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Questions and Answers
What is the purpose of pleurodesis?
What is the purpose of pleurodesis?
What occurs when a segmental bronchus is blocked?
What occurs when a segmental bronchus is blocked?
What is the function of the mucous membrane covering the carina?
What is the function of the mucous membrane covering the carina?
What is acute cor pulmonale?
What is acute cor pulmonale?
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What type of lung cancers may involve the recurrent laryngeal nerve?
What type of lung cancers may involve the recurrent laryngeal nerve?
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How does deep inspiration affect a PA radiograph?
How does deep inspiration affect a PA radiograph?
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Which muscle elevates the ribs during forced inspiration?
Which muscle elevates the ribs during forced inspiration?
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Which muscle weakly depresses the ribs?
Which muscle weakly depresses the ribs?
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Which muscle probably acts in the same manner as the internal intercostal muscles?
Which muscle probably acts in the same manner as the internal intercostal muscles?
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Where does the subcostal muscle insert?
Where does the subcostal muscle insert?
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What is the main action of the transversus thoracis muscle?
What is the main action of the transversus thoracis muscle?
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Where does the innermost intercostal muscle insert?
Where does the innermost intercostal muscle insert?
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What is the superior attachment of the internal intercostal muscle?
What is the superior attachment of the internal intercostal muscle?
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Where does the external intercostal muscle insert?
Where does the external intercostal muscle insert?
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What is the inferior attachment of the subcostal muscle?
What is the inferior attachment of the subcostal muscle?
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Where does the transversus thoracis muscle insert?
Where does the transversus thoracis muscle insert?
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Where is the central tendon of the diaphragm located?
Where is the central tendon of the diaphragm located?
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What is the purpose of mediastinoscopy?
What is the purpose of mediastinoscopy?
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Where is the needle inserted for pericardiocentesis?
Where is the needle inserted for pericardiocentesis?
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Which artery bifurcates at the upper border of the thyroid cartilage into internal and external branches?
Which artery bifurcates at the upper border of the thyroid cartilage into internal and external branches?
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What is located at the bifurcation of the common carotid artery and monitors O2, CO2, and pH levels?
What is located at the bifurcation of the common carotid artery and monitors O2, CO2, and pH levels?
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What serves as the principal venous return for the neck?
What serves as the principal venous return for the neck?
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Where is the needle inserted for accessing the right subclavian vein?
Where is the needle inserted for accessing the right subclavian vein?
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What access is used for right cardiac catheterization?
What access is used for right cardiac catheterization?
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What is the major cause of acute respiratory distress in a patient with a large embolus occluding a pulmonary artery?
What is the major cause of acute respiratory distress in a patient with a large embolus occluding a pulmonary artery?
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What condition may develop due to a medium-sized embolus blocking an artery supplying a bronchopulmonary segment?
What condition may develop due to a medium-sized embolus blocking an artery supplying a bronchopulmonary segment?
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In physically active people, why may infarction be less likely to occur in the presence of a pulmonary embolism?
In physically active people, why may infarction be less likely to occur in the presence of a pulmonary embolism?
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What is the outcome of a pulmonary embolism if an area of visceral pleura is deprived of blood?
What is the outcome of a pulmonary embolism if an area of visceral pleura is deprived of blood?
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Which type of lung cancers may involve the recurrent laryngeal nerve, resulting in hoarseness?
Which type of lung cancers may involve the recurrent laryngeal nerve, resulting in hoarseness?
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How does deep inspiration affect a PA radiograph?
How does deep inspiration affect a PA radiograph?
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What procedure might be required before placing a prosthetic crown on an abutment for dental implants?
What procedure might be required before placing a prosthetic crown on an abutment for dental implants?
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Surgical access to the pterygopalatine fossa is gained through which sinus?
Surgical access to the pterygopalatine fossa is gained through which sinus?
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What important structures are contained within the pterygopalatine fossa?
What important structures are contained within the pterygopalatine fossa?
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What anatomical structures are found in the superior mediastinum?
What anatomical structures are found in the superior mediastinum?
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What occurs when a patient changes from standing to supine position regarding the level of the arch of the aorta relative to the transverse thoracic plane?
What occurs when a patient changes from standing to supine position regarding the level of the arch of the aorta relative to the transverse thoracic plane?
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Which vein is not ideal for right cardiac catheterization due to its angle of junction with the subclavian vein?
Which vein is not ideal for right cardiac catheterization due to its angle of junction with the subclavian vein?
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What serves as an 'internal barometer' indicating rising venous pressure, such as in heart failure?
What serves as an 'internal barometer' indicating rising venous pressure, such as in heart failure?
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Where should the needle be inserted for right internal jugular vein (IJV) catheterization?
Where should the needle be inserted for right internal jugular vein (IJV) catheterization?
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For a supraclavicular brachial plexus block, where is the main injection site?
For a supraclavicular brachial plexus block, where is the main injection site?
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What is the role of the carotid bodies?
What is the role of the carotid bodies?
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Which cranial nerves are at risk of injury during carotid endarterectomy?
Which cranial nerves are at risk of injury during carotid endarterectomy?
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What may cause a transient ischemic attack (TIA) due to partial occlusion of the internal carotid artery?
What may cause a transient ischemic attack (TIA) due to partial occlusion of the internal carotid artery?
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What is affected due to the inclusion of the phrenic nerve in a cervical plexus block?
What is affected due to the inclusion of the phrenic nerve in a cervical plexus block?
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Which veins may give diagnostic signs of heart failure or SVC obstruction when observed during physical examinations?
Which veins may give diagnostic signs of heart failure or SVC obstruction when observed during physical examinations?
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Where is the main injection site for anesthesia of the upper limb in a supraclavicular brachial plexus block?
Where is the main injection site for anesthesia of the upper limb in a supraclavicular brachial plexus block?
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For right cardiac catheterization, which vein is preferable due to its larger and straighter nature?
For right cardiac catheterization, which vein is preferable due to its larger and straighter nature?
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Where do the internal thoracic arteries descend?
Where do the internal thoracic arteries descend?
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Where do the internal mammary arteries terminate?
Where do the internal mammary arteries terminate?
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What is the primary location of the intercostal neurovascular bundle?
What is the primary location of the intercostal neurovascular bundle?
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What does the pulmonary circulation supply?
What does the pulmonary circulation supply?
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How many lobes does the right lung have?
How many lobes does the right lung have?
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Which lung region corresponds to its region of the chest that contains the root (hilum)?
Which lung region corresponds to its region of the chest that contains the root (hilum)?
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What is a pneumothorax?
What is a pneumothorax?
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Where is a needle placed for thoracentesis?
Where is a needle placed for thoracentesis?
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Which space is drained by a chest tube?
Which space is drained by a chest tube?
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What is a pleurodesis?
What is a pleurodesis?
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What techniques are important during physical examinations?
What techniques are important during physical examinations?
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Study Notes
Pulmonary Procedures and Conditions
- Pleurodesis: A procedure aimed at causing the pleural layers to adhere, often performed to manage recurrent pleural effusion or pneumothorax.
- Segmental Bronchus Blockage: Leads to atelectasis, where the affected lung segment collapses due to lack of airflow, which may cause respiratory distress.
- Mucous Membrane of the Carina: Provides protection by trapping particles and pathogens, facilitating mucociliary clearance in the airway.
- Acute Cor Pulmonale: A condition characterized by right heart failure due to increased pulmonary artery pressure, often resulting from chronic lung disease or pulmonary embolism.
Lung Cancer and Nerve Involvement
- Lung Cancers and Recurrent Laryngeal Nerve: Typically non-small cell lung cancers and neuroendocrine tumors can invade this nerve, leading to symptoms like hoarseness.
- Deep Inspiration Effects on PA Radiograph: Expands the lung fields, enhancing visual differentiation of vascular structures and pathology on the radiograph.
Muscles and Their Functions
- Muscle Elevating Ribs During Forced Inspiration: Scalenes and external intercostals facilitate rib elevation.
- Muscle Weakly Depressing Ribs: Internal intercostals, particularly during forced expiration, assist with rib depression.
- Muscle Acting Like Internal Intercostals: Innermost intercostals which also contribute to managing rib movement during respiration.
- Subcostal Muscle Insertion: Inserts on the internal surface of the ribs, aiding in rib depression.
- Transversus Thoracis Muscle Action: Primarily functions to depress the ribs during expiration.
- Innermost Intercostal Muscle Insertion: Inserts onto the internal surface of adjacent ribs.
- Internal Intercostal Muscle Superior Attachment: Attaches to the inferior border of the rib above.
- External Intercostal Muscle Insertion: Inserts onto the superior border of the rib below.
- Inferior Attachment of Subcostal Muscle: Attaches to the rib below, typically spanning one or two ribs.
- Transversus Thoracis Muscle Insertion: Inserts onto the costal cartilage of the second to sixth ribs.
Anatomical and Clinical Procedures
- Central Tendon of the Diaphragm: Located at the center of the diaphragm, serving as the attachment point for muscle fibers.
- Mediastinoscopy Purpose: Used for biopsy or surgical exploration of mediastinal structures, often assessing for cancer.
- Pericardiocentesis Needle Insertion: Typically inserted at the left xiphocostal angle to avoid lung puncture.
- Bifurcation of the Superior Thyroid Artery: Divides into internal and external branches at the upper border of the thyroid cartilage.
- Carotid Bifurcation and Chemoreceptors: Carotid bodies monitor blood O2, CO2, and pH levels.
- Principal Venous Return for Neck: Internal jugular vein serves as the main pathway for venous drainage.
- Right Subclavian Vein Access: Needle inserted directly above the clavicle or into the infraclavicular space for catheterization.
- Right Cardiac Catheterization Access: Femoral or internal jugular veins preferred for achieving access to the right side of the heart.
Pathophysiology and Diagnostic Signs
- Major Cause of Acute Respiratory Distress: A significant pulmonary embolus can obstruct blood flow leading to sudden respiratory failure.
- Medium-sized Embolus Impact: May cause ischemia of a bronchopulmonary segment, prompting localized injury.
- Infarction Risk in Physically Active Patients: Increased activity can maintain collateral blood flow, reducing necrosis risk during pulmonary embolism events.
- Pulmonary Embolism and Visceral Pleura: Deprivation of blood supply can lead to necrosis and inflammation in the affected pleural area.
Vascular and Anatomical Considerations
- Veins Indicative of Heart Failure: Distended neck veins or prominent external jugular veins may signal heart failure or superior vena cava obstruction.
- Superior Mediastinum Structures: Contains the aortic arch, major vessels, trachea, esophagus, and thymus gland.
- Standing to Supine Position Changes: Shifts the level of the aortic arch relative to the transverse thoracic plane due to gravitational forces.
- Ideal Vein for Right Cardiac Catheterization: The right internal jugular vein is preferred due to its straight vertical course.
- Internal Barometer: The jugular venous pressure acts as an indicator for heart function and vascular health.
- Cervical Plexus Block Effects: Inclusion of the phrenic nerve can impact diaphragmatic function and cause respiratory issues.
Clinical Techniques and Anesthesia
- Supraclavicular Brachial Plexus Block Injection Site: The main injection is typically made above the clavicle, targeting the brachial plexus for upper limb anesthesia.
- Anesthesia for Upper Limb: Achieved through supraclavicular injections to block sensory and motor pathways in the arm.
- Thoracentesis Needle Placement: A needle is inserted between the ribs into the pleural space to relieve pleural effusion.
- Chest Tube Drainage: Employed in the treatment of pneumothorax or significant pleural effusions for fluid removal.
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Description
Test your knowledge on the effects of pulmonary embolism, acute respiratory distress, and acute cor pulmonale. Understand the consequences of embolism on blood oxygenation and heart function.
