Lecture 6: Thorax Flashcards
1
Q
Surface anatomy points (4)
A
- Midclavicular line: Passes just medial to the nipple
- Mid-axillary line: descends from midpoint of Avila
- Nipple: dome of respiratory diaphragm at T4 level
- Xipoid Process: at level of T10
2
Q
Midclavicular Line
Surface Anatomy
A
Passes just medial to nipple
3
Q
Mid-axillary line
surface anatomy
A
descends from midpoint to avila
4
Q
Nipple
surface anatomy
A
dome of respiratory diaphragm at T4 level
5
Q
Xiphoid precess
surface anatomy
A
at level T10
6
Q
Bones of Thoracic Wall (2)
A
- Sternum
A. Manubrium
B. Body
C. Xiphoid Process - Ribs- 12 pairs
A. True 1-7
B. False 8-12
C. Floating 11-12
7
Q
Muscles of Thoracic Wall
movement
(3) muscles
A
- Anterior Thoracic Wall muscles that act on upper limb
A. Pec. major
B. Pec. Minor
C. Serratus Anterior
8
Q
Types of Joints in Thoracic Wall (4)
A
- Sternoclavicular: saddle-type synovial
- Sternocostal: primary cartilagenous/synchondroses
- Costcohondral: Primary cartilaginous
- Intechondral: Synovial plane
See slide 7-9
9
Q
Nerves of Thoracic Wall (3)
A
- intercostal nerves
- 12th spinal nerve
- Neurovascular bundle
10
Q
Intercostal Nerves
A
anterior rami of first 11 thoracic spinal nerves
11
Q
12th spinal nerve
A
gives rise to subcostal nerve
12
Q
Neruvascular bundle (NAV)
A
lives inferior to each rib
13
Q
Female Breast (2)
A
- mammary tissue composed of compound tubuloacinar glands
- organized into 15-20 lobes, separated by fibrous connective tissue (suspensory of ligaments of cooper) - Tail of spence (axillary tail)- extension of mammary tissue superolatterally toward axilla
14
Q
Suspensory ligaments of cooper
A
fibrous connective tissue separating tubuloacinar glands in female breast
15
Q
Tail of spence
A
“axillary tail”
extension of mammary tissue superolatterally toward the axilla
16
Q
Female Breast Lymphatics (3)
A
- lymph is drained from breast tissues
- 75% of lymphatic drainage is to the axillary nodes
- Remainder lymph drains to infraclavicular, pectoral, or parasternal nodes
17
Q
Breast cancer clinical pearl
A
~ 50% breast cancer develops in upper, outer, quadrant of the breast
18
Q
Sings Female Breast Cancer
A
- Nipple Retraction
- Skin Edema
- Skin dimpling
19
Q
Nipple Retraction/Breast Cancer
A
Carcinomatous involvement of mammary ducts may cause duct shortening and retraction or inversion of nipple
20
Q
Skin Edema
A
Involvement and obstruction of SQ lymphatic by tumor result in lymphatic dilation and lymph accumulation in the skin
Reluctant edema created orange peel appearance owing to prominence of skin gland orifices
21
Q
Skin Dimpling
A
Dimpling of skin over a carcinoma is caused by involvement and retraction of suspensory cooper’s ligaments
22
Q
Lungs (2)
A
- lie in pleural cavityA. Visceral Pleura: lines the lung
B. Parietal Pleura: Line’s the cavity/thoracic wall - Lobes
A. R=3 lobes
B. L=2 lobes and lingual
23
Q
Visceral Pleura of Lung
A
lines the lung
24
Q
Parietal Pleura
A
line’s cavity/thoracic wall
25
Lobes of Lung (2)
1. Right=3 lobes
| 2. Left= 2 lobes + lingula
26
External Lung Features (9)
1. Lobes
2. Horizontal Fissure
3. Oblique Fissure
4. Impressions
5. Hilum
6. Lungula
7. Cardiac notch
8. Pulmonary Ligament
9. Bronchopulmonary Segment
27
Lobes: external features
1. Three Lobes R lung: Superior, Middle, Inferior
| 2. Two Lobes L: Superior/inferior
28
Horizontal Fissure of lung
external features of lung
Only in R lun, extends along line of 4th rib
29
Oblique fissure of lung
External features of lung
On both lungs, extends from T2-T3 vertebra spine to 6th costal cartilage anteriorly
30
Impressions
External features of lung
made by adjacent structures in fixed lungs
31
Hilum
External features of lung
Points at which structures (bronchus, vessels, nerves, lymphatics) enter or leave lungs
32
Lingula
external feature of lung
tongue-shaped feature of left lung
33
Cardiac Notch
Indentation for the heart, in left lung
34
Pulmonary Ligament
Double layer of parietal pleura, hanging from the hilum that marks reflection of visceral pleura to parietal pleura
35
Bronchopulmonary Segment
10 functional segments in each lung supplied by a segmental bronchus and a segmental artery from the pulmonary artery
36
Trachea (4)
1. single airway that extends midline from circoid cartilage to its bifurcation at sternal angle of louis
2. T4/T5
3. Trachea lies anterior to the esophagus and its supported by cartilaginous rings
4. Trachea bifurcates into right and left main stem bronchi
37
Features of Trachea
1. 5 inched long and 1 inch in diameter
| 2. inferiorly anterior to esophagus and posterior to aortic arch
38
Cartilaginous rings
1. 16-20 C shaped rings
39
Bronchus
Divides into R and L main primary bronchi at level of sternal angle of Louis
40
Right Bronchus
1. Shorter, Wider, and more vertical than L Bronchus
| 2. aspirated foreign objects more likely to pass into R bronchus
41
Carina
internal, keel-like cartilage at bifurcation of trachea
42
Secondary Bronchi
supply lobes of each lung
- 3 R
- 2L
43
Tertiary Bronchi
Supply bronchopulmonary segments
| -10 for each lung
44
Lung muscles: inspiration (2)
1. diaphragm moves down and intercostal muscles increase diameter of thoracic wall, decreasing intrapleural pressure
2. accessory muscles may assist in very deep inspiration
45
Lung muscles: exhalation movements (4)
1. elastic recoil of lungs
2. reaction diaphragm
3. relaxation thoracic cage
4. muscles expels air
46
Phrenic Nerve (3)
purppose
roots
1. innervates diaphragm
2. C3, C4, C5 roots
3. Keeps diaphragm alive
47
Vagus Nerve (3)
1. Paraympathetic bronchoconstrictor fibers contract smooth muscle
2. vasodilator pulmonary muscles
3. initiate secretion of alveolar glands
48
Blood/Lymph (2)
1. supply
2. return
1. lung parenchyma is supplied by small bronchial arteries
- arise from proximal portion of descending thoracic aorta
2. blood returns to heart via pulmonary via pulmonary, but some collect into small bronchial veins
- -> azygos system of veins
49
Lymphatic Drainage
4 steps
Pulmonary (intrapulmonary) -> bronchopulmonary (hilar) nodes -> tracheobronchial nodes
50
Landmarks
Pericordial Areas of Auscultation (4)
1. Aortic Area
2. Pulmonic Area
3. Tricuspid area
4. Mitral Area
51
Heart Anatomy Components (3)
1. Chordae Tenidinae
2. Papillary muscles
3. pectinate muscles
52
Chordae Tendinae
fibrous cords that connect papillary muscles to valve leaflets
53
Papillary muscles
superoposteriar, inferior, and septal projections of myocardium extending into ventricular cavity
54
Pectinate muscles
ridges myocardium inside auricle (pouchlike appendage of atrium)
55
Heart Vavles
1. tricuspid/R AV
2. pulmonary/ semilunar
3. mitral/ bicuspid
4. aortic/ semilunar
56
Tricuspid (3)
Location/characteristics
1. A/V valve
2. between R atrium and R ventricle
3. 3 cusps
57
Pulmonary valve
location/characteristics
1. Semiluar valve
2. between R ventricle and pulmonary trunk
3. 3 semilunar cusps (leaflets)
58
Mitral
location/characteristics
1. bicuspid
2. between L atria and L ventricle
3. 2 cusps
59
Aortic
Location and characteristics
1. Semilunar
2. between L ventricle and Aorta
3. 3 semi-lunar cusps
60
Conduction system components (3)
1. SA node
2. AV node
3. Bundle of His
4. Purkinje Fibers
61
SA node/Sinuatrial (2)
1. pacemaker
| 2. superior end of crista terminals near opening of SVC (sup. vena. cava)
62
AV node/Atrioventricular (2)
1. receives from SA node and conveys to bundle of HIS
| 2. located between opening of coronary sinus and origin of septal cusp of tricuspid valve
63
Bundle of his
inferior to AV node, splits interventricularly to form L and R bundle branches
64
Purkinje Fibers
ramification of bundle branches in ventricles of heart's conduction system
65
Cardiac Cycle
1. heart's conduction system moderated the cardiac cycle
- coordinated systole (contraction)
- and diastole (relaxation) or atria and ventricle
slide 44 for full cycle
66
systole
contraction
67
Diastole
relaxation
68
Nerves of Heart
Parasympathetic
Functions (3)?
1. Parasympathetic fibers from CN X (vagus) determine
A. HR
B. force of contraction
C. vasodilates coronary resistance vessels
69
Nerves of Heart
```
Sympathetic
functions (3)
```
1. fibers from T1-T4/T5
A. HR
B. force contraction
C. minimally vasoconstrictor coronary resistance vessles
70
Cardiac Tamponade
causes?
complication?
tx?
1. can results from fluid accumulation or bleeding in pericardial sac
2. bleeding can be caused by ruptured aortic aneurysm, ruptured myocardial infarct or a penetrating unjury (most common)
3. compromises heart and decreased venous return and cardiac output
4. fluid can be removed by a pericardial tap
71
Myocardial infarction (2)
cause?
1. major cause of death
2. caused by
- coronary artery artherclerosis and thrombosis
- ->precipitate local ischemia and necrosis in myocardial area
- ---> necrosis occurs approximately 20-30 minutes after coronary artery occlusion
3. MI begins in the subendocardium because this region is the most poorly perfused part of the ventricular wall
72
Vavlular heart disease
2 types of complications
most common valve
1. Most commonly, *mitral and aortic valves
A. Stenosis (narrowing)
B. insufficiency (comprised valve function, leads to regurgitation)
73
Repair tetralogy of fallot (2)
1. surgical repair done on cardiopulmonary bypass to close the VSD (ventricular septal defect) and provide unobstructed flow into the pulmonary trunk
2. stenotic pulmonary outflow tract is widened by inserting a patch into the wall (pericardial) thus increasing the volume the subpulmonic stenosis and/or the pulmonary artery stenosis
74
Medistinum (2)
division?
1. "Middle Space"
- middle of thoracic cavity
2. Superior and inferior divisons
- horizontal line from sternal angle of Louis to intervertebral disc between T4-T5
75
Superior Divison Medistinum Components(8)
1. thymus
2. superior vena cava
3. brachiocephalic veins
4. aortic arch and 3 branches
5. trachea
6. phrenic and vagus nerves
7. thoracic duct
8. lymphatics
76
Inferior media stinum divisions (3)
1. anterior
2. middle
3. posterior
77
Inferior Mediastiunum: Anterior portion (3)
location(2)
contents (1)
1. Posterior to the body of the sternum
2. anterior to pericardium
3. contains fat
78
Inferior Mediastinum: Middle portion (2)
1. Contains pericardium
| 2. contains heart
79
Inferior Mediastinum: Posterior position
(9) components
- location (2)
- contents (6)
1. posterior to heart
2. anterior to bodies of T5-T12
4. esophagus and its nerve plexus
5. thoracic aorta
6. azygos system of veins
7. sympathetic trunks and thoracic spinal nerves
8. lympatics
9. thoracic duct
80
Tetralogy of Fallot
usually results from maldevelopment of the ventricular septum
-normally divides the truncus anteriosus into the pulmonary trunk and aorta
81
Tetralogy of Fallot defects (4)
1. Pulmonary Stenosis or narrowing of the R ventricular outflow tract
2. Overriding (transposed) aorta
3. R ventricular hypertrophy
4. Ventricular petal defect (VSD)
82
Aortic Stenosis (3)
complications? (2)
cause? (3)
1. Leads to left ventricular overload and hypertrophy
2. calcific stenosis
3. congenital bicuspid valve
4. caused by RHD
83
Aortic Regurgitation
6 causes
1. caused by congenitally malformed leaflets
2. RHD
3. IE (infective endocartitis= infection of cardiac valves)
4. ankylosing spondylitis
5. Marfan's syndrome
6. Aortic root dilation
84
Mitral Stenosis
complication?
cause?
Leads to left atrial dilation
usually caused by RHD
85
Mitral Regurgitation
5 causes
1. caused by abnormalities of valve leaflets
2. rupture of papillary muscle or cordae tendinaea
3. Papillary muscles fibrosis
4. infective endocarditit
5. left ventricular enlargement
86
Frequency of Areas affected by MI
1. LAD (left anterior descending artery)- 40-50%
2. Right coronary 30-40%
3. Left circumflex 15-20%
87
Signs snd Sx of Cardiac tamponade (4)
1. patient in variable degrees of shock or in extremis
2. decreased arterial and pulse pressures often exist but not pathognomic
3. Neck veins distended
4. Venous pressure elevated
88
Blood flow (14)
1. Superior/inferior Vena Cava
2. R atrium
3. tricuspid valve
4. R ventricle
5. Pulmonary valve
6. Pulmonary artery
7. lungs
8. Pulmonary vein
9. L atria
10. Mitral valve
11. L ventricle
12. Aortic valve
13. Aorta
14. systemic circulation
89
Aortic heart sounds
location
sound
upper R sternal border
-aortic stenosis
90
Pulmonary heart sounds
location
sound (4)
Upper L sternal border, below L clavicle
1. second heart sounds
2. pulmonary valve murmurs
3. VSD (ventricular septal defect) murmur
4. continuous murmur of patient ducts seteriosus (PDA)
91
Tricuspid heart sounds
location
sound
Left 4th intercostal space
or sternal border 5th rib
tricuspid and aortic regurgitation
92
Mitral heart sounds
location
sound (3)
L 5th intercostal space in midclavicular line
apex
1. 1st heart sound
2. murmurs of mitral or aortic valves,
3. 3rd and 4th heart sounds
93
COPD (3)
Chronic Obstructive Pulmonary Disease
1. broad classification of lung diseases including
A. Chronic Bronchitis
B. Asthma
C. Emphysema
2. smoking major rx
94
Emphysema
4 characteristics
1. permanent enlargement of air spaces at and distal to the respiratory bronchioles
2. destruction to bronchiole walls by chromic inflammation
3. Lung compliance increases because elastic's recoil of the lung decreases
4. airways collapse during expiration
95
Lung cancer types
1. Squamous cell/ bronchiogenic 20%
| 2. Adenocarcinoma 37%
96
Pancoast syndrome
Atypical lung tumor ay spread to involve sympathetic trunk, and affect lower portion of brachial plexis
can lead to horner's syndrome
97
Horner's syndrome
1. mitosis: constricted pupil
2. Ptosis: drooping of upper eyelid
3. Anhidrosis: lack of sweating
4. Flushing: SQ vasodilation
5. pain/parasthesia in neck, shoulder, limb
- complete or incomplete paralysis of limb and head
*due to lung carcinoma that has spread to brachiocephalic trunk
