Thoracic deformities

Question 1

what is Pectus Carinatum

Answer 1

abnormal prominence of sternum in a convex
shape
no respiratory complications

Question 2

what is Pectus Excavatum

Answer 2

aka: funnel chest/cobblers chest
depressed sternum
ribs protrude anteriorly
heart displaced to left

Question 3

what is the clinical manifestation of pectus excavatum

Answer 3

chest discomfort
SOB
exercise intolerance

Question 4

what is the pathophysiology of pectus excavatum

Answer 4

Excessive growth of costal cartilages

overgrowth either cause ribs to push inward or outward

Question 5

What disorder is associated with with pectus deformaties ?

Answer 5

Marfan’s Syndrome (inherited connective tissue disorder)

Scoliosis

Question 6

what treatment is used to correct pectus excavatum?

Answer 6

Ravitich Procedure (surgery only)

Question 7

what is the effect on the respiratory system by kyphoscoliosis

Answer 7

causing reduces reserve

Question 8

What is Ankylosing Spondylitis?

Answer 8

Chronic, inflammatory joint disease
characterized by stiffening (arthritis) and
fusion of the spine and sacroiliac joints

Question 9

where is the primary site of inflammation

Answer 9

the entheses (connection tissue between bone, ligament, tendon)

fibrosis, ossification, fusion of the joint

Question 10

what else can happen in Ankylosing Spondylitis

Answer 10

may cause inflammation of eyes, lungs and

heart valves

Question 11

how to diagnosis Ankylosing Spondylitis?

Answer 11

rule out other back
problems

1. lack of lumbar
   spine flexibility
2. eye inflammation
3. heart valve
   involvement

Question 12

what is the s&s of Ankylosing Spondylitis?

Answer 12

low back pain & stiffness
kyphosis
pain on inspiration
immobility of the lumbar and sacroiliac
regions first then progression to upper back
& neck

Question 13

what are the types of chest trauma

Answer 13

Penetrating
Blunt
MVA’s, falls, crush injuries, assaults
crushing tissue, fractured ribs, shearing tissue

Question 14

what are the injures due to chest trauma

Answer 14

Chest Wall Injuries
Lung Parenchymal Injuries
Airway Injuries
Heart and Great Vessel Injuries
Diaphragmatic Injuries
Delayed Complications

Question 15

what are different ribs fracture

Answer 15

more common in adults than children

rib 1- 2 : rare
ribs 4- 9: maybe force through pleural
ribs 9 - 11: abdominal injuries (liver, spleen)

Question 16

what causes sternal fracture

Answer 16

due to high speed deceleration impact to
anterior chest MVA

frequently associated with flail chest, cardiac
contusion, great vessel rupture or
tracheobronchial rupture

Question 17

What is flail chest?

Answer 17

“flail” refers to paradoxical (asymmetric)
motion of chest during breathing due to loss
of chest wall stability (affected ribs cave in

Multiple rib fractures to one side or two or
more rib fractures in two or more places

Question 18

what is the pathophysiology of flail chest

Answer 18

lung directly beneath flail area is compressed
during inspiration
during expiration gas is pushed toward flail
area
air is shunted from one lung to the other
during ventilatory cycle due to unequal
pleural pressures

referred to as: AIR PENDULUFT

Question 19

what is the result of penduluft?

Answer 19

rebreathing of dead space

gas and hypoventilation

Question 20

what is the treatment of flail chest

Answer 20

wrap chest tightly, position body so injured side is down
pain medication
internal: intubate & ventilate (volume
ventilation & PEEP)
external: early surgical repair if extensive

Question 21

what is Pulmonary Contusion

Answer 21

interstitial edema and hemorrhage localized to
the area of lung at impact site of blunt trauma

lung compliance and airway inflammation can
lead to ARDS

treatment: O2 therapy, and/or MV with PEEP

Question 22

what is pulmonary Hemorrhage

Answer 22

massive bleeding into lungs (trauma, TB, GPS)

Question 23

what is the managment for pulmonary hemorrhage

Answer 23

endobronchial ETT,
bronchoscopy (flexible/rigid)
treat blood loss)