Blue Boxes Flashcards
Rib fractures (1st, middle, lower)
1st rib is rarely fractured, when it is, brachial plexus injuries and subclavian impingments can occur
Middle ribs - most common, weakest just anterior to angle
Lower ribs- may tear diaphragm
Flail chest
multiple rib fractures
paradoxical movements with respiration
thoracotomy is the surgical opening of
Anteriorly - thoracic chest - H shaped cut through perichondrium
5th-7th intercostal spaces, posterolaterally (abduct patients arm, lateral recumbent) - pneumonectomy
supernumarary ribs
normally 12 ribs each side, some people have
Cervical ribs (.5-2%)
Lumbar ribs
Failure of 12th pair to form
protective function and aging of costal cartilages
prevents fracturing from blows (although injury still occurs)
costal cartilages brittle in old folks
ossified xiphoid process occurs at what age
partially ossifices in early 40s
complaints of hard lump in pit of stomach
sternal fractures
rare- usually comminuted (multiple)
displacement of fragments uncommon due to fascia
eldery - sternal angle where manubriosternal joint is fused
primary concern is heart/lung injury
median sternotomy is used in what procedures
split in median plane and retracted
coronary artery bypass
tumors in superior lobe of lung
sternal biopsy done by
bone marrow needle biopsy
evaluate for metastatic cancer, blood dyscrasias
sternal anomolies
normal development involves fusion of bilateral vertical condensation of sternal band/bars (precartilaginous tissue)
partial clefts - can be repaired by direct apposition/fixation
complete cleft may result in ectopia cordis
perforation (sternal foramen) - not clinically significant, shows up in xrays
pectus excavatum/pectus cavinatum
perforated xiphoid process in elderly
anteriorly protruding xiphoid process in neonates does not require correction
Thoracic outlet syndrome
arteries and T1 spinal nerves emerge from thorax
dislocation of ribs
common in body-contact sports
dislocation of sternocostal joint
dislocation of interchondral joint occurs unilaterally at ribs 8,9,10 and trauma may affect underlying structures
separation of ribs
dislocation of costochondral junction
3rd-10th ribs usually tears pericondrium and periosteum
overrides rib above causing pain
paralysis of diaphragm
phrenic nerve damage will affect one half (each dome has separate nerve supply)
if this has occured, paradoxical movement of affected dome will be noted
dyspnea
individuals with respiratory problems/heart failure will have difficulty breathing (dyspnea)
will utilize their accessory respiratory muscles to assist in expansion of thoracic cavity
lean on knees/arms of a chair to fix pectoral girdle
extrapleural intrathoracic surgical access
loose, thin endothoracic fascia
separation from costal parietal pleura lining the thoracic wall allows intrathoracic access to extrapleural structures (lymph nodes) without opening and contaminating pleural cavity around lungs)
herpes zoster infection of spinal cord
causes classic dermatomally distributed skin lesion known as shingles
described as painful af
virus invades ganglion, producing sharp burning pain in dermatome supplied by involved nerve - skin becomes red and vesicular eruptions occur
intercostal nerve block
local anesthesia produced by injected anesthetic agent around intercostal nerves between paravertebral line and are of required anesthesia
changes in breasts
branching of lactiferous ducts occurs during menstrual periods and pregnancy
colostrum (premilk) may be secreted during third trimester, rich in protein, immune agents and growth factor for intestines
multiparous women - breasts become large and pendulous
elderly - small because decrease in fat and atrophy of glandular tissue
breast quandrants
superiomedial
Superiolateral
inferolateral
inferomedial
carcinoma of the breast
typically adenocarcinomas (glandular cancer) arising from epithelial cells of lactiferous ducts lymphedema (caused by interference with lymphatic drainage by cancer) may cause Peau d'orange sign fingertip size dimples (from shortening of supsensory ligaments) retraciton of nipples
breast cancer typically spreads by lymphatic vessels (most of which goes to axillary LN)
if breast elevates when pectoral muscle contracts, cancer has advanced enough to invade retromammary space (overlying pectoral fascia)
mammography
radiographic examination of the breasts
carcinoma appears as large, jagged density
skin thickening in area over tumor
surgical incisions of breast
typically done at inferior quadrants - less vascular structures
inferior cutaneous crease best aesthetic results, crease may hide incisions
areolar incisions are made radially to either side of nipple or circumferentially
simple masectomy
breast is removed down to retromammary space