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chap. 3 chest

anatomy and procedures of the thoracic viscera

thoracic cavity chest cavity
what are the thoracic cavity components? cardiovascular, respiratory, digestive, endocrine, nervous, and lymphatic system
what are the three separate chambers of the thoracic cavity? pericardium and the right and left pleural cavities
pleural double layer membrane that surrounds the lungs (space between visceral and parietal membranes)
parietal pleural (lining) the outer membrane, wall covering of the thoracic cavity
visceral pleural (lining) the inner membrane, direct contact with the organ
name two thoracic cavity boundaries? the superior thoracic aperture (STA) and the and the inferior thoracic aperture (ITA)
Superior Thoracic Aperture apex of lungs
Inferior Thoracic Aperture where diaphragm is
what position separates air and fluid best? upright position
pneumothorax air in pleural cavity/space seen on an image as pitch black
hemathorax blood in the pleural cavity/space
pleural effusion fluid in the pleural cavity/space
empyema puss in the pleural cavity puss will appear lighter on image due to density
atelectasis complete or partial collapse of a lung due to obstruction
CAB coronary artery bypass graph (cabbage)
pleural cavity function and blood supply adhesive of two membranes parietal/visceral. visceral is dual blood supply
mediastinum area between the lungs right in the center
what are the three openings from the mediastinum through the diaphragm? esophagus, vena cava, and the aorta
radiographically important mediastinum structures heart shadow, thymus gland (only seen in children), trachea, esophagus, and great vessels
where is the thymus gland located? right in front of the trachea in the superior mediastinum
function and size of thymus gland primary control organ of the lymphatic system as a child its bigger but as you age it gets smaller (controls immune system)
glotis is a slit or opening
what consists of the respiratory system? nasal cavities, oral cavity, pharynx, larynx, trachea, bronchi and lungs
what are three divisions of the pharynx? nasopharynx, oropharynx, and the laryngopharynx
larynx voice box, vocal cords
esophagus part of the digestive system that connects pharynx to stomach. posterior to larynx and trachea
trachea windpipe which divides into or bifurcates into bronchi
right primary bronchus wider and shorter than the left bronchus and divides into three secondary bronchi each entering into a separate lobe
left primary bronchus smaller in diameter but about twice as long and divides into two separate secondary bronchi each entering into a separate lobe
carina specific prominence or ridge that divides/ bifurcates into the right and left bronchi
terminal bronchioles smaller branches that spread from secondary bronchi to all parts of each lobe
avioli small air sacs where gas exchange take place (oxygen in c02 out)
NASAL CAVITIES right and left chambers
nasal septum made up of two bones, cranial bone where the appendicular plate of the ethmoid meets up with the vomer
sinuses 4 sets which are interconnected and open up into nasal cavity
mucous membrane contains scilia
nasal conchae turbines 3 sets, inferior facial bones
PHARYNX nasopharynx- hard plate- maxilla bone palatine process
soft palate behind hard palate, connects to nasal cavity
tonsils and adenoids immune system
auditory tubes hook up to nasal pharnyx
oropharnyx behind mouth
laryngopharnyx behind throat leads into trachea
LARYNX glotis - slit or opening
epiglottis fibrocartilage that sits atop the glotis. when down food goes to the esophagus
thyroid cartilage palpable landmark at the level c4-c5 (adams apple)is part of the voice box
cricoid cartilage sits below thyroid cartilage, does not articulate with anything
vocal cords surrounded by voice box
TRACHEA hollow tube/ conducting zone. measurements diameter 1/2 inch/ length 4 1/2 inches long posterior aspect: flat location mediastinum, anterior to esophagus
carina hook like process where trachea splits
subdivisions of bronchial tree bronchus/bronchi/bronchioles
primary bronchus right and left primary bronchus
how many lobar or secoundary bronchi are there in the body? 3 on the right and 2 on the left
how many segmental or tertiary bronchi are there in the body? 10 on the right and 8 on the left
primary bronchioles
terminal bronchioles respitory zone leads to aviolar ducts to alveolar sacs to aveoli
parenchyma spongy, elastic material that makes up the lungs
alveoli functional unit of the lungs/ oxygen and carbon dioxide exchange. millions in each lung
pulmonary arteries carry oxygenated blood from the heart to the lungs
pulmonary veins carry oxygenated blood from lungs to heart (left atrium)
LUNGS organs of respiration
apex top portion (of lungs)
base flat and bottom portion (of lungs)
costophrenic angles angles at the base of lungs on lateral sides, by ribs
cardiophrenic angles angles at the base in direct contact with the heart
hilum hilar region, where all bronchi enter at middle of lungs also blood vessels
cardiac notch indentation in left lung where the heart sits
costal surface surface that is in contact with the ribs, visceral surface of the ribs
diaphragmatic surface in contact with diaphragm
mediastinal surface in contact with mediastinum, where hilar region is
what is the position of the right lung? the righ lung is higher becuase of the liver.
how many lobes are in each lobe? 3 right/ 2 left
fissures deep grooves which divides the lobes
how many fissures are in each lobe and what are there names? the left lobe has 1 oblique fissure and the right has 2 a horizontal and oblique
lingula not a fissure, an area of left lung near the heart, if it had a middle lobe that is where it would be
inspiration inhalation. lung movement when lungs move down, becuase diaphragm contracts and moves down. lungs expand, maximum capacity of lungs is reached
expiration exhalaation. diaphragm moves up and lungs contract, gert shorter
ageniesis lung number formed
hypoplasia lung under developed
cysts hollow cavity filled with fluid
broncheosphageal fistula abnormal communication between structures or organs (can be born with or created)
tracheotomy a hole put in trachea so patient can breath
lobectomy to take out portion of lung
pneumonectomy complete removal of a lung
segmental resection to remove a tumor from the lung
thoracoplasty a portion of the rib is removed to get to the lung
thoracentesis fluid drained from thoracic cavity
bronchography an injection of contrast in bronchiole tree
bronchitis inflammation of the bronchi
laryngitis inflammation of the voice box
pneumonitis inflammation of the lungs, infection
bronchopneumonia inflammation of part of a bronchi
lobar pneumonia inflammation of the lobe
pleurisy inflammation of the pleura, also called pleuritis
COPD chronic obstructive pulmonary disease
emphysema disease of aviola, aviola loose elastic ability, longs are long and dark
general guidelines for chest patient preparation- remove artifacts bra/ earrings etc, IR size 14x17 for adults, dependant on body habitus/3 yr old 10x12 SID- 72" CHEST to get true size, ID markers, sheild, patient instructions (double breathing for chest)
general patient position ambulatory - upright nonambulatory patients- sitting upright in a stretcher
IR size depends on body habitus, use the smallest IR that will demonstrate anatomy, do not forget to collimate
what is the SID for chest xrays? 72" for chest
ID markers right or left side markers must be included on each image. other required ID markers must be must be in the blocker or elsewhere on the final image
radiation protection always shield patients
other radiation protection measures SID, technique factors and collimation
patient instructions explain and demonstrate positions, when possible. respiration instructions are critical to image lung aeration. exposures are usually made after the second deep inspiration
why would two radiographs be taken, one on inspiration and one on expiration? it demonstrates the presence of a foreign body, diaphragm movement, atelectasis (expiration) and pneumothorax
what are essential projections of the chest? PA/LAT/AP- axial- lordotic if you want to see the appexes of the lungs
PA chest patient position upright if possible to demonstrate air fluid levels and allow diaphragm to move to its lowest position
PA chest part position patient faces vertical grid with MSP centered and perpendicular. MCP parallel with IR 1.5-2" above shoulders. elbows flexed with back of hands rested on low hips. shoulders depressed and rolled forward
PA/ CR perpendicular to center of IR. enters at MSP and level of t7. technique 90-125 kv; automatic exposure control (AEC)two outer shells 1&3/ halifax 1&2. exposure should be made at end of second respiration
Lateral chest patient patient upright if possible top of IR 1.5-2"
Lateral part position MSP parallel with IR. MCP perpendicular to IR. extend IR over head, elbows flexed and forearms rested on head
lateral chest/ CR perpendicular to IR. enters patient on MCP at level t7. technique 105 kv automatic exposure control (AEC) center cell. exposure made at end of second inspiration
what is the patient position for an AP chest? supine used when patient is too ill for upright positions
what is the part position for an AP chest? center MSP to IR top of IR 1.5 to 2" above the shoulders. if pt. condition permits, flex elbows, pronate hands on hips to draw scapulas laterally
where is the CR on an AP chest? perpendicular to long axis of sternum and center of IR. 3" below jugular notch. technique high ma, low time. use grid if pt. is larger than 12 cm. expose after second full inspiration
what is the pt position of AP axial chest lordotic? upright facing tube about one foot in front of the grid
part position for AP axial chest lordotic position MSP centered to midline of grid. assist pt. to lean backwards until shoulders rest on grid. top of IR placed 3" above shoulders when pt. is in lordotic position
CR position for AP axial chest lordotic CR perpendicular to IR, enters MSP at midsternum. AEC 1&3 /105 kv exposure made after second full inspiration. 15 to 20 degrees cephalic
for decubs which side do you mark? the side that is up
AP/PA lateral decubitus pt. position lateral decub on right or left side to demostrate fluid, pt. should lie on affected side. to demonstrate free air the pt. should be positioned on unaffected side. pt. needs to be in position for 5 minutes
part position for AP/PA lateral decubitus position elevate body 5-8 cm if lying on affected side. true lateral without rotation(perpendicular to IR) extend arms over head. anterior or posterior surface of chest against vertical grid device. top of IR 1.5 to 2" above shoulders
what are the essential projections for lungs and pleurae? AP or PA- right or left lateral decubitus position lateral- ventral or dorsal decubitus position
CR for AP/PA lateral decubitus position horizontal and perpendicular to center of IR. enters MSP at 3" below jugular for AP, t7 for PA.exposure made on second full inspiration
patient and part position for lateral ventral or dorsal positions pt. position- prone or supine. body elevated 2-3" part position- true prone or supine position without rotation. affected side against vertical grid device with arms above head. top of IR at level of thyroid cartilage
CR for lateral or dorsal decubitus positions CR horizontal and perpendicular to IR. enters at level of MCP , 3 to 4" below jugular notch dorsal decubitus, t7 for ventral decubitus. technique 105 kv/ AEC center field 2 (@ chest bucky) otherwise manual technique with grid.expo sec inspir/ 5min flui/ai
Created by: eckoultd1972