Moore's Blue Boxes for Thoracic Region

Question 1

Chest Pain

Answer 1

Most important Sx of cardiac disease - ppl who have had MI describe crushing sub-sternal pain that does not disappear with rest

May also appear with intestinal, gallbladder, and MSK disorders.

Question 2

Rib Fractures

Answer 2

1st rib - rarely fractured. If fractured, structures superior to it (brachial plexus, subclavian a.) may be injured

Middle ribs most commonly fractured from blows/crushing injury

Weakest part = just anterior to angle

Simple vs. Complicated (complicated - trauma to pleura, blood vessels, heart, etc.)

Question 3

Flail Chest

Answer 3

Multiple rib fractures leads to a sizable segment of the thoracic wall moving freely

Question 4

Thoracotomy vs. Thoroscopy

Answer 4

Thoracotomy = Surgically opening thoracic wall to enter pleural cavity

Thoroscopy = insertion of thoroscope into pleural cavity through small incisions for visualizing space inside pleural cavity

Question 5

Supernumerary Ribs

Answer 5

Extra ribs either in cervical or lumbar region usually with no significant symptoms

Question 6

Dislocation vs. Seperation

Answer 6

Dislocation is at the SC joint

Seperation is at the costochondral joint

Question 7

Thoracentisis

Answer 7

Insertion of a needle through the intercostal space between ribs to obtain fluid sample or drain blood/fluid from pleural cavity. Needle must be inserted below neuromuscular bundle but above collateral branches.

Question 8

Insertion of Chest Tube

Answer 8

Tube is inserted into the 5th/6th intercostal space to remove large amounts of air, fluid, blood, pus, etc.

Question 9

Lung Cancer

Answer 9

Can derive from actual lung tissue or bronchi. Can involve phrenic, vagus, and recurrent laryngeal n.

Tx: Pneumonectomy, lobectomy, segmentectomy - lung resection

Question 10

Pleuritis

Answer 10

Inflammation of pleura producing roughness on lungs making breathing difficult

Question 11

Pulmonary Collapse

Answer 11

When enough air enters pleural cavity to break surface tension between 2 layers of pleura - elasticity causes collapse

Question 12

Pneumothorax,

Answer 12

Entry of air into pleural cavity from penetrating wound to thoracic wall or rupture of pulmonary lesion into pleural cavity - results in lung collapse

Question 13

Hydrothorax

Answer 13

Accumulation of excess fluid into pleural cavity - result is fluid escape into pleural cavity (pleural effusion)

Question 14

Hemothorax

Answer 14

Accumulation of blood in pleural cavity due to chest wound. Blood accumulating from intercostal vessel rather than lung laceration

Question 15

Bronchial Asthma

Answer 15

Widespread narrowing of airways produced by contraction of smooth muscle, edema of mucosa in lumen of bronchi and bronchioles

Question 16

Bronchoscopy

Answer 16

Insertion of a bronchoscope into trachea to visualize main bronchi

Question 17

Myocardial Infarction

Answer 17

Lack of blood flow to specific area of myocardium, usually result of blockade in a coronary artery.

Coronary Atherosclerosis, buildup of lipids on internal walls, decreases size of lumen of vessel, increasing likelihood of embolus or block of vessel entirely

Question 18

Angina Pectoris

Answer 18

Pain that originates in heart and produces strangling pain of chest (literal meaning).

Result of narrow or obstructed coronary arteries that produces ischemia of myocardium

Question 19

Atrial Septal Defect

Answer 19

Involves incomplete closure of Foramen Ovalis
15-20% adults have small latency of foramen ovals - clinically insignificant

Larger openings in inter arterial septum can be clinically significant and they allow for mixture of oxygen rich and depleted blood

Question 20

Cardiac Catheterization

Answer 20

Insertion of catheter into femoral vein which is then passed up to IVC allowing radiographic visualization of right atrium, right ventricle, pulmonary trunk, and pulmonary arteries

Question 21

Ventricular Septal Defects

Answer 21

Due to embryologically divergent tissues that make up inter ventricular septum, it is particularly susceptible to defects. Clinically significant as they allow for mixture of oxygen rich and depleted blood

Question 22

Artificial Cardiac Pacemaker

Answer 22

Produces regular electrical impulse that is carried to the ventricles via electrodes which are inserted through a large vein to the SVC, into right atrium past the tricuspid valve into the endocardium of the trabecular carnae of the right ventricle

Question 23

Atrial Fibrillation

Answer 23

Irregular twitching of the atrial cardiac muscle fibers to which the ventricles respond at irregular intervals. Circulation usually remains satisfactory.

Question 24

Ventricular Fibrillation

Answer 24

Rapid irregular twitching of ventricles rendering the heart unable to pump blood.

Electric shock administered by electrodes can cease all cardiac movement (defibrillation)

Question 25

Cardiac Referred Pain

Answer 25

Ischemia stimulates visceral pain sensory fibers in the heart of ANS. These visceral sensory fibers share a spinal ganglion with the somatic sensory fibers of areas such as UE and superior lateral chest wall

Question 26

Surgical significance of Transverse pericardial sinus

Answer 26

Space allows cardiac surgeons to access area posterior to aorta and pulmonary trunk to clamp or insert the tubes of a bypass machine into these large vessels

Question 27

Pericarditis

Answer 27

Inflammation of the pericardium, which can make the pericardium rough and produce friction. If untreated, pericardium can calcify

Friction –> pericardial friction rub can be observed with stethoscope

Question 28

Pericardial Effusion

Answer 28

Inflammation of pericardium can result in accumulation of fluid or pus in the pericardial sac which can compress heart

Heart compression = cardiac tamponade

Question 29

Pericardiocentesis

Answer 29

Drainage of blood, fluid, or pus form pericardial sac.

Done to relieve cardiac tamponade

Question 30

Coronary Artery Bypass Graft

Answer 30

Obstruction of coronary arteries may necessitate replacement of segment of coronary artery

Great saphenous vein is often used based on its comparable diameter of the coronary arteries, its easy dissection

Radial artery is also used

Question 31

Coronary Angioplasty

Answer 31

Insertion of small balloon catheter into lumen of coronary artery. Balloon inflated to flatten the obstruction plaque against the wall and increase size of lumen improving blood flow