Exam 1 Blue Boxes

Question 1

What is happening anatomically in the occurrence stretch marks?

Answer 1

Protein breakdown leading to reduced cohesion between collagen fibers, damaging the collagen fibers in the dermis and reducing elasticity.

Question 2

Why do stretch marks occur?

Answer 2

Marked and fast size increases (pregnancy)

Question 3

What is a superficial burn?

Answer 3

when damage is limited to the epidermis with symptoms of erythema, pain, edema, desquamation (peeling), but quickly heals

Question 4

What is a partial thickness burn?

Answer 4

epidermis and superficial dermis are damaged with blistering. nerve endings are damaged which makes this very painful (most? the book says), sweat glands and hair follicles NOT damaged so can help with healing (3 weeks to several months). Some scarring

Question 5

What is a full thickness burn?

Answer 5

entire thickness of skin is damaged. Marked edema and area is numb (nerve endings are destroyed), minor degree of healing but will require skin grafting

Question 6

What is a fourth degree burn?

Answer 6

damage extends through entire thickness into underlying fascia, muscle, bone, life-threatening

Question 7

What classifies a burn as severe?

Answer 7

20% or more of total body surface area, are complicated by trauma/inhalation, or chemicals/electricity

Question 8

What are three factors that increase the risk of death from burn injury?

Answer 8

> 60, partial./full thickness of over 40% area, presence of inhalation injury

Question 9

What is the rule of nines?

Answer 9

full arm = 9
front leg = 9
back leg = 9
abdomen = 9
chest = 9
upper back = 9
lower back = 9
full head = 9
genitals = 1%

Question 10

What is the anatomical process of varicose veins?

Answer 10

vein walls lose their elasticity –> weakened veins –> dilation under pressure –> varicose veins due to inflammation. Valves are either destroyed or do not meet caliber which further exacerbates the problem
varicose veins = incompetent valves

Question 11

How does cancer invade the body?

Answer 11

contiguous spread (direct growth into adjacent tissue) or by metastasis (dissemination of tumor cells to sites distant from original/primary tumor)

Question 12

How does metastasis occur?

Answer 12

1) direct seeding 2) lymphogenous spread 3) hematogenous spread

Question 13

What is the most common route of metastasis for carcinomas?

Answer 13

lymphogenous spread where the lymphnodes trap the cancer and then become cancerous themselves

Question 14

What is important when removing a metastatic tumor?

Answer 14

to examine the lymphnodes that recieve lymph from organ or region to make sure there is no cancer and find primary cancer sites for the future

Question 15

What is usually the first sign of cancer?

Answer 15

enlarged, NON PAINFUL when compressed lymphnode

Question 16

How are the less common but more severe cancers spread throughout the body? (sarcomas)

Answer 16

hematogenuous (through the blood), which make the liver and lungs the most common locations of secondary sarcomas

Question 17

What is a normal fracture of the atlas?

Answer 17

fractures of one or both of the anterior or posterior arches

Question 18

If it is a severe fracture of the atlas, what will occur?

Answer 18

rupture of the transverse ligament –>Jefferson or burst fracture. The transverse ligament rupture may make spinal cord injury more likely

Question 19

What is the most common injuries of the cervical vertebrae?

Answer 19

fractures of the vertebral arch of axis (up to 40%)

Question 20

Where does a fracture of the axis occur?

Answer 20

vertebral arch (bony column formed by superior and inferior articular processes of axis), called a “traumatic spondylolysis”

Question 21

What causes a traumatic spondylolysis?

Answer 21

hyperextension of the head on the neck (Note: NOT whiplash, that is more of a muscular/ligament problem) hangman’s fracture

Question 22

What causes a more severe hangman’s fracture?

Answer 22

incomplete or complete dislocation of the axis, which makes likely causing injury to the spinal cord and brainstem, resulting in quadriplegia or death

Question 23

What can a horizontal blow to the head cause?

Answer 23

fracture of the dens (40-50% of common axis injuries). can also happen from complication of osteopenia

Question 24

What happens in a cervical vertebrae dislocation?

Answer 24

With less force than a fracture, the vertebrae can be pushed forward or completely, tearing ligaments which may not be seen in a CT but can be seen in an MRI.

Question 25

What is a well-recognized cause of lower back pain?

Answer 25

herniation of the nucleus pulposus through the anulus fibrosus

Question 26

What happens in younger persons in IV discs?

Answer 26

young people are usually strong, so that usually their vertebrae fractures before disc rupturing. violent hyperflexion may rupture an IV disc and fracture adjacent bodies

Question 27

Where are herniated discs most common?

Answer 27

lumbar and lumbosacral regions because the discs are the largest here and movements are greater

Question 28

Where do 95% of disc protrusions occur?

Answer 28

L4-L5 or L5-S1

Question 29

Where would the disc herniation be in acute middle and low back pain?

Answer 29

L5-S1 region affecting nocioceptive endings, like the posterior longitudinal ligament

Question 30

Where does sciatica occur?

Answer 30

L5-S1 region with pain radiating from lower back into the buttocks, compressing sciatic nerve

Question 31

What can cause shooting pains down the lower limbs?

Answer 31

bone spurs

Question 32

What is the test to test for a herniated disc?

Answer 32

Lasegue sign, where the patient is passively flexed by examiner, which will reproduce the pain felt

Question 33

What is the general rule for IV disc herniation?

Answer 33

usually compresses the nerve root numbered one inferior to the herniated disc – i.e., L5 nerve is compressed by L4-L5 disc herniation (note: cervical does not follow this rule, as the nerve exits superiorly)

Question 34

How is a lumbar puncture performed?

Answer 34

patient lying on side with back and hips flexed, anesthetize the skin above the lower lumbar vertebrae, and needle is inserted between L3/L4 or L4/L5 which is a safe location to protect the spinal cord.

Question 35

What is the process of the lumbar puncture’s entrance into the spine?

Answer 35

4-6cm –> “pops” through the ligamentum flavum –> dura and arachnoid –> enters lumbar cistern
Do not perform when intracranial pressure is high

Question 36

What is flail chest?

Answer 36

when multiple rib fractures allow a sizable segment of anterior/lateral thoracic wall to move freely, which in turn moves paradoxically (inward on inspiration and outward on expiration). extremely painful and impairs ventilation, limiting oxygenation of blood must be fixed surgically.

Question 37

What is thoracic outlet syndrome?

Answer 37

emerging structures are affected by obstructions/compressions of the superior thoracic aperture, causing common symptoms of nerve, artery, and vein occlusion (think like when your foot falls asleep)

Question 38

What does herpes zoster usually cause?

Answer 38

shingles, a painful condition with red and vesicular eruptions, with weaker patients also having motor weakness of the affected area. Usually occurs among a dermatome

Question 39

Where is the majority of breast cancer?

Answer 39

in the region of the breast closes to the axillary area

Question 40

What is the most common carcinoma of the breast?

Answer 40

adenocarcinomas (glandular cancer) from the lactiferous ducts, until they enter a lymphatic vessel which can cause lymphedema and may result in deviation of nipple, thickened leather-like appearance of skin, “puffy”

Question 41

Where is the most common site of metastasis from breast cancer?

Answer 41

axillary sites and abdomen, and through the azygos veins, may spread to vertebrae and cranium/brain

Question 42

What is a clinical sign of advanced cancer of the breast?

Answer 42

breast elevation with muscle contraction. To test, tense pectoral muscles

Question 43

Where do the cervical pleura and apex of lung project through?

Answer 43

above clavicle and into the neck, posterior to the inferior attachment of lungs and pleural sacs

Question 44

What is an unforeseen consequence of wounds to the base of the neck?

Answer 44

pneumothorax. Children and infants are especially at risk for this injury due to reaching a higher level in childhood.

Question 45

What is a mediastinoscopy?

Answer 45

where surgeons enter an endoscope through root of neck (superior to the jugular notch of the manubrium) to view mediastinal lymph nodes to determine if cancer cells have metastasized to them, as well as biopsy!!!

Question 46

What is a pericardiocentisis?

Answer 46

drainage of fluid which is usually necessary to relieve cardiac tamponade

Question 47

How can you approach a pericardiocentisis?

Answer 47

A large-bore needle may be inserted through 5th or 6th intercostal space because of the cardiac notch the bare area of the pericardium , or also xiphocostal angle superoposteriorly

Question 48

What is angina pectoris?

Answer 48

pain that originates in the heart, “tightness in thorax deep to the sternum for 15s-15m”, a result of narrowed coronary arteries which results in less oxygen being delivered to the myocardium

Question 49

What does angina pectoris signify?

Answer 49

a change in life style or healthcare intervention is needed, as the coronary arteries are compromised and cannot function the way they need to. Short term help is medication for vasodilation to minimize resistance from the narrowed arteries.

Question 50

What is a consequence of a laceration of the thoracic duct?

Answer 50

lymph escapes into thoracic cavity from 75-200ml per hour, which produces chylothorax (lymph in the pleural cavity) in which it needs to be removed by thoracentesis or tying off the thoracic duct

Question 51

What is the cause of acute back pain from disc herniation?

Answer 51

pressure on longitudinal ligaments, periphery of annulus fibrosis, and local inflammation from rupture

Question 52

What is the cause of chronic back pain from disc herniation?

Answer 52

Compression of spinal nerve roots (referred pain)