Exam 3: The Thorax Handout Part 2
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Exam 3: The Thorax Handout Part 2
review of thorax handout for exam 3
Are most cases of uncomplicated pneumothorax dangerous?
What happens if the opening of the pneumothorax in visceral pleura has a flap over it?
air can enter pleural cavity on nspiration but can't leave it during expiration
If air can enter the pleural cavity on inspiration but can't leave during expiration, what happens to the amount of air in the pleural cavity?
increases (positive pressure pneumothorax)
With positive pressure pneumothorax (increased air in pleural cavity), what does this cause?
pushes mediastinum to contralateral side, compressing opposite lung, and creating medical emegency
How is air/fluid (blood, pus, and chyle) removed from pleural cavity?
w/ wide-bore needle
How are large amounts of air/fluid removed from pleural cavity?
insert drainage tube through intercostal space
Where is the other end of the drainage tube connected?
underwater seal in a bottle
What is thoracotomy?
removal of large amount of air/fluid from pleural cavity by use of drainage tube through intercostal space
Why might the costal pleura be injured during surgical removal of a kidney?
because costal pleura is in contact w/ 12th rib
Why might the 11th rib be mistaken for the 12th rib?
when 12th rib is very short
What is a bronchoscope?
instrument inserted via mouth for examining trachea and bronchi
What is the name of the keel-like ridge between the orifices of the main bronchi?
What plane is the carina normally in?
nearly in a sagittal plane and has fairly definite edge
What happens if tracheobronchial lymph nodes in angle between main bronchi enlarge?
carina becomes distored, widened posteriorly, and immobile
The morphological chages in the carina are important diagnostic signs for:
the bronchoscopist in assisting w/ differnetial diagnosis of disease of rpiratory system
What is one of the most sensitive areas of the tracheobronchial tree?
the mucous membrane at carina
What part of the tracheobronchial tree is associated wth the cough reflex?
mucous membrane at carina
Knowledge of normal anatomy of bronchopulmonary segments is essential for accurate interpretation of what?
chest radiographs and surgical resection of diseased segments
Where do bronchial and pulmonary disorders often localize?
in bronchopulmonar segment
Are each bronchopulmonary segment supplied by own nerve, artery and vein?
yes, but planes between thm crossed by tributaries of pulmonary veins and small branches of pulmonary arteries
What do the connective tissue septa separating segments prevent?
air from passing between segments
What causes segmental atelectasis?
air in bronchopulmonary segment whose segmental bronchus is obstructed and absorbed by bloodstream
What is segmental atelectasis?
collapse of affected segment of lung tissue
Knowledge of branching of bronchial tree is essential for determining what?
the appropriate posture for draining infected area of lung
When patient w/ bronchiectasis (dilation of bronchi) is on left side, secretions from right lung/bronchi flow toward what?
carina of trachea
Since the carina is very sensitive, the secretions flowing toward it stimulate what?
cough reflex, patient brings up purulent sputum, clearing R bronchial tree
A person w/ bronchiectasis of lingula of supeiror lobe drains it by lying on which side?
Oropharyngeal and nasopharyngeal contents containing bacteria may be aspirated into what?
Aspiration of bacterial contents from oropharyneal and nasopharyngeal into the lungs causes what?
inflammation of lungs (pneumonitis or pneumonia
lung abscess in one or more bronchopulmonary segments
How does inflmmation of lungs or lung abcess in one or more bronchopulmoary segments relate to the position of very ill and unconscious patients?
position changed frequently to promote good aeration of lungs
usual supine position assumed in bed, is poor for lung drainage
A tumor may block a segmental bronchus and cause what?
collapse of bronchopulmonary segment, owing to absorption of air in segment by blood circulating through it
Pulmonary thromboembolism (PTE) is a common cause of what?
morbidity and mortality
How does an embolus form?
when thrombus (blood clot), fat globules, or air bubbles are carried from distant site
thrombus passes through R side of heart and carried to lung via pulmonary artery
What is the immediate result of PTE?
complete/partial obstruction of arterial blood flow to lung
What does embolicobstruction of pulmonary artery produce?
sector of lung ventilated by not perfused w/ blood
What might a very large embolus do?
occlude pulmonary trunk or one of main pulmonary arteries
When large embolus occludes pulmonary trunk/pulmonary artery what happens to the patient?
suffers acute respiatory distress and may die in few minutes
What might a medium-sized embolus do?
block artery to bronchopulmonary segment/produce infarct
What is an infarct?
area of dead tissue
In healthy people, collateral circulation often develops so what?
so that infarcton doesn't occur
What is collateral circulation?
abundant anastomoses in region of teminal bronchioles
What happens in ill people whom circulation in lung is impaired?
PTE commonly results in infarction of lung
B/c area of pleura is deprived of blood, what happens?
becomes inflamed, which results in pain
Where is pain from inflammed pleura referred to?
cutaneous distribution of intercostal nn (thoracic wall/anterior abdominal wall)
What do lymph from lungs carry?
What do phagocytes contain?
ingested carbon particles from inspired air
In cigarette smokers/city dwellers, these particles give surface of lungs what kind of appearance?
mottled gray to black apearance
Where are the carbon particles carried to?
lymph nodes in hilum of lungs and mediastinum, giving them similar appearance
What happens if parietal and visceral layers of pleura adhere to one another?
lymphatics in lung and visceral pleura may drain into axillary lymph nodes
Presence of carbon particles in axillary lymph nodes is presumptive evidence of what?