Exam 2 - Clinical Notes Flashcards
These cartilages may ossify, can be mistaken for a fracture on a x-ray
Corniculate + Cuneiform Cartilage
In Hoarseness due to excessive singing or excessive speaking, the lubricant from the saccule is temporarily depleted. Nodules can form. This is referred to as?
Laryngeal saccule depletion
Inflammation of the vocal folds by viral infection is called?
Laryngitis
Paralysis of what muscle does NOT cause suffocation…the neutral position of vocal cords is partially abducted which reduces the risk of suffocation
Posterior Cricoarytenoid Muscle
Voice Dimorphism is determined by what 3 things?
1) Length of vocal cords (males have longer)
2) Size of Resonating chamber
3) Thickness of vocal cords
Lymph is moved by _________ _______ contraction, ________ helps clear toxins from tissues (a benefit of massage)
skeletal muscle, exercise
What node? Enlarged supraclavicular node usually on the left, often 1st indication of visceral tumor of thorax/abdomen, lung/breast cancer
Signal (Sentinel) Node
Primary tumor of the lymph nodes.
Hodgkin’s, Non-Hodgkin’s…which is worse?
Lymphoma, Non-Hodgkins has much worse prognosis
Using Lymphatics for Diagnosis:
An enlarged nodule which is…
1) Tender/Painful: indicates?
2) Hard + Painless: indicates?
1) Tender/Painful: infection
2) Hard + Painless: cyst development or Cancer
Parasitic infection of lymphatic system (worms) is called?
Filariasis
Most common cancer in women. Spreads to lymphatics before entering blood stream. (Usually spreads to axilla first)
Breast Cancer
Clinical Signs of Breast Cancer? (3)
1) dimpling of the skin (due to invasion of suspensory ligament)
2) inverted nipples (invasion of lactiferous duct)
3) leathery thickening of the skin (like an orange)
_________ provides collateral circulation, which provides safety net in case of a blockage
Anastomosis
What condition? Pleural cavities fill with air…causes? (3)
Pneumothorax, causes…
1) trauma (“sucking chest wound”)
2) Disease (COPD, Emphysema, TB)
3) congenital weak spot (common in people with large growth spurts)
* *(in causes 2 + 3, air comes in from the lung itself through rupture)
What condition? Can be life threatening. Instead of a hole, a flap is present on the visceral pleura. Air enters pleural cavity on inspiration, but not exit on expiration.
Pleural cavity inflates like an inner tube, pushing the mediastinum to the opposite side and compressing the other lung (tire pump like mechanism)
Tension Pneumothorax
Pleural Cavity fills with blood is known as what condition?
Hemothorax
Both Hemothorax and Pneumothorax conditions are present, simultaneously. What condition?
Hemopneumothorax
Lung Collapse is referred to as? (All of the aforementioned lung conditions can result in this)
Atelectasis
Inflammation of the pleura which leads to adhesions between parietal and visceral pleura is called?
Pleuritis
Most commonly occur with children…usually enter the _____ main bronchus due to its wider, short ventricle arrangement.
Aspiration of Foreign Objects, right
Obstructive airway disease characterized by coughing, wheezing, difficulty breathing
Asthma
2 types of Asthma
1) Extrinsic: triggered by _______
2) Intrinsic: triggered by stimuli such as ______, _____, _______
1) Extrinsic: triggered by allergens
2) Intrinsic: triggered by stimuli such as stress, cold, exercise (non-allergenic)
Lungs and Tracheobronchial tree are rich with ________ b/c they are an interface with the environment.
lymphatics
_______ destroys the cilia, resulting in heavy coughing
Smoking (smoker’s cough)
Primary tumor of the bronchus? Most common tumor in males and females….directly related to cigarette smoking a/o air pollution.
Bronchogenic Carcinoma
Chiropractic Note: intrathoracic diseases such as bronchogenic carcinoma or lung infections may refer pain to where? (both have sympathetic + vagal branches to lungs that contain sensory fibers)
Upper or middle thoracic spinal cord segments
What may occur due to weakness in the diaphragmatic wall around the esophageal hiatus? Upper part of stomach slides up into the thoracic cavity through opening
Hiatal Hernia
Result of spasmodic contraction of the diaphragm. Most commonly caused by irritation of the phrenic nerve, usually benign
Hiccups
What condition? Fibrous pericardium is very unyielding. If fluid leaks into the pericardial cavity (pericardial effusion), the heart may be compressed and venous return impeded. (Superior Vena Cava particularly vulnerable)
Cardiac Tamponade
Inflammation of the pericardium is known as? (Always life threatening)
Pericarditis
Important to differentiate from Pleural friction rub. Distinguish by auscultating while patient holds their breath (heart doesn’t stop beating, but lungs will stop moving)
Pericardial Friction Rub
What causes obstruction of the pulmonary artery via blood clot? The clot forms in systemic venous system (ex. Leg), passes through the heart to the lungs. Blood flow is blocked to the lung, results in acute respiratory distress. Leads to dilation of RV + RA, resulting in heart failure.
Pulmonary Embolism
Pulmonary Embolism which blocks BOTH pulmonary arteries, death can occur within minutes
Saddle Embolism
Auscultation of Tricuspid Valve…
Reasons why you can NOT listen directly to the Tricuspid valve? (3)
1) bc the presence of the sternum
2) orientation of the heart
3) blood carries sound in its direction of flow
When the Foramen Ovale persists as a small opening in the superior part of the Fossa Ovalis is known as what? (25% of adults have this abnormality) There are 2 types.
Atrial Septal Defect
Enlargement of the heart can occur in what two ways?
1) Muscular Hypertrophy
2) Chamber Dilation
Deposition of lipid plaques on the inner walls of arteries results in a narrowing of the lumen is known as?
Atherosclerosis
What condition?
Causes subcostal chest pain upon exertion**
Is a symptom of PARTIAL occlusion/blockage of coronary artery branches occurs due to insufficient blood flow to heart tissue (ischemia)
Angina Pectoris
Occurs when a coronary artery branch becomes COMPLETELY occluded/blocked. Portion of the heart supplied by the artery dies (necrosis) and is converted to fibrous scar tissue.
Myocardial Infarction
Chiropractic note for heart…
Subluxations and related soft tissue changes restrictive to T1-T4 are frequently associated with what?
Hypothesis: Impingement on sympathetics could allow parasympathetic activation to dominate, lead to constriction of what?
Myocardial infarctions and other heart problems
Coronary arteries
Vocal Cord + Vocal ligament have _________ receptors
androgen receptors
Breast Caner spreads to ________ first before entering blood stream (Usually spreads to axilla first)
lymphatics
(Referring to Breast Cancer) Posterior Intercostal V drains to azygos + hemiazygos…connection to the vertebral venous plexus allows spread to ________ and ______
vertebral column + brain
Chiropractic note: ______ is one cause of mid-thoracic back pain in females
Breast cancer
______ will be out of midline in Tension Pneumothorax?
Trachea
Pleuritis can be painful due to sensory innervation of ________ pleura. (not _______ pleura, which lacks innervation)
parietal, visceral
In Pleuritis, pain is often referred to the _______ via _______ nerve (C3,4,5). Pain radiates along distribution of _____________ nerves (c3,4).
shoulder, phrenic, supraclavicular
Pleuritis produces a sound known as _______ ______ ___ (which can be heard on auscultation)
Pleura Friction Rub
The ______ is covered with sensitive mucous membrane. It represents the lowest part in the tracheobronchial tree where ______ reflex is mechanically initiated. Once Carina is passed, coughing stops but chemical bronchitis and atelectasis may ensue
Carina, cough
With aspiration of a foreign object…once Carina is passed, ________ stops but chemical bronchitis and atelectasis may ensue
coughing
Asthma is caused by spasm of the ______ ______, which lines the segmental bronchi and bronchioles. Accompanied by excessive secretion of _____
smooth muscle, mucus
Chiropractic Note: What condition is often associated with upper thoracic subluxations. Adjustments often bring relief
Asthma
_________ originate from T2-T5. Impingement here may allow ___________ activation to dominate. Lower thoracics (T9-T11) supply adrenal medulla which secretes _________, a potent bronchodilator
Sympathetics, parasympathetic, epinephrine
________ epithelium has ciliated hair like projections
Respiratory
What refers to the movement of mucus + dirt up and out of the Larynx?
Mucociliary Clearance
________ _________ is highly metastatic. Spreads quickly to lymph nodes, enters bloodstream by eroding a venule, traveling via the pulmonary veins to the heart and systemic circulation. Often causes enlargement of a sentinel node.
Bronchogenic Carcinoma
2 nerves that Lung Cancer/Bronchogenic Carcinoma may affect?
1) ? resulting in paralysis of the diaphragm.
2) ? at apex of lung, resulting in paralysis of half of the larynx
Phrenic N
Recurrent Laryngeal N
Major cause of Gastroesophageal reflux? (usually occurs after age 50)
Symptoms: belching + epigastric pain
Hiatal Hernia
(Referring to a Hiatal Hernia) What chiropractic technique can be an effective treatment?
SOT (Sacro-Occipital Technique)
Morbid underlying causes of hiccups? (3)
Brain Lesions, Pleuritis, Peritonitis
Cardiac Tamponade will produce…
1) Prominent _______ _______ Vein
2) Eventually all veins of the _____ and _____ become engorged
1) External Jugular V
2) face and neck
When fluid leaks into the pericardial cavity is known as what?
Pericardial effusion
What aspect of the heart is particularly vulnerable in reference to Cardiac Tamponade?
Superior Vena Cava
In reference to Pericardial Friction Rub…the _____ keeps working, but the _____ will stop.
heart, lungs
In the case of a Pulmonary Embolism…the clot forms in systemic venous system (ex. Leg) and passes through the ____ → ____ → _____ →_____ → _____. Causes blockage of blood flow to lungs.
Inferior/Superior Vena Cava → right atrium → right ventricle → Pulmonary Trunk → Pulmonary Arteries
A Pulmonary Embolism causes blood flow blockage to the lung which results in ____ _______ ______. Leads to dilation of _______ and _______, resulting in heart failure.
acute respiratory distress, right ventricle and right atrium
2 types of Atrial Septal Defects?
Probe Patent Foramen Ovale
Clinical Atrial Septal Defect
Type of Atrial Septal Defect when the defect is small. In most cases, not clinically significant.
Probe Patent Foramen Ovale
Type of Atrial Septal Defect when the defect is larger, blood is shunted from the left atrium, to the right, causing dilation of the 1) RA 2) RV 3) Pulmonary Trunk
Clinical Atrial Septal Defect
In reference to enlargement of the heart…
________ _______ refers to lost elasticity of right ventricle with age, particularly with atherosclerosis a/o hypertension. (More force is required to push blood through arteries, walls of heart grow due to enlargement of cardiac muscle fibers)
Muscular Hypertrophy
In reference to enlargement of the heart…
_______ _______ may be due to: Septal Defects, Valve incompetency, with incompetent mitral valve, there is a regurgitation of blood from left ventricle to left atrium. Left atrium may dilate to accommodate the extra blood
Dilation of Chamber
Most common sites for Myocardial Infarction? (3)
1) Anterior Interventricular Artery (40-50%) (“Widow-Maker”)
2) Right Coronary Artery (30-40%)
3) Circumflex artery (15-20%)
