from medial plane
AD moving towards median plane or midline |
|
|
Term
| this is circular motions combining flexion, extension, abductions and adductions |
|
Definition
|
|
Term
| this is moving something around a long axis |
|
Definition
|
|
Term
|
Definition
supine, on back
prone, face down
lateral on the side |
|
|
Term
| this is a phenotype that is present in less than 1% of the population |
|
Definition
|
|
Term
| where does the thoracic duct empty? How much fluid is returned daily? |
|
Definition
junction of L subclavian vain and L internal junglar vein
1-2 L of fluid |
|
|
Term
| which parts of the body dumps into the R thoracic duct? |
|
Definition
| R head and upper extremitiy, everything else in the L side |
|
|
Term
| where do motor neurons live? |
|
Definition
|
|
Term
| where do sensory nerve bodies live? |
|
Definition
|
|
Term
| are ramuses sensory or motor? Which ones are usually named nerves of the body? |
|
Definition
BOTH!
Ventral. Dorsal just called ramus |
|
|
Term
| this is where skin is innervated by a spinal nerve, what about muscle? |
|
Definition
|
|
Term
|
Definition
c6 thumb
c7 index finger
c8 pinky finger |
|
|
Term
where is xiphiod innervated?
umbilicus, inguinal ligament, external genetalia? |
|
Definition
|
|
Term
| describe slowing of heartbeat |
|
Definition
vagus nerve from brain, down to heart synapes with 2nd order neuron near SA node
parasympathetic |
|
|
Term
|
Definition
1st order neuron fires from sympatetic ganglion down to heart, synapes on SA noed
sympathetic! |
|
|
Term
| the 2 sternoclidomastioid muscles make a ____ at the ______ |
|
Definition
| suprasternal (jugular) notch @ the manubrium |
|
|
Term
| offical divider between thoracic region and abdominal region? |
|
Definition
|
|
Term
| shock absorber between clavicle and manubrium |
|
Definition
|
|
Term
| Describe the neurovascular bundle for the intercostal spaces |
|
Definition
intercostal artery runnning off aorta or internal thoracic artery and intercostal nerves running off spinal cord
both run between innermost and internal intercostal |
|
|
Term
| these muscles "skip a rib" |
|
Definition
|
|
Term
| these ligaments attach breast tissue to skin |
|
Definition
| suspensory ligaments of kupffer |
|
|
Term
| this is where the costal and mediastinal pleura meeet anteriorly to the heart. Which side? |
|
Definition
costomediastinal recess
L |
|
|
Term
| this lil fella is the inf portion of the superior L lobe that is adjacent to the costmediastinal recess |
|
Definition
|
|
Term
|
Definition
rupture of a cyst or small sac on the surface of a lung
hole from lung to pleural cavity where air gets in there |
|
|
Term
| typical cause of hemothorax? |
|
Definition
| lac of an intercostal vessel (vein or artery) |
|
|
Term
| how can we tell if pt had drowned @ autopsy? |
|
Definition
| put lungs in water and they'll sink (cool!) |
|
|
Term
|
Definition
| costal (ribs), mediastinal, diaphragmatic |
|
|
Term
| R hilar vessel orientation (4) |
|
Definition
R bronchus (sup and post)
R Pul arts (middle)
R pul veins (ant and inf)
pulmonary ligament (visceral and parietal pueura on eachother) |
|
|
Term
|
Definition
| baby drinking milk but its not going down |
|
|
Term
| 4 functions of respiration |
|
Definition
ventilation
alveolo cap diffusion
blood gas transport
cap-cell diffusion |
|
|
Term
| air goes into and out of lungs due to |
|
Definition
|
|
Term
| this is the amount of air in the lungs after expiration? Whats special about it? |
|
Definition
functional residual capacity
anything else requires force (inspiration or expiration) |
|
|
Term
| when volume goes up, pressure goes |
|
Definition
|
|
Term
| formula for pulmonary airflow |
|
Definition
Pb-Palv = airflow * resistance
(pb is barometirc alv is alveoli) |
|
|
Term
| What does Transpulmonary pressure measure? Give 2 formulas |
|
Definition
The tendancy of the elasticity of the lungs to recoil inward
Ptp = Palv-Ppl
Ptp = Delta Volume / Compliance |
|
|
Term
|
Definition
At all times:
Pb-Ppl = (Pb-Palv) + (Ptp)
OR ATMOSPHERIC PRESSURE MINUS PLEURAL PRESSURE = ATMOSPHERIC PRESSURE MINUS ALVEOLAR PRESSURE PLUS ALVEOLAR PRESSURE MINUS PLEURAL PRESSURE |
|
|
Term
| pulmonary compliance formula |
|
Definition
| change in lung volume / change in transpulmonary pressure (Ptp) |
|
|
Term
| lung with higher compliance will have a ____ max volume |
|
Definition
higher
this is why emphysema patients tend to have barrel chest |
|
|
Term
| 2 reasons the lungs have elastic recoil |
|
Definition
presence of elastic fibers
surface forces at liquis air interface in alveoli (surface tension)--soap bubble |
|
|
Term
| If I say that the lungs have a "negative pressure" what does that really mean? |
|
Definition
| that the lungs have a pressure that is LOWER than atmospheric pressure |
|
|
Term
| Breiefly describe what is going on with breathing pressures (Palv, Pb and Ppl) |
|
Definition
@ the end of respiration, I only have FRC in my lungs
PPl is still negative (compared to Palv)
Now the diaphragm contracts. PPl drps even more (-5 to -8) because its volume is expanding (PV inverse stupid). Palv expands (pressure drops) as more air comes in Palv returns to about Pb (atm)
THen I relax dipram, size returns to nl, palv is raised until enough air leaves for it to be about ATM, Ppl goes down (elastic recoil) and we start all over again |
|
|
Term
| what do we call the phenomena of the PV curve shifting to the R during inspiration and to the L when it is deflating |
|
Definition
|
|
Term
| lung compliance is lowest at _____ volumes and highest at ____ volumes |
|
Definition
| lowest at high and highest at low |
|
|
Term
| increase in lung compliance is bad why? |
|
Definition
| because it means the lungs ability to recoil has decreased |
|
|
Term
| how does the body aid expiration in a pt with emphysema |
|
Definition
| must involve in muscle contration (can lead to airway compression and increased resistance during expiration) |
|
|
Term
| describe how breathing is affected during a gain and loss of compliance and what conditions might do both |
|
Definition
gain: inspiration is easy, expiration is harder (emphysema)
loss: inspiration harder, expiration easier (interstitial pneumonia) |
|
|
Term
| exactly what does surfactant do? |
|
Definition
works like a bubble that wants to get smaller (so it doesnt pop)
Tons of surfactant working together results in increased elastic recoil of the lung) |
|
|
Term
|
Definition
|
|
