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Finals > Witwer Thorax & Respiratory > Flashcards

Witwer Thorax & Respiratory Flashcards

1
Q

The sternal angle is also called ____. Being an important landmark the 2nd ____ insterts here at the thoracic level of __-__.

A

Manubriosternal, rib, T4-T5

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2
Q

What landmark is at the top of the manubrium? This is at level __-__?

A

suprasternal notch, T2-3

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3
Q

The superior and inferior mediastinum is separated transversely by?

A

Plane of the sternal angle

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4
Q

The sternal angle is very important landmark as it also notes the?

A
  • Superior limit of pericardium
  • Beginning of aortic arch
  • superior vena cava enters right atrium
  • tracheal bifurcation
  • superior limit of pulmonary trunk
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5
Q

Where is central venous pressure determined?

A

Where superior vena cava enters atrium at level of sternal angle

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6
Q

What are the contents of the anterior mediastinum?

A

thymus, internal mammary vessels, lymph nodes, loose connective tissue

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7
Q

What gland is located behind the manubrium

A

Thymus

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8
Q

What are the contents of the middle mediastinum?

A

Pericardia (fibrous and serous), heart, great vessels (aorta, SVC, IVC, pulmonary aa vv), nerves (vagus, sympathetics, phrenics), trachea

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9
Q

What are the contents of the posterior mediastinum?

A

descending aorta, esophagus, intercostal aa/vv, thoracic duct, azygos and hemiazygos vv

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10
Q

What are the contents of the superior mediastinum?

A

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

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11
Q

The phrenic nerve follows ____ through the ____ ____.

A

vasculature, middle mediastinum

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12
Q

Right phrenic n. follows ____ (three of them).

A

Veins = SVC, IVC, RA

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13
Q

Left phrenic n. follows ____ ____ (two of them).

A

arterial vessels = pulmonary artery (PA) and left ventricle (LV)

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14
Q

The vagus n. follows the ____ route through the _____ mediastinum, and the ____ route through the ____ mediastinum.

A

arterial, superior, food, posterior

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15
Q

The right vagus n. takes the ____ route through the ____ mediastinum then the ____ route through the ____ mediastinum.

A

air (next to trachea), superior, food, posterior

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16
Q

superior intercostal aa branches off to form the ____ and ____ ____ ____ aa

A

1st and 2nd posterior intercostal

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17
Q

The descending aorta branches off lower 9 ___ ___ aa

A

posterior intercostal

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18
Q

The 6th rib is a landmark sigifiying?

A

Internal mammary aa bifurcation

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19
Q

The internal mammary vv anastomose w/ which two veins?

A

lateral thoracic vv and superior epigastric vv

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20
Q

What causes caput medusae?

A

portal HTN distends superior and inferior epigastric vv and this extends into the thoraco-epigastric anastomosis (collateral) &laquo_space;are these the lateral thoracic and superior epigastric???

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21
Q

For a refresher, the vagus n. causes ____ of bronchioles while the sympathetic trunk ____.

A

constricts, dilates

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22
Q

The R&L parasternal lymphatics serves as a site of?

A

Metastasis

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23
Q

The thoracic lymphatic duct descends anterior to the vertebral column, passing behind the diaphragm and dilates into a larger collecting duct called?

A

Cisterna chyli (Witty loves these crazy anatomy names)

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24
Q

what are the primary muscles of inspiration?

A

Diaphragm (75% of baseline inspiration), external intercostals (externals Elevate) moving ribs up and out (T1-11), Interchondral portion of the intercostals (T1-11)

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25
Q

What are the accessory muscles of breathing (i.e. forced breathing of exercise or pathology)

A

-Sternocleidomastoids (C
N XI)
-A/P/M scalenes (C3-8)

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26
Q

If you want to be super annoying about the accessory inspiratory muscles some authors also include?

A
  • serratus A/P
  • Pectoralis maj/min
  • latissimus dorsi
  • traperzius
  • erector spinae
  • quadratus lumborum
  • transverse thoracis
  • subcostals and subclavius
27
Q

What is responsible for the passive aspect of expiration

A

Essentially the passive elastic recoil of lungs

28
Q

Muscles of active exhalation?

A
  • Internal intercostals (move ribs down and inward)

- Abdominal muscles (abdominus rectus/transversus, ext/int obliques) **slide 13 pic

29
Q

What is the inspiratory center of the brain?

A

Medulla (not active during normal breathing, but is during active exhalation)

30
Q

The inspiratory center (medulla) receives sensory input from ____ and ____ receptors.

A

-chemo and mechano

31
Q

What nerves carry chemo receptors input to medulla?

A

Glossopharyngeal and vagus

32
Q

What nerve carries mechanoreceptor input to the medulla for inspiration?

A

Pulmonary mechanoreceptors via Vagus nerve.

33
Q

What is the predominant receptor responsible for normal breathing and where is it located?

A

Chemoreceptors in medulla responding to change in pH of CSF.

34
Q

What is the most sensitive peripheral mechanism affecting breathing?

A

Peripheral carotid and aortic chemoreceptors for PaO2 (<60mmHg stimulates these receptors to increase inspiratory rate)

35
Q

What center causes prolonged inspiration?

A

Apneustic center of pons or medulla?

36
Q

What center turns off inspiration?

A

Pneumotaxic

37
Q

Lung compliance will decrease (stiffer) in which type of lung dz?

A

Restrictive. Makes sense because harder for lungs to expand

38
Q

The hilum contains which vessels (4) and are they located superior inferior posterior?

A
  • Pulmonary aa superior
  • Pulmonary vv inferior
  • Main stem bronchi posterior
  • Bronchial arteries from aorta (location not noted)
39
Q

Bronchial arteries branch from the ____ and supply the ____ and pulmonary ____.

A

aorta, bronchi (duh), stroma

40
Q

There are two great nerves that pass anterior and posterior to the hilar roots. Which are they and where do they travel (A/P?)

A 
Vagus = posterior
Phrenic = anterior
41
Q

Which lung contains the lingular segments?

A

Left. Superior and inferior lingular segments

42
Q

The Angle of Louis is located at which costal cartilage level?

A

2nd

43
Q

The lower border of the lung is located around which ribs and locations?

A
  • Anteriorly = Midclavicular 6/7
  • Laterally = rib 8 mid axillary
  • Posteriorly = infrascapular line rib 10
  • Lateral to vertebral column rib 11
44
Q

Between deep inspirations and exhalations the lung borders will move __ ribs.

A

2

45
Q

What rib is located just below the inferior angle of the scapula?

A

Rib 8 (usually)

46
Q

The two exiting motor nerves of the brachial plexus that innervate the trunk are which two and what muscles do they innervate?

A
  • Long thoracic n. = serratus anterior m

- Thoracodorsal n. = latissimus dorsi

47
Q

Brachial plexus motor nerves (5) to the shoulder and muscles innervated?

A

-Axillary n = deltoid

48
Q

Brachial plexus motor nerves (5) to the shoulder and muscles innervated?

A
  • 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
49
Q

Brachial plexus motor nerves to the arm (2) and muscles innervated.

A
  • Musculocutaneous n = all muscles in anterior compartment of the arm
  • Radial n = all muscles in posterior compartment of the arm and forearm
50
Q

Brachial plexus motor nerves to the forearm (3) and muscles innervated.

A
  • 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
51
Q

Brachial plexus motor nerves to the forearm (3) and muscles innervated.

A
  • 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
52
Q

During breast surgery which nerve can be compromised and what does it cause?

A

Long thoracic nerve. Serratus anterior loses function of “forward shoulder thrust” and causes winging of scapula

53
Q

What muscle is known as the “solitary muscle”

A

Subscapularis b/c only muscle to insert on lesser tuberosity of scapula

54
Q

What innervates the latissimus dorsi m?

A

Thoracodorsal nerve

55
Q

What muscles make up the rotator cuff?

A 
SITS muscles
Supraspinatus
Infraspinatum
Teres Minor
Subscapularis
56
Q

Sensory innvervation of brachial plexus:

  • Axillary n
  • Medial cutaneous n of arm
  • Musclulocutaneous n
  • Radial n
  • Ulnar n
  • Median n
A
  • 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
57
Q

What are the branches of the 3 parts of the axillary artery?

A

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

58
Q

Anastomoses around the should are formed via ______ branches.

A

thoracoacromial

59
Q

What are the branches of the thoracoacromial artery that forms anastomoses around shoulder? (6)

A
  1. Clavicular
  2. Acromial
  3. Deltoid
  4. Thoracic
  5. Lateral thoracic a. anastomoses with T4-10 intercostal aa
  6. Superior thoracic a. anastomoses with T1-2 intercostal branches of interanal mammary a.
60
Q

T/F: There are copious anterior anastomoses b/w anterior thoracic and anterior abdominal wall aa.

A

True

61
Q

Inferior and medial to Coracobrachialis muscle landmark (6)

A 
Axillary vein
Axillary artery 
Median nerve
Ulnar nerve
Radial nerve 
Medial cutaneous nerves of forearm and arm
62
Q

What nerve is involved in the “Saturday night palsy” nerve or “Nerve d’ amour”

A

Causes radial neuropathy from pressure on back or medial axillary area

63
Q

wrist drop is characterized by…

A

Numbness on back of hand and wrist. Pt cannot straighten fingers (extensors)

Finals (24 decks)

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