Exam II - Clinical Aspects Flashcards
What causes hoarseness?
Excessive speaking or singing. Lubricant from laryngeal saccule is temporarily depleted.
Laryngitis
Inflammation of the vocal folds
What are the three factors of voice dimorphism?
1) length of vocal cords
2) size of resonating chamber
3) thickness of vocal cords
Signal (Sentinel) Node
- Enlarged supraclavicular node, usually on left side
- Often the first indication of a visceral tumor of the thorax or abdomen
Lymphoma
- Primary tumor of lymph nodes
- Hodgkin’s Disease: type of lymphoma
- Non-Hodgkin’s Lymphoma: another type w/ poorer prognosis
Enlarged lymph node that is tender or painful
Indicates infection
- Filariasis: parasitic infection of lymphatic system
Enlarged lymph node that is hard and painless
Indicates cyst development or cancer
What are 3 clinical signs of breast cancer?
1) Dimpling (invasion of suspensory ligaments)
2) Inverted Nipple (invasion of lactiferous ducts)
3) leathery thickening of skin (like an orange)
How does breast cancer spread?
Accumulates in axilla first.
Spreads to lymphatics, then to bloodstream.
Posterior intercostal veins drain to azygos and hemiazygous systems; connections to vertebral venous plexus allows spread to vertebral column and brain.
What is a “barrel chest” indicative of?
Barrel chest may suggest COPD
What is a pneumothorax?
Collection of air in the pleural cavity.
What are 3 causes of pneumothorax?
1) Trauma (sucking chest wound)
2) Disease (Chronic bronchitis)
3) Congenital weak spot
What is a Tension Pnemothorax?
Instead of a hole, a flap is present on the visceral pleura.
- Air enters pleural cavity on inspiration, but cannot exit on expiration.
- Pleural cavity inflates, pushing mediastinum to the opposite side and compressing the other lung
What is a hemothorax?
Collection of blood in pleural cavity.
What is Pleuritis?
AKA: Pleurisy
Inflammation of pleurae which leads to adhesions between parietal and visceral pleura
- Produces a “pleural friction rub”
How does pain in pleuritis present?
- Very painful due to sensory innervation of parietal pleura.
- Pain is often referred to the shoulder via the phrenic nerve (C3,4,5).
- Pain radiates along distribution of supraclavicular nerves (C3,4).
Where will an aspired object get stuck in a child?
Aspired objects usually enter the right main bronchus and lodges itself next to the Carina where the cough reflex is initiated. Once past the Carina, coughing stops, but chemical bronchitis and atelactasis may ensue.
What is Asthma?
- An obstructive airway disease characterized by coughing, wheezing, and difficiulty breathing.
- Caused by spasm of smooth muscle (segmental bronchi and bronchioles).
- Accompanied by excessive secretions of mucus
What are the 2 types of Asthma?
Extrinsic Asthma: triggered by allergens
Intrinsic Asthma: triggered by non-allergic stimuli (stress, cold, exercise)
Asthma Hypothesis
impingement of sympathetic origins (T2-T5) may allow PSNS activation to dominate
What is mucociliary clearance?
Movement of mucus and dirt up and out of the larynx.
- Smoking damages the cilia - resulting in smoker’s cough
What is Bronchogenic Carcinoma?
- Primary tumor of bronchus, directly related to cigarette smoking and air pollution
- Highly metastatic, causing enlargement of sentinal node
- May affect phrenic nerve (causing paralysis in half the diaphragm) and recurrent laryngeal (paralysis of half the larynx)
- May refer pain to upper or middle thoracic cord segments.
What is a Hiatal Hernia?
- Upper part of the stomach slides up into the thoracic cavity through the esophageal hiatus.
- Due to weakness in the diaphragmatic wall, usually occurring after age 50.
- Major cause of gastroesophageal reflux (belching and epigastric pain)
What are the 4 morbid underlying causes of hiccups?
1) brain lesions
2) pleuritis
3) pericarditis
4) peritonitis
What is cardiac tamponade?
- Fluid leaks rapidly into the pericardial cavity, compressing the heart and impedes venous return.
- Affects Sup. Vena Cava especially; leads to prominent EJV
How can you tell the difference between pericardial and parietal friction rub?
Have the patient hold their breath.
What is a pulmonary embolism?
- Blood clot that forms in the systemic venous system that moves and blocks a pulmonary artery.
- blood flow is blocked to lung, resulting in acute respiratory distress
- Dilation of RV -> Dilation of RA-> Heart Failure
What is the path of a venous embolism?
Blood Clot forms
Sup./Inf/ Vena Cava -> Rt. Atrium -> Rt. Vent. -> Pulmonary Artery -> Smaller pulmonary arteries until it gets caught.
Atrial Septal Defect
- Present in 25% of adults
- Foramen Ovale persists as a small opening in the superior part of fossa ovalis
- Sometimes called a “probe patent foramen ovale”
- Serious defect is called “clinical septal defect”
How does a clinical septal defect affect the heart?
- Blood is shunted from the left atrium to the right
- Dilation of the RA, RV, and Pulmonary Trunk ensues
What are the two ways the heart can enlarge?
1) Muscular Hypertrophy
2) Dilation of a chamber
How does muscular hypertrophy of the heart occur?
- Elasticity of blood vessels is lost due to age, hypertension, or atherosclerosis
- More force is required to push blood through arteries
- Walls of heart grow thicker as a result
How does dilation of a heart chamber occur?
1) septal defects
2) valve incompetencies
What is atherosclerosis?
- Deposition of lipid plaques on inner walls of arteries
- narrows the lumen
What is angina pectoris?
- Substernal chest pain upon exertion
- Symptom of partial occlusion of coronary artery branches
- Occurs due to insufficient blood flow to the heart
What are the 3 most common sites of Myocardial Infarction?
1) Anterior Interventricular Artery
2) Right Coronary Artery
3) Circumflex Artery
What is Myocardial Infarction?
- Complete occlusion of a coronary artery or branch
- The portion of the heart supplied by the blocked artery dies and is converted to fibrous scar tissue
