Midterm 1 Clinicals Flashcards
Gastrochisis
1 in 3000 births
Protrusion of viscera, happens to right of umbilical cord
Differs from epigastric hernia: bowel is uncovered and floating in amniotic fluid
Congenital Epigastric Hernia
Midline Bulge of abdominal wall b/n xiphoid and umbilicus
Bowel not exposed, remains covered by skin
Congenital Diaphragmatic Hernia (CDH)
Posterolateral Defect: 1 in 2200 Viscera bulges into pleural cavity Lung maturation delayed Polyhydramnios Left side impacted Corrected at birth
Most Common Rib Fractures
- Middle Ribs
- Anterior to Costal Cangle
Supernumerary Ribs
- Occur in Cervical and Lumbar Region
- Cervical has no symptoms unless if presses agaist Subclavian A or Brachial Plexus
- Lumbar Ribs unproblematic
Dislocation vs. Separation of Ribs
Dislocation occurs at Sternocostal Joint
Separation occurs at Costochondral Joint
Thoracocentesis
- Insertion of hypodermic needle through intercostal musculature
- Inserted inferior to intercostal neurovascular bundle, but superior to collateral branches
Insertion of Chest Tube
- To remove large amounts of air, fluid, blood, pus from Pleural cavity
- Inserted in 5th or 6th intercostal space
Thoroscopy
Insertion of Thoroscope into Pleural cavity for visualization and biopsying Pleural Cavity
Lung Cancer Derivations
- Actual Lung Tissue
- From Bronchi (Bronchogenic Carcinoma)
- Phrenic, Vagus, Recurrent Larygneal N
Removal Of Lung Procedures
Pneumonectomy: Removal of Lung
Lobectomy: Removing a Lobe
Segmentectomy: Removing specific Bronchopulmonary segment
Pleuritis
inflammation of pleura - - - -
- producing roughness on lungs
- Makes breathing difficult
Pulmonary Collapse
- Occurs when air enters Pleural cavity to break surface tension b/n the two layers of pleura
- Elasticity of lungs causes them to collapse
Entry of substances in Pleural Cavity
Pneumothroax: Entry of air through penetrating wound
Hydrothorax: Excess fluid, also caused Pleural Effusion
Hemothorax: Accumulation of blood, result of chest wound or laceration of intercostal/internal thoracic vessel
Bronchial Asthma
- Widespread narrowing of lairways
- Produced by contraction of smooth muscle, edema of mucosa/mucus in lumen of bronchi/bronchioles
Bronchoscopy
Insertion of Bronchoscope into trachea to visualize Main Bronchi
Laryngeal Atresia
- Failure of recanalization of Larynx
- Congenital High Airway Obstruction Syndrome (CHAOS)
- Airways dilates, lungs enlarged, diaphragm flat/inverted
- Treated by endoscopic dilation of laryngeal web
Tracheoesophageal Fistula
- Abnormal connection b/n trachea and esophagus
- Most common congenital abnormality of lower respiratory tract
- Failure of foregut endoderm to proliferate in relation to rest of embryo
- Associated with esophageal atresia
- Child unable to swallow
Fetal Breathing Movements
- Essential for lung development
- Used during fetal monitoring and predictor of fetal outcome
- Aeration of lungs needs to happen rapidly at birth
- Occurs by vaginal delivery, pulmonary vessels, lymphatics
Pulmonary Agensis
- Unilateral
- Complete absence of lung or lobe
- Respiratory bud fails to split into bronchial buds
Oligohydraminos
- Insufficient amniotic fluid production
- Associated with renal agenesis/failure
- Slows lung development
Pulmonary Hypoplasia
- Restriction of fetal thorax from uterine pressure
- Decreased hydraulic pressure on lungs
- Impacts stretch receptors and lung growth
Respiratory Distress Syndrome
- Rapid labored breathing shortly after birth
- Surfactant Deficiency
- Underinflated lungs, alveoli resemble glass membranes
- Symptoms: Nasal flaring, grunting, cyanosis
- Suprasternal, intercostal, subcostal retractions
Congenital Lung Cysts
Filled with fluid or air
- Formed by dilation of terminal bronchi
- Disturbance of bronchial development during late fetal life
- Weezing cyanosis etc
Cause of Asthma
- Infiltration of bronchiolar wall by eosinophils, lymphocytes, mast cells
- Symptoms: Dyspnea, wheezing, productive cough
Emphysema
- Permanent enlargement of air spaces distal to terminal bronchiole
- Chronic obstruction of airflow due to narrowing, accompanied by destruction of alveolar walls
- Loss of gas exchange with decrease in surface area
- Caused by smoking, particulate material in lungs, genetics
Pneumonia
- Inflammation of lung tissue
- Air spaces filled with exudate (WBCs/neutrophils, RBSs, fibrin)
- Hepatization stage where lungs look like liver
- Enlarged capillaries
- Symptoms: fever/chills, productive cough, crackles in lungs
Bronchiolitis Obliterans (Popcorn Lungs)
- Plug of granulation tissue in terminal and respiratory bronchioles
- Caused by vaping, lung transplants, infectious pneumonias, alveolar damage
Myocardial Infarction
- Lack of blood flow to specific area of myocardium, result of blockage in Coronary A, coronory arthereosclerosis, or buildup of lipids
Angina Pectoris
Pain that originates in heart and produces strangling pain in chest
- Results from narrow/obstructed coronary arteriesproducing ischemia of myocardium
Atrial Septal Defects
Incomplete closure of Foramen Ovale
- 15-20% of adults have small potency of Foramen Ovale
- Larger openings in interatrial septum can be clinically significant as it allows blood mixture
Cardiac Catheterization
Insertion of catheter into femoral vein, passed to inferior vena cava to allow radiographic visualization of right atrium, right ventricle, and pulmonary trunk
Ventricular Septal Defects
All defects are clinically relevant as these septal defects allow mixture of oxygen rich and oxygen depleted blood
Artificial Cardiac Pacemaker
- Produces regular electrical impulse that is carried to ventricles via electrodes
- Electrodes inserted through large vein to Superior Vena Cava –> Right atrium –> tricuspid valve –> endocardium of trabeculae carnae
Atrial Fibrillation
- Irregular Twitching of Atrial Cardiac Muscle
- Ventricles respond at irregular intervals, circulation comprimised
Ventricular Fibrillation
- Rapid irregular twitching of ventricles
- Heart unable to pump blood
- Electric shock ceases all cardiac movement in hopes of restarting
Cardiac Referred Pain
- Ischemia stimulates visceral pain sensory fibers in ANS
- Fibers share a spinal ganglion with somatic sensory fibers of areas in upper limb/lateral chest etc.
- Travels via Left Medial Brachial Cutaneous N.
Transverse Pericardial Sinus
- Space allows cardiac surgeons to access area posterior to aorta and pulmonary trunk
- Clamp/insert tubes of bypass into vessels
Pericarditis
- Inflammation of pericardium which makes it rough and frictious
- This pericardial friction rub is observed with stethoscope and can calcify
Pericardial Effusion
Inflammation of pericardium resulting in buildup of fluid/pus in percardial sac
- Can compress heart (Cardiac Tamponade)
Percardiocentesis
- Drainage of blood/fluid/pus from pericardial sac
- Relieves cardiac tamponade
Coronary Artery Bypass Graft
- Obstruction of coronary arteries can result in replacement of segment
- Great saphenous vein often used b/c of its diameter + ease of access
- Radial artery also used
Coronary Angioplasty
- Insertion of small balloon catheter into lumen of coronary artery
- Balloon inflated to flatten plaque and increase size of lumen
Pulmonary Embolism
- Obstruction of a Pulmonary A. by an embolus
- Embolus passes from vein through right side of heart into pulmonary arteries
Angiomas
- Abnormal blood vessels and lymphatic capillary growth via vasculogenesis
- Capillary Hemangioma: Excessive capillary formation
- Cavernous Hemangioma: Excessive formation of venous sinuses
Proepicardial Organ
- Remnant of dorsal mesocardium attached to primitive heart
- Migrates and forms majority of epicardium
Heterotaxia
Symmetrical anomaly of internal body plan
- Ventricular Inversion: Reverse cardiac looping results in right sided left ventricle
- Situs Inversus: Total reversal of organs
- Situs ambiguous: Partial reversal of organs
- Visceratrial Heterotaxia: Right heart, normal GI
Persistant AV Canal
- Failure of AV septum fusion
- Abnormal/agenesis of AV valves
- Results in pulmonary hypertension, exercise intolerance, shortness of breath
- Very strong link with Down Syndrome
Atrial Septal Defects
- Small gap in foramen ovale allows blood to bypass pulmonary system
- Types of defect:
1) Excessive resorption of septum primum: very big foramen ovale
2) Absence or inadequate development of septum secundum
3) Ostium Primum defect
Cyanosis
- Bluish skin tone due to low O2 saturation
- Mixing of deoxy blood with oxy
- Club fingers, blue features
Double Outlet Right Ventricle
- AV septum does not shift over
- Aorta and pulmonary artery exit into right ventricle
- Everything mixed, cyanosis, breathlessness, murmurs
Ventricular Septal Defects
- Left to right ventricle shunt
- Left does more work as right hypotrophies
- Deoxy mixes with oxy
Persistant Truncus Arteriosus
Outflow tract between aorta and pulmonary artery does not get separated
- Common trunk
- Can be fixed by closing off defect
Tetralogy of Fallot
Conal truncus does not separate from atrial well
- Very narrow pulmonary arteries
- Right sided ventricular hypertrophy as it must pump extra hard to get blood through
- Accompanied by a VSD and overriding aorta
- Most common
Transposition of Great Vessels
No spiralling which designates correct side to aorta/pulmonary artery
- Aorta receives deoxy, pulm receives oxy
Pulmonary Valvular Atresia
Persistance of foramen ovale
- Pulmonary artery closed off and right ventricle severely underdeveloped
- Mixing of oxy and deoxy blood
Aortic Valve Stenosis
- Narrowing of aortic valve
- Left ventricular hypertrophy
- 4:1 male:female ratio
Can be congenital, pathological, degenerative
Aortic Valvular Atresia
- No outleft for left ventricle, aortic valve closed
- Right ventricle must push out blood; hypertrophy
- Accompanied with ASD
Bicuspid Aortic valve
- Asymptomatic but can cause LV hypertrophy
- Associated with aortic aneurysms
Tricuspid Atresia
- Whole tricuspid valve closed off
- Left sided ventricular hypertrophy
Hypoplastic Left Ventricle
- Left ventricle underdeveloped
- Mitral/Aortic valve not formed/ver small
- Ascending aorta underdeveloped
- ASD
- RV does all work
Heart Murmur
- Heard when blood is moving in a direction it shouldn’t be
- Blood is having a hard time moving in direvtion it should be
- Can be hear in diastole and systole
Spontaneous Pneumothorax
- Spontaneous rupture of alveoli through visceral pleura
- Air leaks into cavity
- Risks: Smoking, COPD, cystic fibrosis
Tension Pneumothorax
- Air enters thorax but cannot exit
- Trauma where injury fails to seal (penetrating wound)
Pulmonary Meniscus Sign
- Meniscus found on surface of fluid with pleural effusion
- Due to surface tension b/n two different fluids
Coin Sign
- Solitary, round circumscribed shadows on X-Ray
- May be calcified
- Causwed by tuberculosis, neoplasms, cysts
Pulmonary Radiological Signs of Disease
- Kerley A Lines: running from hila to periphery, caused by distension of anastomosic channels
- Kerley B Lines: Short parallel lines at periphery perpindicular to pleura
Patent Ductus Arteriosus
- Prostoglandins keep the ductus arteriousus b/n aorta and pulmonary arteries open
- After birth, should become ligament, but can remain there
- Results in severe LV hypertrophy, and congestive heart failure
- Risk increased with rubella
- Treated with indomethacin or surgery
Coartctation
Postductal: Narrowing of descending aorta after ductus arteriosus
Preductal: Narrowing before dusctus arteriosus
- Body compensates by pushing blood around through the subclavians, makes them longer
Aberrant Origin of Right Subclavian
- When right subclavian forms much further downstream of dorsal aorta than the left
- Occurs via abnormal obliteration of 4th aortic arch
Double Aortic Arch
Whole Dorsal Aortic section on right does not obliterate
- Results in constriction of vagus nerve and trachea/esophagus
Interrupted Aortic Arch
- Both left and right aortic arches disappear
- Lose entire systemic circulation
- Newborn cant survive
Coronary Heart Disease
- 1/6 adults in US affected
- STEMIs account for 30% of all MIs
- Presents with history of chest discomfort, heavy pressure, nausea, vomiting, diaphoresis, dyspnea
Sinus Tachycardia
- HR > 100
- Normal physiological response for pregnancy, emotion, anxiety, fear, exertion
- Abnormal with drugs, hyperthyroid, fever, preggos, anemia
Sinus Bradycardia
- HR < 60
Premature Atrial Contraction
- Seen in absence of significant heart disease
- Associated with stress, alcohol, tobacco, COPD CAD
Premature Ventricular Contraction (PVC)
- Many causes
- More ominous than Premature atrial contraction
- Indictative of heart failure, AMI, ischemic heart disease, hypokalemia
- Appears as wide QRS
Ventricular Tachycardia
- Non-sustaines/sustained/pulseless
- Wide complex
- Multiple causes
- Shown as multiple PVCs on EKG
Supravetricular Tachycardia
- Narrow complex, fast HR
- Thyroid disease, caffeine, stimulants, stress
- Atrial rate greater than 160-180
- Shown as tight QRS with p-wave buried behind
Atrial Fibrillation
- Very high rate 360-600
- Multiple causes: heart disease, CHF, CAD, obesity
- Atria not contracting
- no P-waves, irregularly irregular rate
1st Degree AV Block
- Very long PR interval, more than 1 block
Tangier’s Disease
- Lose ABC A1 receptor on macrophages and endothelial cells
- MAcrophages and endothelial cells can’t give cholestrol to HDL
- Foam cell development is end result
Type 1 Hyperlipoproteinemia
- 2 Types:
- Primary Capillary Lipoprotein Lipase Def
- Apo-C2 Def
- Cant hydrolyze hydroglycerides in chylos and VLDL
- ## Result is very high plasma triglycerols
Type 2 Hyperlipoproteinemia
“Familial hypercholestrolemia”
- Caused by defective LDL receptor cant bind APO-B100
- High cholestrol in blood
- can have the atherosclerosis where LDLs get oxidized and they start making plaques
