Académique Documents
Professionnel Documents
Culture Documents
Jugular notch at T2
Xiphoid process at T9
Vertebral levels
Denver F. Sapo, MD
Ribs
TRUE ribs
Attach to sternum
Ribs 1 to 7
Ribs 3-9
ATYPICAL rib
Ribs 1, 2
FALSE RIBS
Ribs 8 to 10
No attachment anteriorly
Ribs 11 and 12
HPEParadoxical chest
movement
MCribs 5 to 10
Cx?
Costochondral junction
Angle
RxPEEP
FLOATING RIBS
Manubriosternal joint
Vertebral level
Xiphoid process at T9
Nipple at T4
Umbilicus at L4
Xiphoid process at T7
Umbilicus at T10
Inguinal ligament at L1
At the level of
V3?
T4/5 IV disk
Dermatomal level
Costovertebral and
costotransverse joints
Headvertebral body
Costovertebral joints
Corresponding
Above
Treatment?
Costotransverse joints
Tubercletransverse process
Corresponding
Thoracic outlet???
Intercostal muscles
Costal groove
V-A-N
Intercostal arteries
Innermost intercostal
Intercostal arteries
Rib notching
PE?
Subcostal artery
Posterior/Internal intercostal
membrane
Thoracic aorta
Anterior/external intercostal
membrane
Internal intercostal
Intercostal space
External intercostal
V-A-N
Cx
Pneumothorax
Hemorrhage
Anterior approach
Incision
Lateral approach
Diaphragm
AAL or MAL
Indications
Air removal
Fluid drainage
Structures penetrated?
Diaphragm
Diaphragmatic apertures
Esophageal opening
Nerve supply?
Esophagus
Vagus nerve
Which is higher?
Septum transversum
Esophageal mesentery
Pleuroperitoneal membrane
HeartT1-T4
Aortic hiatus
Aorta
Thoracic duct
Azygous vein
Caval opening
IVC
Transverse diameter
AP diameter
Vertical diameter
Contraction of diaphragm
Mechanics of respiration
Herpes zoster
EtiologyVZV reactivation
Vesicular eruptions
Dermatomal pattern
Inferior mediastinum
Anterior mediastinum
Contents
Thymus
Sternopericardial ligament
Inferior wall MI
LN
Epigastrium
fat
Referred to epigastrium
T7, 8, 9
Inferior mediastinum
Middle mediastinum
Heart
Thoracic aorta
Esophagus
Primary bronchi
Phrenic nerve
Vagus nerve
Arch of azygous
Thoracic duct
Sympathetic trunk
SVC
Brachiocephalic veins
(L) RLN
Thoracic duct
Esophagus
Thymus
Obstruction of SVC
Thoracic aorta
Ascending aorta
Aortic arch
Question
Descending aorta
Thoracic duct
Starts as the?
Empties where?
Vagus nerve
Phrenic nerve
(R) RLN
Contents
SVC
Pemberton sign
Posterior mediastinum
Contents
Contents
Superior mediastinum
Inferior mediastinum
Treatment?
Stanford classification
DeBakey classification
B-A-D
Azygos system
valveless
Incidental finding
Mediastinal masses
(Clinical correlation)
Tracheal shift
Atelectasis?
Pleural effusion?
Pneumothorax?
Asthma?
Pneumonia?
Diagnose?
Pleura
Parietal pleura
Visceral pleura
Sensitive to pain
Parietal pleura
Parts and innervation
Spontaneous pneumothorax
HPE
Pleura?
Sucking chest wound
Pleura?
Cervical/cupula
Costal
Diaphragmatic
Tension pneumothorax
Ball-valve effect
Clinical dx
Intercostal nerves
Centralphrenic nerve
Peripheralintercostal nerve
Mediastinal
Medisatinal shift VR
Open pneumothorax
Phrenic nerve
Shoulder?
Right
Bottom of
lung
XS joint
6th rib
8th rib
MAL
8th rib
10th rib
Paravertebral
line
10th rib
12th rib
Becks triad
Intercostal approach
Bottom of
parietal pleura
(Costal line)
MCL
Left
Pleural cavity
Initial management?
Definitive treatment?
Xiphisternal approach
compromised
Costodiaphragmatic angle
Posteriormost dependent
Lateral
Anteriorleast dependent
300 mL
Endothoracic fascia
Conducting portion
Respiratory portion
Clara cells
Trachea
Bronchi
Bronchiole
Pseudostratified
ciliated epithelium
Pseudostratified
ciliated epithelium
Simple cuboidal
epithelium
Bronchioles
C-shaped
Irregular plates
none
Function
Glands
++
none
Smooth muscle
yes
yes
yes
Epithelium
Cartilage
Alveoli
Type I pneumocyte
Type II pneumocyte
Cuboidal
Synthesize surfactant
Surface tension
Compliace/Elasticity
Alveolar macrophage
Secrete GAGs
Blood-gas barrier
Trachea
Extent?
Type B
1%
AXRgasless abdomen
Type D
SSx?
AXRgasless abdomen
Type C
EA + distal TEF
THINKCommon
85%
Type EH-type
TEF without EA
THINKDouble connection
THINKEyts
2%
Principal/Primary/Main bronchi
Right
excessive secretions
Eparterial bronchus
Tertiary/Segmental bronchus
8%
Left
Secondary/Lobar bronchus
How many?
How many?
Placement?
Complications?
Fissures
Fissures
Oblique/Major fissure
THINKAtresia Alone
Bronchi
THINKBlank
EA + proximal TEF
Horizontal/Minor fissure
THINKRALeS
Lobes
Right lung
2 lobes
Right lung
Standing/sittingposterobasal of
RLL
Supinesuperior segment of
RLL
Pulmonary artery
Pulmonary vein
Bronchial artery
Bronchial vein
Oxygen content?
Hamptons hump
Wedge-shaped
Surgically resectable
Left lung
Lingula
Cardiac notch
3 lobes
Left lung
Bronchopulmonary segments
Horner syndrome
Ptosis
Anhidrosis
Mio
Westermark sign
Oligemia
Lymphatic drainage
Superficial plexus
Deep plexus
(pulmonary nodes)
Bronchopulmonary
nodes
Tracheobronchial
nodes
sis
Bronchomediastinal trunk
Pericardium
Fibrous pericardium
Indistensible!
Serous pericardium
Parietal pericardium
Visceral pericardium
Lining epithelium?
Oblique sinus
Transverse sinus
HPE
Pain?
EKG?
Rx?
Truncus arteriosus
Adult structure
Aorta
Pulmonary trunk
AP septum
Nonspiral development of AP
septum
THINKPROVe
PS
RVH
Trilogy?
Pentalogy?
Adult structure
Egg-on-a-string sign
Bulbus cordis
Adult structure
Infundibulum/conus arteriosus
Aortic vestibule
Sinus venosus
Adult structure
Sinus venarum
Coronary sinus
Fetal circulation
Ductus arteriosus
Remnant in adults
Functional closure--immedeately
(mediated by bradykinin)
Fetal circulation
Umbilical arteries?
Umbilical vein?
Foramen ovale
Functional closure--immedeately
Ductus venosus?
Foramen ovale?
Ductus arteriosus?
IVC FO LA
SVC LV
*Langman
Borders
Surface projections
RightRA
LeftLV + LA
InferiorRV
ApexLV
Surfaces
Base/PosteriorLA
AnteriorRV
DiaphragmaticLV
bicuspid valve
tricuspid valve
pulmonary valve
aortic valve
Triangle of auscultation?
Internal features
LCA
RA
Circumflex artery
Anterior IV artery
Supplies
AV valves
S1closure of AV valves
vestibule
Rough
Pectinate
muscles
(Auricle)
Trabeculae
carnae
papillar
y
muscle
chordae
tendina
Moderator
e
band
Trabeculae
carnae
papillary
muscle
chordae
tendinae
Semilunar valvesTHINKLARP
MitralAnterior, posterior
Fossa ovalis
Crista
terminali
s
Sulcus
terminalis
Pectinate
muscles
(Auricle)
Supraventricular
crest
LV
Infundibulum
conus arteriosus
Unique features
RV
IV septum?
Heart valves
LA
Smooth
RCA
Origin?
Marginal artery
Posterior IV artery
Supplies?
SAN, AVN
IV septum?
Wall is 3x
thicker
LCA
Circumflex artery
Anterior IV artery
Supplies
Occlusion
CABG
IV septum?
Diabetic
Elderly
Infract localization
(Clinical correlation)
Septal wall MI
Lateral wall MI
Artery occluded?
Artery occluded?
Infract localization
(Clinical correlation)
Inferior wall MI
Artery occluded?
Left dominant
Codominant
Radial artery
Silent MI
Infract localization
(Clinical correlation)
IMA95%
Coronary sinus
Septa
Interatrial septum
Interventricular septum
Muscular
Conduction system
Slowest velocity?
Fastest conduction?
Only connection
SAN
AVN
AV bundle
Bundle branches
Purkinje fibers
Triangle of Koch