Clinical Correlations- Exam 3 Flashcards
Simple Rib Fracture
Affects Ribs 4-10
- Blunt or penetrating trauma to chest wall
- Angle of Rib is prone to fracture
Treatment is pain control and respiratory care
Thoracic Outlet Syndrome
Positional, intermittent compression of the Brachial Plexus and/or Subclavian Artery or Vein
Costoclavicular Syndrome:
-Clavicle compressing vessels from the neck
Scalenes-Anticus Syndrome:
-Scalene muscles compressing vessels from the neck
Hyperabduction Syndrome:
-Pectoralis minor compressing vessels from the neck
Neurogenic Thoracic Outlet Syndrome
- Most common type of TOS
- Compression of the Brachial Plexus
- Pain, numbness, weakness
- Treated with Physical Therapy
Venous Thoracic Outlet Syndrome
- Compression of the Subclavian Vein
- Extremity swelling, Deep Vein Thrombosis
- Treated with Thrombolysis and surgery
Arterial Thoracic Outlet Syndrome
- Compression of the Subclavian Artery
- Pain with exertion, thromboembolism
- Treated with surgery
Paralyzed Diaphragm
- Lesion or compression of the Phrenic Nerve
- Diaphragm will rise on inspiration instead of depress due to unopposed pressure from abdominal viscera
- Rises on same side as Phrenic injury
Pulmonary Collapse
Penetration through thoracic wall and parietal pleura admitting air and causing lung to collapse
Secondary Atelectasis
Penetrating wound through Parietal Pleura breaking the tension that holds the Parietal and Visceral Pleura together causing the lung to collapse
- Can be seen on x-ray during inspiration
- Diaphragm elevates, organs shift in the mediastinum
- Lung appears whiter and surrounding space is darker
Open Pneumothorax
Clean wound that allows air to enter & exit the cavity
- Mediastinal shift on inspiration that corrects itself on expiration
- Chest pain, shortness of breath, cyanosis
- Unilateral diminished breath sounds
Treatment includes:
- Occlusive dressing
- Tube thoracostomy
Tension Pneumothorax
Wound where air enters but cannot exit thoracic cavity
- Mediastinal shift cannot fix itself putting pressure on opposite lung decreasing ventilation
- Pressure increases with each breath
Treatment includes:
- Needle thoracostomy
- Tube thoracostomy
Tube Thoracostomy
Incision in thoracic cavity to insert a chest tube for drainage of fluid or air
Thoracocentesis
Inserting a needle in thoracic cavity to remove fluid from the costodiaphragmatic recess
-Insert needle below the 9th rib in the mid-axillary space angled upwards to avoid the diaphragm
Bronchoscopy
Using an endoscope to view the interior of the tracheobronchial tree for:
- Abnormalities/growths
- Foreign objects
Transverse Pericardial Sinus
Space behind Aorta and Pulmonary Trunk crossing in front of the Superior Vena Cava
-Space allows cardiac surgeons to clamp the Aorta
Cardiac Tamponade
Fluid accumulation between the Visceral and Parietal layers of the pericardium
-Puts pressure on the Heart as it beats because fibrous Pericardial Sac will not expand
Treated with Pericardiocentesis
- Insert needle at 5th or 6th intercostal space at the left sternal border
- Insert needle at the infrasternal angle
Mitral Valve Prolapse
Improper closure of the Mitral valve causing regurgitation during ventricular contraction
-Affects 1 in 20 people (mostly young females)
Characterized by:
- Chest pain
- Fatigue
- Characteristic murmur
Referred pain of the Phrenic Nerve
Visceral and somatic sensory neurons synapse on the same neurons in the spinal
-Cannot distinguish messages from the arm/neck and the diaphragm
Coronary Atherosclerosis
Lipid deposits in the lining of the coronary arteries eventually resulting in stenosis
Treated with:
- Atherectomy
- Medications
Coronary Artery Disease
Coronary arteries are blocked or narrowed reducing blood flow to the Heart muscle
Causes angina or myocardial infarction
-Pain signal from Phrenic Nerve
Myocardial Infarction
Sudden occlusion of a major coronary artery causing myocardium to undergo necrosis
- Occurs mostly in the LAD (40-50%)
- Second most in the Right Coronary Artery (30-40%)
- Third most in the Circumflex Branch (15-20%)
Cardiac Arrythmia
May occur if part of conducting system is damaged
-Asynchronous contraction of the heart ventricles
Can be corrected with an internal pacemaker
Aortic Branch Variations
Normal branching (Left Subclavian, Left Common Carotid, and Brachiocephalic Trunk) is observed in only 65% of the population
Aortic Coarctation
Stenosis of part of the Aorta
- Can be preductal (infants) or postductal (adults)
- Causes high pressure in the head and low pressure in the lower limbs
Leads to rib notching
-Rib gets worn down over time due to pulsating artery lying on top of bone
DiGeorge Syndrome
Congenital immunodeficiency disorder caused by a deletion on Chromosome 22
-Most common cause of congenital thymic aplasia
Characterized by: (CATCH-22)
- Cardiac Abnormalities
- Abnormal Facies
- Thymic Aplasia
- Cleft Palate
- Hypocalcemia
- Deletion on Chromosome 22
Liposuction
Removal of Camper’s Fascia using suction tube and high vacuum pressure
Considered “botched” when too much is removed leading to an uneven structure of the skin
Patent Urachus
Urachus is an opening between bladder and umbilicus that should close at birth and become the Median Umbilical Ligament
If left open, bladder infections can occur from opening
Three types:
- Urachal cyst
- Urachal sinus
- Urachal fistula
Prune Belly Syndrome
Associated with Patent Urachus
Suspected if umbilical cord is enlarged with edema or slow to slough off
Characterized by three main features:
- Anterior abdominal wall muscles deficient or missing
- Urinary tract abnormalities
- Bilateral cryptorchidism (undescended testes)
Believed to be caused by:
- Urinary tract obstruction
- Primary mesodermal development defect
Variocele
Blockage and engorgement of the Pampiniform Venous Plexus
-Scrotum left feeling like a “Bag of worms”
Occur more on the left side because of 90 degree angle from Left Renal Vein to Left Testicular Vein
Can be caused by Nutcracker Syndrome or SMA syndrome
Direct Inguinal Hernia
Herniation passes MEDIAL to inferior epigastric vessels
- Busts in to inguinal canal through side wall
- Only passes through Superficial Inguinal Ring
Indirect Inguinal Hernia
Herniation passes LATERAL to inferior epigastric vessels
- Passes through both Deep and Superficial Inguinal Rings
- More than 2/3 of inguinal hernias
Duodenal Ulcers
- Ulceration of duodenal mucosa
- Typically occurs along posterior aspect of the first part of the duodenum
- Typically a result of Peptic Ulcer Disease, Chronic H. Pylori infection, smoking, NSAIDs
- Gastroduodenal artery is most at risk for erosion
Portal Hypertension
Resistance to portal flow through the liver leading to regurgitation
Due to:
- Portal vein stenosis (pre-hepatic)
- Cirrhosis (intrahepatic)
- Right sided Heart failure (post-hepatic)
Causes:
- Encephalopathy
- Ascites
- Splenomegaly
Triangle of Calot
Anatomical landmark for locating the Cystic Artery
Borders:
- Superior: Inferior border of the Liver
- Medial: Cystic Duct
- Lateral: Common Hepatic Duct
Contains:
- Right Hepatic Artery
- Cystic Artery
- Lymphatics
Cholelithiasis
Gallstones formed from insoluble compounds in Bile
Composed of:
- Cholesterol = Yellow
- Bilirubin = Black
Causes epigastric pain radiating to inferior shoulder
Ligament of Treitz
Inferior extension from Diaphragm to Duodenum composed of skeletal and smooth muscle
Landmark for surgical procedures
-Duodenojejunal flexure
Marks tie off point for removing bowel in an autopsy
SMA Syndrome
When the SMA compresses the Duodenum causing an obstruction in the GI tract
-Can also compress the Left Renal Vein
Can occur after significant weight loss, no extra fat to keep SMA extended
Patient presents with:
- Nausea
- Vomiting
- Early satiety
Appendicitis
Acute inflammation of the appendix
Begins as vague periumbilical pain progresses to RLQ as inflammation spreads to the mesoappendix
McBurney’s Point
- Imaginary line from umbilicus to ASIS to palpate appendix
- If painful when palpating, indicative of appendicitis
Psoas Sign
Test for appendicitis
-Extension of the right thigh to test for pain (stretching psoas muscle will irritate the mesoappendix eliciting a response)
Colon Cancer
Adenocarcinoma is most common malignancy of the GI tract
Dietary factors:
- Low fiber diet
- High fat and carb intake
Genetic factor:
-APC Gene
Colostomy
Surgical procedure that fixes the colon to an opening on the skin
- Done after intestinal surgery or resection
- Waste passes through opening into collection system\
Diverticulosis
Mucosa pushes out between weakened muscle fibers in the sigmoid colon making pockets
- Fecal matter impacts the pockets causing inflammation
- Pockets can rupture leaving fecal matter in peritoneal cavity causing peritonitis or sepsis
Meralgia paresthetica
Painful neuropathy of the Lateral Femoral Cutaneous Nerve due to entrapment as it passes through the inguinal ligament
Crossover to thigh is most common site of entrapment
Occurs due to:
- Pregnancy
- Tight clothing
- Obesity
Adrenal Insufficiency
Adrenal glands don’t produce enough hormone
Can lead to life threatening Adrenal Crisis (especially Tertiary)
- Low blood pressure, glucose, sodium
- High blood potassium
Primary (Addison’s Disease)
-Adrenal glands are affected
Secondary
-Pituitary gland is affected
Tertiary
- Hypothalamus is affected
- Can be caused by excessive Prednisone usage
Polycystic Kidney Disease
Multiple clusters of cysts on the kidneys
Can cause kidney to swell:
- Disrupts function
- Chronic high blood pressure
- Kidney infections
- Renal failure
Kidney Stones
Form and become located in the Calices of the kidneys, ureters, or urinary bladder
- If stone is sharp or larger than 3mm, it will distend the ureter and cause severe referred pain in the lumbar and inguinal regions
- May lead to blood in the urine
Ureteric Jets
Visualization of normal efflux of urine from distal end of ureter into the bladder
Used to assess obstructive uropathy
Incontinence
1 in 4 people over 65 have incontinence
Stress Incontinence:
- Increased abdominal pressure under stress
- Weak pelvic floor muscles
Urge Incontinence:
-Involuntary contraction of bladder muscles
Overflow Incontinence:
-Blockage of the Urethra
Neurogenic Incontinence:
-Disturbed function of the nervous system
