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What is pectus Excavatum
Concave anterior wall deformity of the chest
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Pectus Carinatum
Protrusion of the sternum and costal cartilages
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Flial Chest
Trauma induced uncoupling of the chest from the wall of the rib cage, often caused by multiple rib fractures.
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What happens when one breaths with a flial chest
There is paradoxical motion upon respiration with the trauma site protruding inward on inspiration and outward on expiration due to the loss of intra pleural pressure
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What is a thoracic outlet syndrome and what can it potentially effect
This is a condition when structures like the Ulnar nerve, radial nerve, and subclavian vessels are compressed
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What are the true ribs and their characteristics
1-7 They attach directly to the sternum
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What are the false ribs
8-10 they are connected to the rib above them by cartilage
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What are the typical ribs and their features
3-9 They have a head, neck, tubercle, and a body
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Why are the the 12th and 11th ribs atypical
They have no neck, no tubercle, and only one facet on their head
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What is the weakest part of the ribs
The portion just anterior to the angle
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What is the difference between a rib dislocation and a rib separation
- Dislocation is a seperation from the sternum
- Separation is a disconnection from the costal cartilage
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What is the angle of luis used for in a clinical setting
To find the second rib
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The sternum is located where in regard to the vertebrae
T5-T9
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Where is a Xiphoid process located in relation to the vertebrae
T10
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How can the Xiphoid be used as a landmark
It is the location of the inferior border of the heart, the superior border of the liver, and the location of the central tendon of the diaphragm.
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Ankylosing Spondylitis
Chronic inflammation of the joints of the axial skeleton, in many cases it limits the spinal range of motion
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What muscles are involved in normal inspiration
- External intercostals
- Serratus posterior superior
- Levator costorum
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What are the muscles involved in forced inspiration
- External intercostals
- Scalenes
- Sternocleidomastoid
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What are the muscles involved with forced expiration
- Internal intercostals
- Abdonimals
- Serratus posterior inferior
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What does the contraction of the diaphragm cause
It reduces the dome resulting in an increase in the the vertical dimension for inspiration
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When there is paralysis to one of the phrenic nerves (C3,4,5), what is likely to effected
Paralysis of one of the domes of the diaphragm, causing it to move superiorly in inspiration instead of inferiorly like normal
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Where does the lymph go above the clavicle and below the clavicle
- Above - Inferior jugular lymph nodes
- Below - Parietal lymph nodes drain in to the axillary lymph nodes
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What levels of the vertebrae is the manubrium located
T3-4
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What is the order of structures from external to the internal intercostal space
- Skin
- Superficial fascia
- External intercostal muscles
- Internal intercostal
- Innermost intercostals
- Endothoracic fascia
- Parietal pleura
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What arteries branch from the descending aorta to feed the thoracic wall
- Posterior intercostals
- Subcostal artery
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What branches from the subclavian artery to feed the thoracic wall
- Superior intercostal from costocervical trunk
- Internal Thoracic artery
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Where do the anterior intercostal arteries branch from
Internal thoracic arteries
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Where does the Lateral thoracic artery branch from
Axillary artery
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The posterior intercostal arteries feed what
3-11 intercostal spaces
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Where do the most posterior intercostal veins feed
Azygos veins which is formed by the union of the lumbar veins
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What are the typical intercostal nerves and why
3-6 they run in between the innermost innercostal muscles and the internal intercostals
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The 7-11 intercostal nerves continue on to become what
Thoracoabdominal nerves
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How is the parietal pleura attached to the inside of the thoracic wall
Endothoracic fascia
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What are the four different parietal pleurae
- Cervical
- Costal
- Mediastinal
- Diaphragmatic
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What and where is the sibson fascia (supra pleural membrane)
It is located on the cervical pleura and is made of Endothoracic pleura
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What is the name of the endothoracic pleura attaching the diaphragm to the parietal pleura
Phrenico-pleural fascia
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Visceral pleura is insensitive to pain but parietal pleura on the mediastinal and costal refer pain where
- Mediastinal - Neck and the shoulder
- Costal - Thoracic and abdominal wall
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What is pleuritis
This is an inflammation of the pleurae that is painful and audible as one breaths
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Where is a pericardiocenthesis performed
Between the fifth an sixth intercostal space near the sternum. Care should be taken to to damage the thoracic artery
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What is the importance of the sibson fascia
It is a protection from wounds on the supraplueral membrane
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What are the three places in the inferior section of the thoracic wall where the pleura extends past and is therefore more available for trauma
- Right part of the infrasternal angle
- Right costovertebral angle
- Left costovertebral angle
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Pleurodesis
Obliteration of a pleural cavity by disease such as pleuritis, this may not effect function
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What is atelectasis and what is a method of treatment for it
Spontaneous lung collapse, fusion of the parietal and visceral pleura to prevent lung collapse
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The jugular notch of the manubrium is located where in respect to the vertebrae
T2
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The right azygos vein drains where
Superior vena cava
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The left hemizygos and accesory hemiazygos drain where
Into the right azygos vein
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Where does pleura become visceral pleura
At the hilum of the lung
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