Blue Boxes Exam 1 Flashcards
Where is cyanosis most noticeable?
The lips, eyelids, and deep to the transparent nails.
What is it called when the skin looks abnormally red and what causes it?
It is called erythema and it is caused by engorged superficial capillary beds after skin injury, exposure to excess heat, infection, inflammation, or allergic reactions.
What causes the yellow appearance of the whites of the eyes and skin and what is it called?
Bilirubin builds up in the blood in certain liver disorders. It is called jaundice.
Surgeons attempt to minimize scarring for cosmetic reasons using surgical incisions that parallel the ___.
Langer lines, cleavage lines or tension lines is acceptable
A bluish tint to the skin is called ___ and is caused by ____.
Cyanosis, defective circulation that is sending an inadequate amount of blood through the lungs.
What are stretch marks caused by?
I think this got combined with Cushing’s Syndrome
Marked and relatively fast size increases cause distention and loosening of the deep fascia due to protein breakdown leading to reduced cohesion between the collagen fibers.
What is a first degree burn?
Damage is limited to the epidermis and symptoms are erythema, pain, and edema. Desquamification of the superficial later (peeling) occurs several days later. No scarring
What is a second degree burn?
The epidermis and superficial dermis are damaged with blistering (superficial) or loss (deep). It is the most painful burn because nerve endings are lost. Sweat glands and hair follicles are mostly unharmed and complete healing will occur (with some scarring)
What is a third degree burn?
The entire thickness of the skin is damaged and perhaps underlying muscle. There is marked edema and sensory endings are destroyed.
What is a major burn defined by the American burn association?
3rd degree burns over 10% of body surface area, 2nd degree burns over 25% body surface area, or any third degree burns on the face, hands, feet, or perineum
Mortality exceeds 50% when the burn area exceeds ___% of the body surface area
70
In the rule of nines for burns, what are the parts that make up the nines? What is the 1%?
The anterior and posterior head and neck Half of the anterior trunk (The other half of the anterior trunk) Half of the posterior trunk (The other half of the posterior trunk) (If you say the anterior and posterior trunk is 36% that's fine) Left arm Right arm (If you say some combination where the anterior and posterior arms, forearms, and hands equals 18% you're fine) The anterior thighs The anterior legs and feet The posterior thighs The posterior legs and feet (Any combination where the anterior and posterior thighs, legs and feet is 36% is fine) The perineum is the remaining 1%
What are supernumerary bones?
Also known as accessory bones, these develop when additional ossification centers appear and form extra bones. It is important to know that accessory bones are common in the foot, to avoid mistaking them for bone fragments in radiographs and other medical images.
What are sutural bones?
Small, irregular, worm-like bones seen along the sutures of the cranium where the flat bones abut, particularly those related to the parietal bone.
What are heterotrophic bones?
Bones that sometimes form in soft tissues where they are not normally present. (Horse riders develop heterotrophic bones in their thighs often because of chronic muscle strain resulting in small hemorrhagic areas that undergo calcification and ossification.)
What is osteoporosis?
A reduction in the quantity of bone or atrophy of skeletal tissue
What is a sternal puncture?
A wide-bore needle is inserted through the thin cortical bone into the spongy bone of the sternum and a sample of red bone marrow is aspirated with a syringe for laboratory examination.
What are lines of arrested growth (on X-rays)?
The degeneration of cartilage cells in the columns (of bone) continues during starvation and illness, but the proliferation of cartilage slows down, producing a dense line of provisional calcification. These lines later become bone with thickened trabeculae or lines of arrested growth.
What can be mistaken for a fracture (on X-rays) (especially in children)? How do you tell the difference?
A displaced epiphysial plate or separation of an epiphysis.
The edges of the diaphysis and epiphysis are smoothly curved in the region of the epiphysial plate and bone fractures always leave a sharp, often uneven edge
What are osteochondroses?
They are clinical disorders of epiphyses in children that result from avascular necrosis of unknown etiology.
What are fontanelles?
They are fibrous tissue where the bones of the calvaria (skullcap) of a newborn infant’s cranium do not make full contact with each other
What is the “soft spot”? (In babies)
The anterior fontanelle
What does a bulging anterior fontanelle indicate?
Increased intercranial pressure. (It also bulges during crying)
What does a depressed fontanelle indicate?
Dehydration of the baby
What is arthritis?
Degenerative joint disease
What is septicemia?
Blood poisoning
What is arthritis?
Inflammation of the joints
What is arthroscopy?
A surgical procedure where the cavity of a synovial joint is examined by inserting a cannula and an arthroscope into it.
What causes “buck teeth”?
A short lip that is unable to keep the teeth aligned by the to us of the muscle. Sorry this was a crappy card.
What is a muscle that is pulled or that sustains tears more than other muscles? Why?
The hamstrings. When the knee is extended, the hamstrings typically reach their maximum length before the hip is fully flexed
What replaces muscle fibers?
Satellite cells of skeletal muscle
When muscle size in a person grows, do the muscle cells divide?
No, muscle size can increase through the hypertrophy of existing fibers, not the addition of new fibers. Hypertrophy lengthens and increases myofibrils within the muscle fibers.
What is electromyography?
The electrical stimulation of muscles to test muscle action.
It records differences in electron action potentials of muscles during movement.
When does muscle tone disappear (the context is emg’s)?
Sleep, paralysis, and under anesthesia.
What is compensatory hypertrophy? (In the heart)
It is when the myocardium responds to increased demands by increasing the size of its fibers. (If you think the parantheses gives it away, you can also have compensatory hypertrophy of smooth muscle)
What is a myocardial infarct?
A heart attack. An area of myocardial necrosis or fibrous scar tissue.
Are there satellite cells in cardiac muscle?
No
True or false: Smooth muscle cells in the uterine wall during pregnancy increase not only in size but also in number.
True
What is arteriosclerosis?
Hardening of the arteries
What is atherosclerosis?
The buildup of fat (mainly cholesterol) in the arterial walls.
What is an atheromatous plaque?
Also known as atheroma, it is a well-demarcated, hardened yellow area or swelling on the intimal surface of an arteries that is formed by calcium deposits.
What is thrombosis?
Formation of a local intravasular clot, or thrombus
What is an embolus?
A plug occlusing a vessel (a clot that has travelled distally)
What is ischemia?
Reduction of blood supply to an organ or region
What is an infarction?
Local death or necrosis of an area of tissue or an organ resulting from reduced blood supply
What is a varicose vein?
An abnormally swollen, twisted vein (most often seen in the legs) that is caused when the walls of veins loose their elasticity and incompetent valves.
What is incompetent fascia?
Fascia that is incapable of containing the expansion of contracting muscles.
What are the ways metastasis can occur?
Direct seeding of serous membranes of body cavities, lymphogenous spread (via lymphatic vessels) and hematogenous spread (via blood vessels)
What is contiguity (in relation to cancer)?
It is when cancer invades the body by growing into adjacent tissue.
What is the most common route for the dissemination of carcinomas?
Lymphogenous spread of cancer
What is a carcinoma?
An epithelial tumor
What is the most common route of metastasis of sarcomas?
Hematogenous spread of cancer (typically veins over arteries)
What is sarcoma?
Connective tissue cancer
What are the most common sites of secondary sarcomas?
The liver and lungs
What is lympangitis?
Secondary inflammation of lymphatic vessels
What is lymphadenitis?
It is secondary inflammation of lymph nodes.
What is lymphedema?
It is a localized type of edema that occurs when lymph does not drain from an area of the body
Solid cell growths may permeat lymphatic vessels and form minute ______ _____ which may break free and pass to regional lymph nodes.
cellular emboli
Why do the axons of the brain or spinal cord usually not recover?
The growth (of the proximal stumps that begin to regenerate) is blocked by astrocyte proliferation.
What is a rhizotomy?
It is a neurosurgical procedure in which either the posterior or anterior root of a spinal nerve is cut for the relief of intractable pain or spastic paralysis.
Do any neurons in adults regenerate?
Yes, but only those related to the sense of smell in the olfactory system
A “crushing” sub-sternal pain that does not disappear with rest is an indicator of ____.
Myocardial infarction
The first rib is located ____ to the clavicle.
Posteroinferior
What structures pass superior to the first rib?
The subclavian artery and the subclavian vein and the brachial plexus of nerves
Which area of ribs is most commonly fractured?
The middle
Where is the weakest part of the rib?
Just anterior to its angle
Fractures of the lower ribs may tear the ____ and result in a _____.
Diaphragm, diaphragmatic hernia
What is flail chest?
Multiple rib fractures may allow a sizable segment of the anterior and/or lateral thoracic wall to move freely (esp. during inspiration and expiration).
What is a thoracotomy?
It is the surgical creation of an opening through the thoracic wall to enter a pleural cavity. (H-shaped incisions seem to be popular for this procedure.)
Where does an anterior thoracotomy take place?
Through the perichondrium of one or more costal cartilages
Where does a posterior thoracotomy take place?
The posterolateral aspects of the 5th-7th intercostal spaces
What is a pneumonectomy?
Removal of a lung
What is a supernumary rib?
An extra rib, such as a cervical rib (.5-2% have one) or a lumbar rib
Can a child have an injury within the thorax caused by chest compression without a rib fracture?
Yes
What happens when costal cartilages undergo calcification?
They become radiopaque. Note, it is indicated that this does not always happen.
“Many people in their early 40s suddenly become aware of their ____ ____ ____ and consult their phycisian about the hard lump in the ‘pit of their stomach’”, fearing the development of a tumor.
ossified xiphoid process
The most common site of sternal fracture in eledrly people is at the ___ ___ and results in dislocation of the _____ ____.
sternal angle, manubriosternal joint
The concern in sternal injuries is not primarily for the fracture itself, but for the likelihood of ____ injury or ___ injury.
heart, lung. (The mortality rate associated with sternal fractures is 25-45%.)
Patients with sternal contusion should be evaluated for _____.
underlying visceral injury
The sternal body is often used for ___ ___ ___ ___
bone marrow needle biopsy
____ is an uncommon anomaly through which the heart may protrude.
Complete sternal cleft
protruding heart seems to be called ectopia cordis
A perforation remaining in the sternal body because of incomplete fusion
sternal foramen. (It is not clinically significant)
receding sternum
pectus excavatum or funnel chest
projecting sternum
pectus cavinatum or pigeon breast
When clinicians refer to the superior thoracic aperture as the ____ ____ they are emphasizing the ____ and __ _____ ____ that emerge from the thorax through this aperture to enter the lower neck and upper limbs.
thoracic outlet
arteries
T1 Spinal nerves
Where does the obtruction causing thoracic outlet syndrome occur?
Outside the aperture in the root of the neck, and the manifestations of the syndrome involve the upper limb
Rib dislocation is _______.
The displacement of a costal cartilage from the sternum (dislocation of a sternocostal joint) or the displacement of the interchondral joints.
Displacement of interchondral joints usually occurs _____ and involves ribs ____.
unilaterally
8, 9, and 10
What is associated with displacement of interchondral joints?
Trauma sufficient to displace these joints often injures underlying structures, such as the diaphragm and/or liver (causing severe pain) and produces a lump-like deformity at the displacement site.
Rib separation is _____.
Dislocation of the costochondral junction.
In separations of the 3rd-10th ribs, tearing of the ________ and _____ usually occurs. As a result, the rib may move _____.
perichondrium
periosteum
superiorly
One can detect paralysis of the diaphragm radiographically by noting its ___________. Instead of ____ as it normally does during inspiration owing to diaphragmatic contraction, the paralyzed dome _____ because of pressure from _____.
paradoxical movement
descending
ascends
abdominal viscera (that are being compressed by the active contralateral dome)
Dypsnia
Difficulty breathing
When people with respiratory problems or difficulty breathing they use their _______ to assist the expansion of their thoracic cavity. They lean on their knees or on the arms of a chair to fix their _______ so these muscles are able to act on their rib attachments and expand the thorax.
accessory respiratory muscles
pectoral girdle
Shingles
A herpes zoster infection that causes a classic, dermatomally distributed skin lesion. Primarily a viral disease of spinal ganglia, usually a reactivation of the varicella-zoster virus or chickenpox virus. Primarily a sensory neuropathy, but weakness from motor involvement occurs in 0.5-5% of people
Intercostal nerve block (low yield)
local anesthesia of an intercostal space produced by injecting an anesthetic agent around the intercostal nerves between the paravertebral line and the area of required anesthesia. (That’s the obvious part)
It involves infiltration of the anesthetic around the intercostal nerve trunk and its collateral branches.
Complete loss of sensation usually does not occur unless two or more intercostal nerves are anesthetized.
Changes in breast tissue, such as _______, occur during ____ and _____.
branching of the lactiferous ducts
menstrual periods
pregnancy
Colostrum
a creamy white to yellowish premilk fluid. Believed to be especially rich in protein, immune agents, and a growth factor affecting the infant’s intestines.
What are the four quadrants of the breast?
The superolateral, superiomedial, inferomedial, and inferolateral (not too hard). May be referred to as positions on a clock.
Adrenocarcinoma
glandular cancer
_____ may cause retraction of the nipple by a similar mechanism involving the lactiferous ducts
Subareolar breast cancer
The most common site of metastasis from a breast cancer
Axillary lymph nodes (The absence of enlarged axillary lymph nodes is no guarantee that metastasis from a breast cancer has not occurred. The malignant cells may have passed to other nodes, such as the infraclavicular and supraclavicular lymph nodes.)
The posterior intercostal veins drain into the ____ and communicate with the ____.
azygos/hemi-azygous system of veins
internal vertebral venous plexus (surrounding the spinal cord)
When breast cancer cells invade the _______, attach to or invade the _____ overlying the pectoralis major, or metastasize to the interpectoral nodes, the breast ____ when the muscle contracts. This movement is a clinical sign of advanced cancer of the breast. To observe this ____ movement, the physician has the patient place her hands on her hips and press while pulling her _____ forward to tense her pectoral muscles.
retromammary space pectoral fascia elevates upward elbows
Mammography
radiographic examination of the breasts
Surgical incisions are made in the __________ when possible because these quadrants are less vascular.
inferior breast quadrants
deep skin fold beneath breast
inferior cutaneous crease
Incisions that must be made near the areola, of on the breast itself, are usually directed _____.
Radially (to either side of the nipple) or circumferentially
Mastectomy
breast excision (I almost typed beast excision)
Simple mastectomy
The breast is removed down to the retromammary space.
Radical mastectomy
Removal of the breast, pectoral muscles, fat, fascia, and as many lymph nodes as possible in the axilla and pectoral region.
In current practice, often only the ____ and ____ are removed, a ______ or _____ (known as breast-conserving surgery, a wide local exicision) - followed by ____.
tumor and surrounding tissue are removed
lumpectomy or quadrantectomy
radiation therapy
Supernumary breasts
Polymastia
Accessory nipples
Polythelia
Polymastia and polythelia usually occur along the location of the ______.
embryonic mammary crest
Amastia
No breast development
Approximately ___% of breast cancers occur in men.
1.5
Breast hypertrophy in males after puberty
gynecomastia
Gynecomastia may result from ________ and an evaluation must be initiated to rule out important potential causes, such as ____.
an imbalance between estrogenic and androgenic hormones or from a change in the metabolism of sex hormones by the liver
suprarenal or testicular cancer
Approximately 40% of postpubertal males with ______ have gynecomastia.
Klinefelter syndrome (XXY trisomy)
Wounds to the ______ may result in a ____, the presence of air in the pleural cavity.
base of the neck
pneumothorax
The ____ is especially vulnerable to injury during infancy and early childhood because they have shorter necks. (Hint: layer that covers pleural cavity)
cervical pleura
Where might an abdominal incision inadvertently enter a pleural sac?
The right part of the infrasternal angle, the right and left costovertebral angles. (The small areas of pleura exposed in the costovertebral angles inferomedial to the 12th ribs are posterior to the superior poles of the kidneys.)
Atelectasis
collapse of lung
Primary atelectasis
The failure of the lung to inflate at birth
Secondary atelectasis
The collapse of a previously inflated lung
The pressure in the pleural cavities during inspiration
-8 mm Hg
The pressure in the pleural cavities normally
-2 mm Hg
The outer surfaces of the lungs adhere to the _____ as a result of the surface tension provided by the _____.
inner surface of the thoracic walls
pleural fluid
In open-chest surgery, respiration and lung inflation must be maintained by intubating the trachea with a cuffed tube and using a ____.
positive-pressure pump
Entry of air into the pleural cavity
pneumothorax
rupture of a pulmonary lesion into the pleural cavity
bronchopulmonary fistula
bronchopulmonary fistula
rupture of a pulmonary lesion into the pleural cavity
The escape of fluid into the pleural cavity
pleural effusion
blood in the pleural cavity
hemothorax
Hemothorax results more commonly from injury to a ______ or ____ than from laceration of a ______.
major intercostal or internal thoracic vessel
lung
both air and blood in the pleural cavity
hemopneumothorax
Thoracentesis
A hypodermic needle is inserted through an intercostal space into the pleural cavity to obtain a sample of fluid or to remove blood or pus
Where is the needle inserted in a thoracentesis?
In the costodiaphragmatic recess between the 9th and 10th rib in the midaxillary line during expiration. (The needle should be angled upward to avoid penetrating the deep side of the recess)
Where is a chest tube inserted?
In the fifth or sixth intercostal space in the midaxillary line
A resistant fibrous covering that inhibits expansion of the lung
lung decortication
What procedure is performed to prevent recurring spontaneous secondary atelectasis?
A Pleurectomy and pleurodesis that fuses the viesceral and parietal layers together (in one place)
Thoracoscopy
A diagnostic and sometimes therapeutic procedure in which the pleural cavity is examined with a thoracoscope
Inflammation of the pleura
Pleuritis/Pleurisy
How can pleurisy be detected?
The pleural rub/friction between the two pleurae makes a sound “like a clump of hairs being rolled between the fingers”
____ from the lungs carries ____ that remove carbon from the gas-exchanging surfaces and deposit it in the inactive connective tissue or in _______ .
Lymph,
Phagocytes,
lymph nodes
Auscultation of the lungs and percussion of the thorax should always include ______ where the apices of the lungs are located.
the root of the neck
The inferoposterior part of the inferior lobe is at the level of the _____ .
10th thoracic vertebra
Aspirated foreign bodies or food is more likely to enter the _____ .
The right main bronchus (because it is wider and shorter and runs more vertically than the left main bronchus)
A cartilaginous projection of the last tracheal ring
Carina
The cough reflex is associated with the ____ .
Mucous membrane covering the carina
Removal of a whole lung
pneumonectomy
removal of a lobe of a lung
lobectomy
Removal of a bronchopulmonary segment
segmentectomy
Does a segmental collapse (of lung) require compensating space in the pleural cavity to be realized?
No, adjacent segments will expand to compensate for the reduced volume of the collapsed segment.
embolus
Obstruction of a pulmonary artery by a blood clot
An area of necrotic lung tissue
pulmonary infarct
The presence of carbon particles in the axillary lymph nodes is presumptive evidence of ______.
pleural adhesion
The most common causes of hemoptysis
bronchitis, lung cancer, pneumonia, bronchiectasis, pulmonary embolism, and tuberculosis
Lung cancer (AKA)
bronchogenic carcinoma
Common sites of hematogenous metastases of cancer cells from a bronchogenic carcinoma
brain, bones, lungs, and suprarenal glands
Often the _______ are enlarged when bronchogenic carcinoma develops owing to metastases of cancer cells from lung tumors.
supraclavicular lymph nodes
Sentinel lymph nodes
the node or nodes that first recieve lymph draining from a cancer-containing area
Hoarseness could possibly indicate
apical lung cancer (because that’s gonna be such an obvious symptom in a lifetime smoker…)
True or false: The visceral pleura is sensitive to pain.
False
True or false: The parietal pleura is sensitive to pain.
True
Irritation of the mediastinal and central diaphragmatic areas of parietal pleura results in referred pain to _____ .
The root of the neck and over the shoulder (C3-C5 dermatome).
The ______ is used to examine the thoracic respiratory and cardiovascular structures, as well as the thoracic wall.
posteroanterior projection or PA radiograph.
True or false: The right dome of the diaphragm, formed by the underlying liver, is usually approximately half an intercostal space higher than the left dome.
True
True or false: Lateral radiographs allow better viewing of a lesion or anomaly confined to one side of the thorax.
True
When standing or sitting upright, the central tendon of the diaphragm may fall to the level of the middle of the ____ and ____.
xiphoid process,
T9-T10 IV discs
Mediastinoscopy
An endoscope is inserted through a small incision at the root of the neck, just superior to the jugular notch of the manubrium, into the potential space anterior to the trachea. This may be to view or biopsy mediastinal lymph nodes. (This could also be done through a thoracotomy.)
Common cause of widening of the inferior mediastinum
Hypertrophy of the heart due to congestive failure. Widening of the mediastinum is also often obvserved after trauma resulting from a head-on collision.
The SVC and IVC are ____ of the pericardium.
Inside
Inflammation of the pericardium
Pericarditis
By passing a surgical clamp or a ligature around the large vessels anterior to the ______, inserting the tubes of a coronary bypass machine, and then tightening the ligature, surgeons can stop or divert the circulation of blood in these arteries while performing cardiac surgery, such as ______.
transverse pericardial sinus,
coronary artery bypass grafting
How do you detect pericarditis?
Usually the smooth opposing layers of serous pericardium make no detectable sound during auscultation. If there is pericarditis, friction of the roughened surfaces may sound like the rustle of silk when listening with a stethoscope over the left sternal border and upper ribs.
A chronically inflamed and thickened pericardium may ____.
calcify
Pericardial effusion
Passage of fluid from pericardial capillaries into the pericardial cavity, or an accumulation of pus
Non-inflammatory pericardial effusions occur with _____.
congestive heart failure
Congestive heart failure
Venous blood returns to the heart at a rate that exceeds cardiac output, producing right cardiac hypertension (elevated pressure in the right side of the heart).
Heart compression
Cardiac tamponade
Blood in the pericardial cavity
hemopericardium
Cardia tamponade
heart compression
Pericardiocentesis
drainage of fluid from the pericardial cavity
Where is a pericardiocentesis performed?
Through the left 5th or 6th intercostal space near the sternum. (May also be reached via the infrasternal angle by passing the needle superoposteriorly)
Apex of the heart is on right side (condition)
dextrocardia
Isolated dextrocardia
Only the heart is on the opposite side/right side
The thoracic and abdominal viscera (along with the heart) are transposed
situs inversus
Cardiac catheterization
A radiopaque catheter is inserted into a peripheral vein and passed under fluoroscopic control into the right atrium, right ventricle, pulmonary trunk, and pulmonary arteries, respectively.
Cineradiography
Cardiac ultrasonography (not positive these are actually the same thing) (It can be performed to observe the flow of dye in real time (the dye is a radipaque contrast medium)
The line of fusion of the primordial atrium (the adult ___) and the sinus venarum (the derivative of the ______) is indicated internally by the ______ and externally by the ______.
auricle,
venous sinus,
crista terminalis,
sulcus terminalis
When does the oval foramen close?
When the baby takes its first breath
A congenital anomaly of the interatrial septum
atrial septal defect
_____ rank first on all lists of cardiac defects.
Ventricular septal defects
CVA
Cerebrovascular accident (occlusion of an artery supplying the brain).
Stenosis
Failure of a valve to open fully
Failure of a valve to open fully (heart)
stenosis
Insufficiency or regurgitation (heart)
failure of a valve to close completely
Failure of the valve (heart) to open fully
insufficiency or regurgitation
Heart murmur
Restriction of high-pressure blood flow (stenosis) or passage of blood through a narrow opening into a larger vessel or chamber that produces turbulence that sets up eddies that produce vibrations that are audible
Valvuloplasty
Replacement of defective or damaged cardiac valves
An insufficient or incompetent valve with one or both leaflets enlarged, redundant, or “floppy,” and extending back into the left atrium during systole
Mitral valve prolapse or mitral valve insufficiency
