LIBRO + ANEXOS NEUMOLOGÍA PEDIÁTRICA

Libro Blanco de las ACES Pediátricas 2024 206 ❚ a. Know that the cross-sectional area at the cricoid is fixed and not affected by transmural pressure changes b. Know that below the cricoid, the tracheal rings are C-shaped and the cross- sectional area is variable with changes in transmural pressure c. Know that compliance of the trachea is greater in children than in adults B. Thorax 1. Skeleton a. Know the normal anatomy of the rib cage b. Understand the changes in the rib cage that are associated with respiration c. Understand the physiologic significance of maturational ossification of the rib cage 2. Respiratory muscles a. Diaphragm 1. Know that the mechanical advantage of the diaphragm depends on its domed shape 2. Know that the diaphragmatic muscle has two components: a sternal (costal) portion and a crural portion 3. Understand the relationship between diaphragmatic fatigue and changes in chest and abdominal wall motion 4. Know that the diaphragm is innervated by the phrenic nerve (C3, C4, and C5) 5. Know the course of the phrenic nerve from the neck to the diaphragm 6. Know that the diaphragm is the primary muscle of respiration during quiet breathing 7. Know that the diaphragm is composed of different fiber subtypes 8. Know that inspiratory muscles may remain active during expiration in some lung diseases 9. Identify the anatomic attachments of the diaphragm 10. Understand the functional significance of the costal and crural regions of the diaphragm 11. Understand the embryologic development of the diaphragm 12. Understand the length-tension relationship of the diaphragm 13. Understand how the length-tension relationship influences diaphragmatic function in hyperinflated lungs 14. Understand how diaphragmatic contraction results in inspiration 15. Know that quiet expiration is a passive process, ie, there is no active diaphragmatic contraction 16. Know that in infants the diaphragm attachment to the lower rib cage is more perpendicular than in children and adults 17. Understand that intercostal muscle weakness may contribute to the development of scoliosis b. Intercostal muscles 1. Know that intercostal muscles are important in forced expiration and cough 2. Know that intercostal muscles contract synchronously with the diaphragm to maintain rib cage stability c. Accessory muscles 1. Know that the sternocleidomastoid muscles are used only during increased work of breathing and are not active at rest