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Anatomy Examen 1 > Thorax > Flashcards

Thorax Flashcards

1
Q

Chest pain is the most important symptom of what

A

Cardiac disease

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2
Q

What else may chest pain occur with

A

Pulmonary disease, intestinal, gallbladder, and musculoskeletal disorders

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3
Q

What do people with heart attack describe their chest pain as

A

Crushing substernal pain that does not disappear with rest

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4
Q

Why is the 1st rib rarely fractured

A

Protected

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5
Q

First rib fracture is commonly viewed as a hallmark of severe injury in ___ trauma

A

Blunt

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6
Q

When the first rib is broken things crossing its superior aspect may be injured. What is there

A

Brachial plexus of nerves and subcclavian vessels that serve the upper limb

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7
Q

What ribs are most commonly fractured

A

Middle

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8
Q

Most common cause of rib fracture

A

Blow or crushing injuries

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9
Q

What is the weakest part of the rib

A

Just anterior to its angle. However direct violence may fracture a rib anywhere

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10
Q

What is of concern with broken end of rib

A

Injure internal organs such as a lung and or spleen

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11
Q

Fractures of the lower ribs may damage what

A

Diaphragm

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12
Q

What may a lower rib tear in the diaphragm cause

A

Diaphragmatic hernia

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13
Q

Why are rib fractures painful

A

Broken parts move during respiration, coughing, laughing, and sneezing.

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14
Q

Flail chest

A

Multiple rib fractures may allow a sizable segment of the anterior and,or lateral thoracic wall to move freely ,,

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15
Q

In flail chest, the loose segment of the wall moves _____

A

Paradoxically
(Inward on inspiration and outward of expiration)

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16
Q

If flail chest painful

A

YES VERYYYY and affects oxygenation of the blood

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17
Q

Thoracotomy

A

Surgical creation of an opening through the thoracic wall to enter a pleural cavity

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18
Q

Anterior thoracotomy

A

H shaped cuts through the perichondrium of one or more costal cartilages and then shelling out segments to get access to thoracic cavity

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19
Q

Where may posterolateral thoracotomy

A

5th-7th intercostal spaces

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20
Q

When doing the posterolateral thoracotomy why is the patient on their side with arm abducted

A

Elevates and laterally rotates the inferior angle of scapula, allowing access as high as the 4th intercostal space.

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21
Q

Is the neuromuscular bundle above of below rib

A

Above

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22
Q

Rib retraction

A

To do surgery through one intercostal scape

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23
Q

Incision for pneumonectomy

A

Bigger H shaped incision to incise superficial aspect of the periosteum that ensheaths the rain, strip the periosteum from the rib and then excise a wide segment of the rib to gain better access

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24
Q

In the absence of rib, an incision can be made through deep aspect of periosteal sheath , spacing the adjacent intercostal muscles

A

After the operation the missing pieces of the ribs regenerate from the intact periosteum although imperfectly

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25
Q

Supernumerary ribs

A

Cervical or lumbar

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26
Q

What percentage of population has cervical ribs

A

1-2

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27
Q

How remove cervical rib

A

Trans axillary approach

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28
Q

___ ___ provide resilience to the thoracic cage preventing many blows from fracturing the sternum and ribs

A

Costal cartilages

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29
Q

Can chest compression in kids produce injury in thorax even without rib breaks. Why

A

Yea
Amazing elasticity

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30
Q

Why are costal cartilages radiologically opaque in older people

A

Calcification
Lose elasticity and become brittle

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31
Q

CPR more likely to break ribs in kids or old people

A

Old
Costochondral lose elasticity

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32
Q

Someone int heir 40s presents with hard lump in pit of stomach

A

Ossified diploid process

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33
Q

Why try to avoid ossified siphoned process in surgery

A

Result in heterotropic ossification of the upper part of the incision

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34
Q

A fracture if the eternal body is usually a ____ fracture

A

Comminuted

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35
Q

What is a comminuted fracture

A

Lots of little pieces

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36
Q

In stern alone fracture why is displacement of bone fragments uncommon

A

Sternum is invested by deep fascia and the eternal attachments of the pectoralis major muscles

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37
Q

What is the most common site of eternal fractures in elderly is at the eternal angle where the manubriosternal joint has fused . What does this fracture result in

A

Dislocation of the manbriosternal joint

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38
Q

Why is the mortality rate associated with sternal fractures 25-45% (sternal contusion)

A

Underlying visceral injury
Heart and or lung injury

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39
Q

Median sternotomy

A

Sternum is divided in the median plane and retracted
Flexibility of ribs and costal cartilages enables spreading of the halves of the sternum

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40
Q

Why do median sternotomy

A

Gain access to the thoracic cavity for surgical operations in the mediastinum
Coronary artery bypass grafting
Removal of tumors in superior lobes of the lungs

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41
Q

What is more painful after surgery. Median sternotomy or muscle splitting thoracotointercostal space incision

A

Muscle splitting

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42
Q

Why do sternal bone biopsy

A

Breadth and subcutaneous position
For transplantation or detection of metastatic cancer and blood dyscrasias

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43
Q

How does the sternum develop

A

Through fusion of bilateral, vertical condensations of precartilaginous tissue, sternal bands or bars

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44
Q

Complete sternal cleft

A

Sternum of fetus does not fuse

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45
Q

What is associated with sternal cleft

A

Actopia cordis

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46
Q

Partial sternal cleft

A

Involves manubrium and superior half of body. V or U shaped
Repaired during infancy

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47
Q

Sternal foremen

A

Hole, dont confuse for bullet hole

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48
Q

Is perforation of diploid process in old people of concern

A

No

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49
Q

Anterior protruding diploid process neonates

A

Not a prob no surgery

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50
Q

What is the thoracic inlet . Why is it called that

A

Superior thoracic aperature
Bc noncirculating substances (air and food) may enter the thorax only through this aperature

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51
Q

Thoracic outlet

A

Emphasizing the arteries and t1 spinal nerves that emerge from the thorax through this aperture to enter the lower neck and upper limbs

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52
Q

Thoracic outlet syndrome

A

Emerging structures are affected by obstructions of the superior thoracic aperture

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53
Q

Rib dislocation ( slipping rib)

A

Displacement of the costal cartilage from the sternum -sternocostal joint or displacement of the inter Honduras joints

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54
Q

Complications of rib dislocation

A

Pressure on or damage to nearby nerves, vessels, and muscles

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55
Q

Displacement of interchondral joints is usually unilateral and involves ribs _ _ and _

A

8 9 10

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56
Q

Trauma sufficient to displace ribs 8 9 and 10 often injured what else

A

Diaphragm, and or liver
SEVERE PAIN esp in inspiration

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57
Q

Can you see a displaced interchondral joint

A

Yea its a lump

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58
Q

Paralysis to diaphragm is due to injury to its motor supply, the _ nerve

A

Phrenic

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59
Q

If right phrenic nerve is damaged, are both domes of the diaphragm effected

A

No just the right

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60
Q

One can detect a paralyzed diaphragm radiographically by noting its ___ movement

A

Paradoxical

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61
Q

If paralyzed. How does the diaphragm move on inspiration and expiration

A

Inspiration -ascends in response to being pushed superiority by the active contralateral dome
Expiration-descends in response to passive pressure of lungs

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62
Q

What breast changes occur during menstrual cycle

A

Branching of lactiferous ducts

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63
Q

Mammary glands are prepared for secretion mid pregnancy. When do they start producing milk

A

Shortly after baby is born

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64
Q

Colostrum

A

Creamy white to yellowish premilk fluid , it may secrete from the nipples during the last trimester and beginning of nursing

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65
Q

What is colostrum rich in

A

Protein, immune agents, growth factor affecting the infants intestines

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66
Q

Multiparous woman breast

A

Large and pendulous

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67
Q

Elderly woman breasts

A

Small bc decreased fat and atrophy of glandular tissue

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68
Q

The breast is divided into 4 quadrants for examining

A

Superolateral, superomedial, inferolateral, inferomedial

Hard irregular mass felt in the superior medial quadrant of the breast at the 2 o clock position 2.5 cm front he margin of the areola

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69
Q

Carcinoma of the breast is usually ___

A

Adenocarcinoma
From epithelial cells of the lactiferous ducts in mammary gland lobules

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70
Q

Interference with dearmal lymphatics by cancer may cause ___

A

Lymphedema in skin of breast

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71
Q

What may lymphedema of breast cause in breast

A

Deviation of nipple and thickened leather like appearance of the skin

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72
Q

What is peau d’orange sign

A

Prominent puffy skin between dimpled pores gives it an orange peel appearance
Lymphedema
Inflammatory breast cancer

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73
Q

Large dimples in breast

A

Cancerous invasion of the glandular tissue and fibrosis which causes shortening or places traction on suspensory ligaments.

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74
Q

Subareolar breast cancer

A

Causes retraction of nipple by a similar mechanism involving the lactiferous ducts

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75
Q

How does breast cancer spread

A

Lymph vessels to lymph nodes

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76
Q

Describe spread of breast cancer

A

Communications among lymphatic pathways and among axillary, cervical, and parasternal nodes may cause metastasis from the breast to develop in the supraclavicular lymph nodes , the opposite breast, or abdomen

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77
Q

Most lymphatic drainage of the breast is to the ___ nodes

A

Axillary

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78
Q

Most common site of breast metastasis

A

Axillary nodes

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79
Q

Enlargement of palpable axillary nodes is suggestive of what

A

Possibility of breast cancer and may be key to early detection

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80
Q

Where else may breast cancer pass besides axilllary if axillary nodes not enlarged but still cancer

A

Infraclavicular, supraclavicular, or directly into the systemic circulation

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81
Q

Removal or destruction of axillary lymph nodes

A

Lymphedema in the ipsilateral upper limb which also drains through the axillarylymph nodes

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82
Q

Describe venous spread of breast cancer to vertebrae and cranium and brain

A

The posterior intercostal veins drain into the azygos,hemi—azygos system of veins alongside the bodies of the vertebrae and communicate with the internal vertebral venous plexus surrounding the spinal cord

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83
Q

Contiguous spread of breast cancer

A

Breast cancer cells invade the retromammary space , attach to or invade the pectoral fascia overlying the pectoralis major, or metastasize to the interpectoral nodes……in this case the breast will elevate when the muscle contracts

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84
Q

Breast elevates when muscle contracts (patient place hands on hips and press while pulling elbows forward to tense her pectoral muscles)

A

Clinical sign of advanced breast cancer

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85
Q

Mammography

A

Radiographic study of the breast , which is flattened to extend the area that can be examined and reduce thickness, making it more uniform for increased visualization

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86
Q

How do carcinomas appear on mammography

A

Large, jagged density

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87
Q

Clinical breast cancer

A

Mammography-jagged large density
Skin thickened over tumor
Nipple depressed

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88
Q

In classic mammography,, denser structures appear ___

A

Light

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89
Q

Xeromammography denser structures appear __

A

Dark

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90
Q

MRI on breast

A

Further examination and rule out false positives

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91
Q

Incision along inferior cutaneous crease

A

Scar hidden

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92
Q

Simple Mastectomy

A

Breast removed down to retromammary space
Nipple and areola may be spared and immediate reconstruction usually

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93
Q

Radical mastectomy

A

Removal of breast, pectoral muscles, fat, fascia, and as many lymph nodes as possible in axilla and pectoral region

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94
Q

Lumpectomy and quadrantectomy

A

Only tumor and surrounding tissue removed
Breast conserving surgery
FOLLOW WITH RADIATION

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95
Q

Polymastia

A

Breast supernumerarcy

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96
Q

Polythelia

A

Accessory nipple

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97
Q

Where are extra nipple or breast

A

Usually in axillary fossa or anterior abdominal wall

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98
Q

Mole that changes a darker color during pregnancy in axillary fossa also fat around it gets bigger with lactation

A

May be accessory boob

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99
Q

Small supernumerary breasts may appear anywhere along the ___ crest extending from axilla to Groin

A

Mammary

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100
Q

Amastia

A

No breast development
No breast tissue, nipple or areola

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101
Q

1.5% of breast cancer is in __

A

Men 1000 men a year in USA

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102
Q

With male breast cancer, where does it usually mtasticize

A

Axillary lymph nodes but also bone, pleura, lung, liver, and skin

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103
Q

What may indicate a malignant tumor in men

A

Visible and,or palpable subareolar mass or secretion from a nipple

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104
Q

Breast cancer in males invades what

A

Axillary nodes, pectoral fascia, pectoralis major

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105
Q

Breast cancer is uncommon in men. Why is is severe

A

Usually detected after extensive metastasis

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106
Q

Gynecomastia

A

Breast hypertrophy in males after puberty (a little is normal at puberty )

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107
Q

Cause of gynecomastia

A

Drugs (treatment with diethylstilbestrol for prostate cancer)
Change in metabolism of sex hormones from liver (imbalance estrogen and androgen)

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108
Q

Gynecomastia is a symptom. What could it be a symptom of

A

Suprarenal or testicular cancers
Klinefelter

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109
Q

Characteristics of klinefelter

A

XXY
Small testes and long lower limbs

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110
Q

Because of the inferior slope of the 1st pair of ribs and superior thoracic aperture they form, the ___ and the ___ _ _ __ project through this opening into the neck, posterior to the inferior attachments of the sternocleidomastoid

A

Cervical pleura
Apex of the lung

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111
Q

How may the apex of the lung and pleural sacs be injured and what can this cause

A

Wounds to the base of the neck resulting in pneumothorax

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112
Q

Why does the cervical pleura reach a higher area in infants and kids

A

Shorter necks

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113
Q

What ages is the cervical pleura at increased risk of injury

A

Infancy and childhood

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114
Q

What are the three regions that the pleura descends inferior to the costal margins, where an abdominal incision might inadvertently enter a pleural sac

A

Right part of infrasternal angle
Right and left costovertebral angles

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115
Q

The small areas of pleura exposed int he costovertebral angles inferomedial to the 12th ribs are posterior to the __ _ __ ___

A

Poles of the kidney

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116
Q

Why is the pleura in danger inferomedial to the 12th ribs

A

A pneumothorax may occur , for example, form an incision in the posterior abdominal wall when surgical procedures expose a kidney to trauma

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117
Q

Atelectasis

A

If dissension is not maintained in alveoli their inherent elasticity will cause them to collapse

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118
Q

Primary atelectasis

A

Failure of lung to inflate at birth

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119
Q

Secondary atelectasis

A

Collapse if a previously inflated lung

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120
Q

Why do lungs remain distended even when the airway passages are open

A

The outer surface of the lungs (visceral pleura) adhere to the inner surface of the thoracic walls (parietal pleura) as a result of the surface tension provided by the pleural fluid

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121
Q

The elastic recoil of the lungs causes the pressure in the pleural cavities to be _____

A

Subatmospheric

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122
Q

The pressure in the pleural cavities

A

-2mm Hg

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123
Q

The pressure in pleural cavities is what during inspiration

A

-8 mm Hg

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124
Q

How does a bullet cause the lung to collapse

A

Punctures thoracic wall and parietal pleura, admitting air and causing lung to collapse

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125
Q

Order of pleura from outside to inside of lung

A

Parietal, visceral

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126
Q

If a penetrating wound opens through the thoracic wall or the surface of the lungs, why will air be sucked into the pleural cavity

A

The negative pressure

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127
Q

What happens when air is sucked into the lungs

A

Surface tension adhering visceral to parietal pleura (lung to thoracic wall) will be broken and the lung will collapse, expelling most of its air bc of its inherent elasticity (recoil)

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128
Q

The pleural cavity is normally a “potential space” what is it when the lung collapses

A

A real space

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129
Q

If one lungs collapses, does the other? Why?

A

No bc they do not communicate

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130
Q

Laceration or rupture of the surface of a lung(and its visceral pleura) or penetration of the thoracic wall (and itsparietal pleura) reuslts in _____ and the entrance of air into the pleural cavity

A

Hemorrhage

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131
Q

How will a collapsed lung appear radiographically

A

Lung occupies less volume (elevation of the diaphragm above its usual levels, intercostal space narrowing(ribscloser together), and displacement of the mediastinum (mediastinal shift) and the pulmonary cavity does not increase in size during inspiration
Collapsed lung will be more white and surrounded by more radiolucent(black) air

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132
Q

Describe mediastinal shift with collapsed lung

A

Shifts to the affected side.
Most evident by the air filled teachea within it

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133
Q

In open chest surgery, how is respiration and lung inflation maintained

A

Incubating the trachea with a cuffed tube and using a positive pressure pump, varying the pressure to alternately inflate and deflate the lung

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134
Q

Pneumothorax

A

Entry of air into the pleural cavity

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135
Q

How may someone get pneumothorax

A

Bullet into parietal pleura
Rupture of a pulmonary lesion into the pleural cavity (bronshopulmonary fistula)
Fractured ribs may tear visceral pleura and lung

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136
Q

How may someone get hydrothorax

A

Pleural effusion

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137
Q

How may someone get hemothorax

A

Chest wound, blood may also enter the pleural cavity

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138
Q

Hemothorax results more commonly from injury to a major ______ or ____ ___- than from laceration of the lung

A

Intercostal or internal thoracic vessel

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139
Q

If both air and fluid(eg. hemopneumothorax) accumulate int he pleural cavity, what will be seen radiographically

A

Air-fluid level or interface (sharp line, horizontal regardless of the patients position, indicating the upper surface of the fluid)

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140
Q

Thoracentesis

A

Insert a hypodermic needle through an intercostal space into the pleural cavity to obtain a sample of fluid or to remove blood or pus

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141
Q

When doing a thoracentesis, how do you avoid damage to the intercostal nerve and vessels

A

Needle is inserted superior to the rib, high enough to avoid collateral branches

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142
Q

During thoracentesis, the needle passes through the intercostal muscles and costal parietal pleura into the pleural cavity. When the patient is in the ___ position, intrapleural fluid will accumulate in the ____ recess

A

Upright
Costodiaphragmatic

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143
Q

During thoracentesis, inserting the needle into the __ intercostal space in the mid axillary line during expiration will avoid the inferior border of the lung

A

9th

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144
Q

During a thoracentesis why should the needle be angled upward

A

To avoid penetrating the deep side of the recess (a thin layer of the diaphragmatic parietal pleura and diaphragm overlying the liver)

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145
Q

Major amounts of air, blood, serous fluid, pus, or any combo of these in the pleural cavity are removed by what?

A

Insertion of a chest tube

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146
Q

For inserting a chest tube, a short incision is made in the _ or _ intercostal space in the mid axillary line

A

5 6

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147
Q

A chest tube may be directed superiorly (toward cervical pleura)for removal of ____ or inferiorl (toward the costodiaphragmatic recess)y for removal of ___

A

Air
Fluid

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148
Q

Removal of air from a collapsed lung allows what

A

Reinflation

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149
Q

Failure to remove fluid from lung causes what

A

Lung to develop a resistant fibrous covering that inhibits expansion unless it is peeled off

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150
Q

What is lung decortication?

A

Lung develops a resistant fibrous covering that inhibits expansion unless it is peeled off

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151
Q

Why may one get lung decortication?

A

Hydrothorax

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152
Q

Pleuritis

A

Inflammation of the pleura

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153
Q

What conditions may obliterate the pleural cavity

A

Pleutiris or pleurectomy

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154
Q

Does obliteration of the pleural cavity cause appreciable functional consequences

A

No

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155
Q

However, obliteration of the pleural cavity may produce _ during exertion

A

Pain

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156
Q

Pleurodesis

A

Adherence of parietal and visceral pleura with an irritating powder or sclerosis agent

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157
Q

Why perform a pleurectomy and pleurodesis

A

Prevent recurring spontaneous secondary atelectasis caused by chronic pneumothorax or malignant effusion resulting from the lung disease

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158
Q

Thorascopy

A

Diagnostic or therapeutic, or to take biopsy , excise pathological formations , drainage, treatments
Procedure in which pleural cavity is examined with a thoracoscope

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159
Q

Where make an incision for a thoracoscopy

A

Small incision into he pleural cavity via 1- 3 intercostal spaces

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160
Q

During normal inspiration and expiration, the normally smooth and moist pleura makes no sound. During auscultation of someone with pleuritis (pleurisy), what is the case

A

Lung surfaces are rough. Resulting friction (pleural rub) is detectable with a stethescope

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161
Q

What do you hear during auscultation of an inflamed lung

A

Pleural rub
Sound like a clump of hairs being rolled between the fingers

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162
Q

Pleural adhesion

A

Parietal and visceral layers adhere

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163
Q

What causes pleural adhesion

A

Inflammation pleuritis

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164
Q

Signs of acute pleuritis

A

Sharp, stabbing pain, especially on exertion, ugh as climbing stairs, when the rate and depth of respiration maybe increased even slightly

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165
Q

What are some variations in lobes of the lung

A

Oblique or horizontal fissures may be incomplete or absent in some specimens , with consequent reductions in the number of lobes
An extra fissure could divide lung
Left lung sometimes has 3 lobes and right only 2
Accessory lobe

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166
Q

What is the most common accessory lung lobe

A

Azygos lobe , appears in the right lung in 1% of ppl

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167
Q

Where is an accessory azygos lobe

A

Superior to the hilum of the right lung, separated front he rest of the lung by a deep groove lodging the arch of the azygos vein .

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168
Q

What is the normal, healthy color of lungs

A

Light pink

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169
Q

Who has lungs that are dark and mottled and why

A

Adults who live in urban or agricultural areas, especially smokers bc of accumulation of carbon and dust particles in the air and irritants in tobacco that are inhaled

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170
Q

How do lungs remove carbon from gas exchanging surfaces and deposit it in the inactive ct which supports the lung, or lymph nodes receiving lymph from the lung

A

Lymph from he lungs carries special cells (phagocytes)

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171
Q

Why do we auscultation the lungs

A

Assess airflow through the tracheobronchial tree into the lobes of the lung

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172
Q

Why do we percuss the thorax

A

Tell whether tissues are air filled (resonant)
Filled with fluid(dull) or solid (flat sound

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173
Q

How do you auscultate the inferoposterior part of the inferior lobe (base of the lung)

A

Stethescope to the posterior thoracic wall at the level of the 10th thoracic vertebra

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174
Q

The __ main bronchus is wider and shorter and runs more vertically

A

Right

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175
Q

Aspirated foreign bodies are more likely to lodge in the branches of the __ bronchus

A

Right

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176
Q

Bronchoscope

A

An endoscope for inspecting the interior of the tracheobronchial tree

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177
Q

What is the carina

A

Ridge between the orifices of the right and left main bronchus

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178
Q

Why would the carina be distorted, widened posteriorly and immobile

A

If the tracheobronchial lymph nodes in the angle between the main bronchi re enlarged bc cancer have metastasized from a bronchogenic carcinoma

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179
Q

What are morphological changes int he carina seen during bronchoscope useful for

A

Differential diagnosis

180
Q

The mucous membrane covering the carina is one of the most sensitive areas of the tracheobronchial tree and is associated with the ___ ____

A

Cough reflex

181
Q

If someone aspirates a peanut and coughs, when does the coughing stop

A

When peanut passes carina

182
Q

If the choking victim is inverted to use gravity to get the peanut out, why would they cough?

A

Lung secretions pass carina

183
Q

Pneumonectomy

A

Remove whole lung

184
Q

Lobectomy

A

Remove lobe

185
Q

Segmentectomy

A

Remove bronchopulmonary segment

186
Q

What does blockage of a segmental bronchus cause

A

Segmental atelectasis
Prevent air from reaching the bronchopulmonary segment it supplies , air in blocked segment will be gradually absorbed into the blood, the segment will collapse

187
Q

In segmental atelectasis(volume loss) may initially cause what? Then what?

A

Mediastinal shift to the side of the atelectasis
But ipsilateral segments may expand to compensate for the reduced volume of the collapsed segment

188
Q

Obstruction of a pulmonary artery by blood

A

Embolus

189
Q

What causes a pulmonary artery embolus

A

Blood clot, fat globule, air bubble travels in the blood to the lungs from a. Leg vein (ex. After compound fracture)

190
Q

Explain path of embolus starting in the leg

A

Leg vein to right side of heart to a lung through pulmonary artery

191
Q

Pulmonary embolism

A

Embolism that blocks a pulmonary artery

192
Q

Immediate result of PE

A

Partial of complete obstruction of blood flow to the lung
Results in lung or sector of lung to be ventilated with air but not perfumed with blood

193
Q

What happens when a large embolus occluded a pulmonary artery

A

Acute respiratory distress bc major decrease in oxygenation of blood
Right heart may becomes dilated bc volume of blood arriving cant be pushed along (acute cor pulmonale)

194
Q

Acute cor pulmonale

A

Right side of heart becomes dilated bc blood arriving cant be pushed through the pulmonary circuit

195
Q

Acute respiratory distress from a large embolus can cause death in ____

A

Minutes

196
Q

A medium size embolus may block an artery supplying a bronchopulmonary segment. What does this cause

A

Pulmonary infarct, an area of necrotic dead lung

197
Q

Why is a PE less likely to cause infarction in a physically active person

A

Physically active people -a collateral circulation often exists and develops
Anastomoses with branches of the bronchial arteries abound in the region of the terminal bronchioles

198
Q

Chronic congestion(ill ppl) and PE

A

In ill people with impaired circulation in the lung , PE results in infarction

199
Q

What happens when an area of visceral pleura is also deprived of blood in

A

Inflamed (pleuritis) and irritates to become fused to the sensitive parietal pleura

200
Q

Describe pain from the parietal pleura

A

Referred to the cutaneous distribution of the intercostal nerves to the thoracic wall or, in the case of inferior nerves, to the anterior abdominal wall

201
Q

In pleural adhesion, the lymphatic vessels in the lung and visceral pleura may _____ with the parietal lymphatic vessels that drain into the axillary lymph nodes

A

Anastomoses

202
Q

What do carbon particles in the axillary lymph nodes provide evidence for?

A

Pleural adhesion

203
Q

Why does someone spit blood or blood stained sputum

A

Bronchial or pulmonary hemorrhage

204
Q

In 95% of cases of spitting blood, the bleeding is from what?

A

Branches of the bronchial arteries

205
Q

What is the most common cause of spitting blood

A

Bronchitis, lung cancer, pneumonia, tb, pulmonary embolism, bronchiectasis

206
Q

What i the main cause of lung cancer

A

Cigarette smoke

207
Q

Where do most lung cancers arise

A

Mucosa of the large bronchi and produce a persistent, productive cough or hemoptysis

208
Q

Hemoptysis

A

Spitting blood

209
Q

Early metastasis of lung cancer

A

Bronchopulmonary nodes

210
Q

Common sites of lung cancer hematogenous metastasis

A

Brain, bones, lungs, suprarenal glands

211
Q

Hematogenous spread of lung cancer

A

Tumor invade systemic circulation, then transported in pulmonary veins to the left heart, aorta, and these structures

212
Q

What lymph nodes are enlarged whe bronchogenic carcinoma develops owing to metastasis of cancer cells from the tumor

A

Supraclavicular lymph nodes

213
Q

Why were supraclavicular lymph nodes called sentinel nodes

A

Their enlargement alerted the physician to the possibility of malignant disease in the thoracic and or abdominal organs

214
Q

What are sentinel nodes now

A

Node or nodes that first receive lymph draining from a cancer containing area, regardless of location following injection of dye or radioactive tracer

215
Q

What may lung cancer involving the phrenic nerve cause

A

Paralysis of one half of the diaphragm (hemidiaphragm)

216
Q

What nerve may be involved in apical lung cancer

A

Recurrent laryngeal nerve bc of its close relationship with the apex of the lung

217
Q

Signs that there is recurrent laryngeal nerve involvement

A

Hoarseness owing to paralysis of a vocal fold (cord) bc the recurrent laryngeal nerve supplies all but one of the laryngeal nerves

218
Q

Why is the visceral pleura insensitive to pain

A

Receives no nerves of general sensation

219
Q

Why is parietal pleura EXTREMELY sensitive to pain

A

Richly supplied by branches of the intercostal and phrenic nerves

220
Q

What is pain from pleura felt like

A

Projected to dermatology supplied by the same spinal (posterior root) ganglia and segments of the spinal rod

221
Q

What kind of pain results from irrigation of the costal and peripheral parts of the diaphragmatic pleura

A

Local pain and referred pain to the dermatologist of the thoracic and abdominal walls

222
Q

What kind of pain is felt with irritation of the mediastinal and central diaphragmatic areas of parietal pleura

A

Referred pain to the root of the neck and over the shoulder (C3-c5)

223
Q

Why do a PA radiograph of the thorax

A

To examine respiratory, cardiovascular structures and thoracic wall

224
Q

Why take a deep breath and hold when taking a PA radiograph of chest

A

Causes diaphragmatic domes to descend , filling the lungs with air (increasing radiolucency) and moving the inferior margins of the lungs into the costodiaphragmatic recess

225
Q

How will you see pleural effusions on a PA chest radiograph

A

The inferior margins should appear as sharp acute angles
Pleural effusions accumulate here and do not allow the inferior margin to descend into the recess and the usual rediolucent air density is replaced by hazy radiopacity

226
Q

How does lobar disease, such as pneumonia appear on a PA radiograph of chest

A

Localized, relatively radiodense areas that contrast with the radiolucency of the remainder of the lung

227
Q

How is a PA radiograph viewed

A

As if facing the patient , an AP view

228
Q

In older people costal cartilages May be calcified

A

Especially inferior cartilages

229
Q

In the radiograph, inferior ribs are obscured by the ___

A

Diaphragm

230
Q

In OA projections, the right and left domes of the diaphragm are separated by what

A

The central tendon, which is obscured by the heart

231
Q

The __ dome of the diaphragm, is usually half an intercostal space higher than the __. Why

A

Right
Left
Liver on right

232
Q

The areas obscured in PA projections are usually visible in lateral radiographs.

A

Yup

233
Q

In a lateral projection, the middle and inferior thoracic vertebrae are visible, although they are partially obscured by the ___

A

Ribs

Can also see three parts of sternum

234
Q

Lateral radiographs

A

Allow better viewing of a lesion of anomaly confined to one side of the thorax

235
Q

In a lateral projection, both domes of the diaphragm are often visible as they arch superiorly from the sternum. A lateral radiograph is made using a lateral projection, with the side of the thorax against the film cassette or x ray detector and the upper limbs elevated over the head

A

Ok

236
Q

Transverse thoracic plane

A

Divides superior and inferior mediastinum

237
Q

Does the thoracic plane depend on gravity

A

No mainly in terms of bony body wall

238
Q

The level of the viscera relative to the subdivision of the mediastinum depends on the position of the person(gravity). When a person is supine, the viscera are ___ relative to the subdivisions of the mediastinum than when. A person is upright

A

Higher
More superior

239
Q

Gravity pulls the viscera__

A

Down

240
Q

Anatomical descriptions traditionally describe the level of the viscera as if the person was ___

A

Supine

241
Q

In the supine position: the arch of the aorta lies ___ to the transverse plane

A

Superior

242
Q

In the supine position the bifurcation of the trachea is transacted by the __ ___ ___

A

Transverse thoracic plane

243
Q

In the supine position: the central dtendon of th diaphragm lies at the level or what

A

Xiphisternal junctional and vertebra t9

244
Q

When sitting upright: the arch of the aorta is ___ y the transverse thoracic plans

A

Transected

245
Q

When sitting upright: the tracheal bifurcation lies ___ to the transverse thoracic plane

A

Inferior

246
Q

When sitting upright: the central tendon of the diaphragm may fall to the level of the middle of what

A

The xiphoid process and t9-t10 IV discs

247
Q

Why is all this important

A

Must know when doing radiological examinations in the erect and supine position.

248
Q

When lying on side?

A

Mediastinum sags toward the lower side under the pull of gravity

249
Q

Mediastinoscope

A

Endoscope, surgeons can see much of the mediastinum and conduct minor surgical procedures.

250
Q

Where do surgeons insert a mediastinoscope

A

Small incision at the root of the neck, just superior to the jugular notch of the manubrium, into the potential space anterior to the trachea

251
Q

What can you see from a mediastinoscope

A

View or biopsy mediastinal lymph nodes to determine if cancer calls have metasticized to them

252
Q

Anterior thoracotomy

A

Mediastinum can also be explored and biopsies when remove part of a costsal cartilage

253
Q

Widening of the mediastinum

A

After trauma, head on collision
Hemorrhage in mediastinum from lacerated vessels such as the aorta of SVC

254
Q

What specific conditions widen the mediastinum

A

Malignant lymphomas
Hypertrophy of the heart (CHF)

255
Q

What is the pericardial sinus

A

After pericardial sac is opened anteriorly, a finger can be passes through the transverse pericardial since posterior to the ascending aorta and pulmonary trunk

256
Q

By passing a surgical clamp or a ligature around these large vessels, inserting the tubes of a corona bypass machine, and then tightening the ligature

A

Surgeons can stop or divert the circulation of blood in these arteries while performing cardiac surgery, such as coronary artery bypass

257
Q

After ascending the entire thoracic part of the IVC is enclosed by _____ (2cm)

A

Pericardium

258
Q

The __ __ must be opened to expose the terminal part of the IVC

A

Pericardial sac

259
Q

Is the same true for the SVC

A

Yup

260
Q

Pericarditis

A

Inflammation of the pericardium

261
Q

What does pericarditis cause

A

Chest pain and makes the serous pericardium rough

262
Q

Usually the smooth opposing layers of the serous pericardium make no detectable sound during auscultation.. what happens if there is pericarditis what happens

A

Friction of the roughened surface may sound like the rustle of silk upon auscultation over the left sternal border and upper ribs (pericardial friction rub)

263
Q

A chronically inflamed and thickened pericardium may ____

A

Calcify

264
Q

Does calcification effect cardiac efficiency

A

Yes

265
Q

Pericardial effusion

A

Passage of fluid from pericardial capillaries into the pericardial cavityor an accumulation of pus

266
Q

Result of pericardial effusion

A

Heart becomes compressed (unable to expand and fill fully) and ineffective

267
Q

Noninflammatory pericardial effusions often occur with what

A

CHF

268
Q

What does CHF cause

A

Venous blood returns to the heart at a rate that exceeds cardiac output, producing right cardiac hypertension

269
Q

Describe the fibrous pericardium

A

Tough, inelastic closed sac that contains the heart , normally the only occupant other than a thin lubricating layer of pericardial fluid

270
Q

If extensive pericardial effusion exists, the compromised volume of the sac does not allow full expansion of the heart, limiting what

A

The amount of blood the heart can receive, which in turn reduces cardiac output

271
Q

Cardiac tamponade

A

Heart compression
Is potentially lethal condition bc heart volume is increasingly compromised by the fluid outside the heart but inside the pericardial cavity

272
Q

Hemopericardium

A

Blood in the pericardial cavity

273
Q

What does hemopericardium produce

A

Cardiac tamponade

274
Q

What may cause hemopericardium

A

Perforation of a weakened area of heart muscle owing to a previous MI or heart attack, from bleeding into the pericardial cavity after cardiac operations or from stab wounds

275
Q

Why is hemopericardium especially lethal

A

High pressure involved and the rapidity with with which the fluid accumulates
Heart is increasingly compressed and circulation. Fails

276
Q

In cardiac tamponade, the veins of the neck and face become engorged because of the backup of blood, beginning where the SVC enters the pericardium

A

T

277
Q

How may someone get a pneumopericardium

A

In patients with pneumothorax, air or gas in the pleural cavity, the air may dissect along CT planes and enter the pericardial sac

278
Q

PeriCardiocentesis

A

Drainage of fluid fromt he pericardial cavity

279
Q

Why may you need cardiocentesis

A

Receive cardiac tamponade

280
Q

In pericardiocentesis, a wide bore needle may be inserted through the _ or _ intercostal space near the sternum

A

5, 6

281
Q

This approach to the pericardial sac is possible because the cardiac notch on the _ lung and the shallowed notch in the leftpleural sac leave part of the pericardial sac exposed-the bare area of the pericardium

A

Left

282
Q

The pericardial sac may also be reached via the xiphoid star angle by passing the needle _______

A

Superoposteriorly

Needle avoids the lung and pleura and enters the pericardial cavity…but take care not to puncture the internal thoracic artery of its terminal branches

283
Q

In acute cardiac tamponade from hemopericardium, an emergency _____ may be performed so that the pericardial sac may be incised to immediately relieve the tamponade and establish stasis of the hemorrhage

A

Thoracotomy

284
Q

Abnormal folding of the embryonic heart tube to the left instead of the right may cause the position of the heart to be completely ___.

A

Reversed

285
Q

Dextrocardia

A

Apex misplaced to right instead of left

286
Q

What is dextrocardia associated with

A

Mirror image positioning of the great vessels and arch of the aorta

287
Q

Situs inversus

A

General transposition of the thoracic and abdominal viscera
Minimal accompanying cardiac defects and heart functions normally

288
Q

Isolated dextrocardia

A

Transposition may affect only the heart

Congenital anomaly may be complicated b severe cardiac anomalies such as transposition of the great arteries

289
Q

The usual pattern of branches of the arch of the aorta is present in __% of ppl

A

65

290
Q

Variations in the origin of the branches of the arch are fairly common

A

Ok

291
Q

In approximately 27% of people, the _ common carotid originates from the brachiocephalic trunk

A

Left

292
Q

In 2.5 % of people a brachiocephalic trunk fails to form . What happens in these peopl

A

The four arteries, right and left common carotid and subclavian arteries originate independently from the arch of the aorta

293
Q

In 5% of people the left vertebral artery originates from the arch of the ____

A

Aorta

294
Q

In 1.2% of people both the right and left ____ __ originate from the arch

A

Brachiocephalic trunks

295
Q

Retro-esophageal right subclavian artery

A

Sometimes arises as the last(most left) branch of the arch of the aorta .. it crosses posterior to the esophagus to reach the right upper limb

296
Q

A retroesophageal right subclavian artery may compress the the ____, causing what

A

Esophagus, causing difficulty in swallowing (dysphagia)

297
Q

Thyroid ima artery

A

Accessory artery may arise from the arch of the aorta or the brachiocephalic artery

298
Q

The most superior part of the arch of the aorta is usually __ cm inferior to the superior border of the manubrium but it may be more superior or inferior

A

2.5 cm

299
Q

Right arch of the aorta

A

Sometimes the arch curves over the root of the right lung and passes inferiorly on the right side,

300
Q

In some cases

A

The abdominal arch after passing over the root of the right lung passes posterior to the esophagus to reach its usual position on the left side

301
Q

Double arch of the aorta

A

Forms a vascular ring around the esophagus and trachea…may compress trachea and affect breathing

302
Q

Surgery for double arch of the aorta

A

Surgical division of the vascular ring

303
Q

The distal part of the ascending aorta receives a strong thrust of blood when the left ventricle contracts. Bc its wall is not yet reinforced by fibrous pericardium, an ___ may develop

A

Aneurysm

304
Q

How do you recognize an aortic aneurysm on a MR angiogram or chest film

A

Enlarged area of the ascending aorta silhouette

305
Q

How do patients with aneurysm of ascending aorta present

A

Chest pain that radiates to the back
Difficulty breathing

306
Q

Why would an ascending aneurysm cause difficulty breathing

A

Aneurysm may exert pressure on the trachea , esophagus, and recurrent laryngeal nerve

307
Q

Coarctationof the aorta

A

The arch of the aorta or thoracic aorta has an abnormal narrowing that diminishes the caliber of the aortic lumen, producing an obstruction to blood flow to the inferior part of the body

308
Q

What is the most common site for coarctation

A

Near the ligamentum arteriosum

309
Q

When the coarctation is inferior to the ligamentum arteriosum (postductal coarctation), what happens

A

A good collateral circulation usually develops between the proximal and distal party’s of the aorta through the intercostal and internal thoracic arteries

310
Q

Is a postductal coarctation compatible with life

A

Yes bc the collateral circulation carries blood to the thoracic aorta inferior to the stenosis

311
Q

In postductal coarctation can you see the collateral vessels superficially

A

Yea they can become so large that they cause notable pulsation in the intercostal spaces and erode the adjacent surfaces of the ribs, which is visible in radiographs of the thorax

312
Q

What does the recurrent laryngeal nerve supply

A

All intrinsic muscles of the larynx, except one

313
Q

What may injure the recurrent laryngeal nerve

A

Any investigative procedures, or disease processes in the superior mediastinum

314
Q

What happens when injure recurrent laryngeal nerve

A

Affect voice difficulty swallowing

315
Q

Explain the course of the left recurrent laryngeal nerve

A

Winds around the arch of the aorta and ascends between the trachea and esophagus

316
Q

Due to the course of the recurrent laryngeal nerve it may be involved in what

A

A bronchiogenic or esophageal carcinoma , enlargement of mediastinal lymph nodes or an aneurysm of the arch of the aorta

317
Q

What happens to recurrent laryngeal nerve if there is an aneurysm of the arch of the aorta

A

May be stretched

318
Q

Why are the impressions produced in the esophagus by adjacent structures of clinical importance

A

The slower passage of substances at these sites

Impressions indicate where swallowed foreign objects are most likely to lodge and where a stricture may develop, for example after the accidental drinking of a caustic liquid such as lye

319
Q

The thoracic duct is thin walled and usually dull white in living people. It may be ___ making it hard to identify

A

Colorless

320
Q

What is the thoracic duct vulnerable to

A

Damage when doing investigative and or surgical procedures int he posterior mediastinum

321
Q

Laceration of the thoracic duct

A

Lymph escapeinto the thoracic cavity
Lymph or chyle from the lacteals of the intestine may also enter the pleural cavity producing chylothorax

322
Q

Chylothorax

A

Lymph and chyle from lacteals of intestine enter the pleural cavity

323
Q

How can we remove lymph and chyle from thorax

A

Needle tap, thoracentesis, or tie off the thoracic duct

324
Q

Why are variations of the thoracic duct common

A

Superior part of the duct represents the original left member of a pair of lymphatic vessels in the embryo. Sometimes two thoracic ducts are present for a short distance

325
Q

The azygos, hemi-azygos, and accessory hemiazygos veins offer alternate means of venous drainage from the thoracic, abdominal and back regions when obstruction of the IVC occurs

A

In some people, an accessory azygos. Vein parallels the azygos vein on the right side

326
Q

Other people have no hemiazygos vein on the right side

A

Sometimes the azygos system receives all the blood from the IVC except that from the liver…in these people the azygos system drains nearly all the blood inferior to the diaphragm , except from the digestive tract

327
Q

Obstruction of the SVC superior to the trance of the azygos vein

A

Blood can drain inferiorly into the veins of the abdominal wall and return to the right atrium through the azygos venous system and the IVC

328
Q

When is the thymus a prominent feature of the superior mediastinum

A

Infancy and childhood

329
Q

In some infants, the thymus may compress the ___

A

Trachea

330
Q

As puberty is reached, the thymus begins to ____

A

Diminish in size

331
Q

By adulthood, what happens to the thymus

A

Replaced by adipose tissue and is often scarcely recognizable, however it continues to produce t lymphocytes

332
Q

Aortic angiogram

A

Catheter is passed into the ascending aorta cia the femoral or brachial artery in the inguinal or elbow region, under fluoroscopic control the tip of the catheter is placed just in size the opening of a coronary artery

Aortic angiogram made by injecting radioopaque contrast material into the aorta and into openings of the arteries arising from the arch of the aorta

333
Q

Cardiovascular shadow

A

Important bc changes in the shadow may indicate anomalies or functional disease

334
Q

PA right border of the cardiovascular shadow

A

Right brachiocephalic vein, SVC, right atrium

335
Q

PA left border of the cardiovascular shadow

A

Terminal part of the arch of the aorta, pulmonary trunk, left auricle and left ventricle

336
Q

The left inferior part of the cardiovascular shadow presents the region of the __

A

Apex

337
Q

The typical anatomical apex, if present, of often __ to the shadow of the diaphragm

A

Inferior

338
Q

Three major cardiovascular shadows occur, depending on body habitus. What are they

A

Transverse type, oblique type, vertical type

339
Q

Transverse type of CV shaddow

A

Obese people, pregnant and infants

340
Q

Oblique type of CV shadow

A

Most people

341
Q

Vertical type of CV shadow

A

Present in people with narrow chests

342
Q

What radiology is commonly used to examine the thorax

A

CT MRI

343
Q

Before CT are taken of the mediastinum, what is done

A

Injection of iodine contract . Breast cancer cells have an unusual affinity for iodine

344
Q

CT is sometimes combined with mammography to examine the

A

Breasts

345
Q

MRI is usually better for detecting and delineating soft tisssue lesions

A

Good for lymph nodes of the mediastinum of the mediastinum and roots of the lungs by means of both planar and reconstructed images

346
Q

Transverse CT and MRI are always from what orientation

A

Physician at patients feet

347
Q

Cardiac catheterization

A

Radioopaque catheter is inserted into a peripheral vein and passes under fluoroscopic control into the right atrium, right ventricle, pulmonary trunk and pulmonary arteries

348
Q

What can we get from cardiac catheterization

A

Intracranial pressure
Blood samples may be taken
If radioopaque contrast medium is injected, can be followed through heart and great cellls

349
Q

Cineradiography/cardiac ultrasonography

A

Can be performed to observe the flow of dye in real time. Permit the study of circulation through he functioning heart and are helpful in the study of congenital defects(like cardiac cath)

350
Q

The right primordial atrium is represented int he adult by the __ ___

A

Right auricle

351
Q

The definitive atrium is enlarged by incorporation of most of the embryonic ___ ___

A

Sinus venosus

352
Q

The coronary sinus is also a derivative of this __ __

A

Venous sinus

353
Q

The part of the venous sinus incorporated into the primordial atrium becomes the what

A

The smooth walled sinus venarum of the adult right atrium into which all the veins drain, including the coronary sinus

354
Q

Crista terminalis

A

Line of fusion of the primordial atrium and the sinus venarum INTERNALLY

355
Q

Sulcus terminalis

A

Line of fusion of the primordial atrium and the sinus venarum EXTERNALLY

356
Q

Where is the SA node

A

Just in front of the opening of the SVC at the superior end of the crista terminalis

357
Q

Before birth the valve of the IVC directs most of the oxygenated blood returning from the placenta in the umbilical vein and IVC toward the oval foramen in the interatrial septum throug which it passes into he left atrium

A

The oval foramen has a flap like valve that permits a right to left shunt of blood but prevents a left to right shunt

358
Q

At birth when a baby takes its first breath the lungs expand with air and pressure in the right atrium falls below that in the left atrium

A

Consequently, the oval foramen closes for its first and last time and its valve usually fuses with the interatrial septum

359
Q

The closed oval foramen is represented in the postnatal interatrial septum b the depressed oval fossa

A

The border of the oval fosssa surrounds the fossa

360
Q

The floor of hte fossa is formed by the valve of the oval foramen

A

The rudimentary IVC valve, a semilunar crescent of tissue, has no function after birth .it varies considerably in size and is occasionally absent

361
Q

Why is pain from an abscess or tumor int he popliteal fossa usually severe

A

The deep popliteal fascia is strong and limits expansion

362
Q

Where do popliteal abscesses spread

A

Superiorly and inferiorly because of the toughness of the popliteal fascia

363
Q

Why is it hard to feel te popliteal pulse

A

Bc the popliteal artery is deep

364
Q

How do you palpate the popliteal pulse

A

Person in prone position with the knee flexed to relax the popliteal fascia and hamstrings
Feel in the inferior part of the fossa where the popliteal artery is related to the tibia

365
Q

What is weakening or loss of the popliteal pulse a sign of

A

Femoral artery obstruction

366
Q

Popliteal aneurysm

A

Dilation of all or part of the popliteal artery

367
Q

What does popliteal aneurysm cause

A

Edema and pain in the popliteal fossa

368
Q

How can you distinguish a popliteal aneurysm from other masses

A

Palpable pulsation (thrills) and abnormal arterial sounds (bruits) detectable with a stethoscope

369
Q

The popliteal artery lies deep to the ___ nerve,

A

Tibial

370
Q

A popliteal aneurysm may stretch the __ nerve or compress its blood supple (vasa varosum)

A

Tibial

371
Q

If a popliteal aneurysm stretches the tibial nerve where do you feel pain?

A

Skin overlying the medial aspect of the calf, ankle, or foot

372
Q

Fractures of the distal femur or dislocation of the knee may rupture the __ artery, resulting in ____

A

Popliteal
Hemorrhage

373
Q

An injury to the poplitealartery and vein may cause what

A

Ateriovenous fistula

374
Q

If the femoral artery must be ligated, blood can bypass the occlusion through the ___ anastomses and reach the popliteal artery distal to the ligation

A

Geniculate

375
Q

Why is injur to the tibial nerve uncommon

A

Deep and protected position in the popliteal fossa

376
Q

What may injure the tibial nerve

A

Deep lacerations
Posterior dislocation of the knee joint

377
Q

What happens with severance of the tibial nerve

A

Produce paralysis of the flexor muscles int he leg and the intrinsic muscles in the sole of the foot
Unable to plantarflex their ankle or flex their toes
Loss of sensation on the sole of foot

378
Q

The fascial compartments of the lower limbs are generally ___ spaces , ending proximally and distally at the joints

A

Closed

379
Q

Bc the septa and deep fascia of the leg forming the boundaries of the leg compartments are strong, the increased volume consequent to infection with ____- increases compartmental pressure

A

Suppuration (pus formation)

380
Q

Inflammations within the anterior and posterior compartments of the leg spread chiefly in a ___direction ; however a purulent infection int he lateral compartments of the leg can ___ proximally I tot he popliteal fossa, presumably along the course of the fibular nerve

A

Distal
Ascend

381
Q

Fasciotomy

A

Incision of fascia may be necessary to relieve pressure and debride pockets of infection

382
Q

Shin splints

A

Edema and pain in the area of the distal two thirds of the tibia-result from repetitive microtrauma of the tibialis anterior which causes small tears in the periosteum covering the shaft of the tibia and/or of fleshy attachments to the overlying deep fascia of the leg

383
Q

Shin splints are a mild form of __ __ __

A

Anterior compartment syndrome

384
Q

What causes shin splints

A

Traumatic injury or athletic overexertion of msucles in the anterior compartment, especially TA, by untrained persons

385
Q

Often persons who lead ___ lives develop shin splints when they participates in long distance walks

A

Sedentary

386
Q

Shin splints also occur in trained runners who do not do warm up or cool down. Why

A

Muscles in the anterior compartment swell from sudden overuse and the edema and muscle-tendon inflammation reduce the blood flow to muscles. The swollen muscles are painful and tender to pressure

387
Q

The foot of humans are relatively exerted (probated) so that the soles lie more fully on the ground. What is this pronation a result of

A

Medial migration of the distal attachment of the fibular is longus across the sole of the foot and the development of a fibular is tertius that is attached to the base of the 5th metatarsal.

388
Q

What is the most often injured nerve of the lower limb and why

A

Common fibular nerve
It is superficial
Winds subcutaneously around the fibular neck, leaving it vulnerable to direct trauma

389
Q

The common fibular nerve may be injured when the __ joint is injured or dislocated

A

Knee

390
Q

Severance of the common fibular nerve causes what

A

Flaccid paralysis of all muscles in the anterior and lateral compartments of the leg (dorsiflexors of ankle and evertors of foot)

391
Q

The loss of dorsiflexion of the ankle causes ___

A

Footdrop

392
Q

Footdrop makes the leg look

A

Too long (the toes don’t clear the ground)

393
Q

What conditions may result in a lower limb that is too long, functionally (for example, pelvic tilt and spastic paralysis or contraction fo the soleus) what are the three means of compensating for this problem

A
  1. Waddling gait
  2. Swing outgait
    3.high stepping steppage gait
394
Q

Waddling gait

A

Individual leans to the side opposite the long limb, hiking the hip

395
Q

Swing out gait

A

Long limb is swung out laterally (abducted) to allow the toes to clear the ground

396
Q

High stepping steppage gait

A

Extra flexion is employed at the hip and knee to raise the foot as high as necessary to keep the toes from hitting the ground

397
Q

Bc the dropped foot makes it difficult to make the heel strike the ground first as in a normal gait, a steppage gait is commonly employed int he case of flaccid paralysis

A

Sometimes an extra kick is added as the free limb swings forward in an attempt to flip the forefoot upward just before setting the foot down

398
Q

The braking action normally produced by eccentric contraction of the dorsiflexors is also lost in flaccid paralysis foot drop

A

Therefore the foot is not lowered to the ground in a controlled manner after heel strike; instead the foot slaps the ground suddenly, producing a distinctive clop and greatly increasing the shock both received by the forefoot and transmitted up the tibia to the knee

399
Q

Individuals with a common fibular nerve injury

A

May also experience a variable loss of sensation on the anterolateral aspect of the leg and the dorsomedial of the foot

400
Q

Excessive use of the muscles supplied by the deep fibular nerve (skiing, running, dancing) may cause what

A

Deep fibular nerve entrapment
Muscle injury and edema in the anterior compartment..causing compression of the deep fibular nerve and pain in the anterior compartment

401
Q

Compression of the deep fibular nerve by tight fitting ski boots for example, may occur where the nerve passes deep to what

A

Inferior extensor retinaculum and extensor hallucis brevis

402
Q

Where does pain occur with a deep fibular nerve entrapment

A

Dorsum of the foot and radiates to the wed space between the 1st and 2nd toes

403
Q

Ski boot syndrome

A

Deep fibular nerve entrapment often caused by ski boots

404
Q

Who also gets deep fibular nerve entrapment and why

A

Soccer players and runners and can also result from tight shoes

405
Q

Chronic ankle sprains may produce recurrent stretching of the _____ ____ nerve

A

Superficial fibular

406
Q

What may entrapment of the superficial fibular nerve cause

A

Pain along the lateral side of the leg and the dorsum of the ankle and foot . Also numbness and paresthesia with increases in activity

407
Q

Fabella

A

Close to its proximal attachment the lateral hear of the gastrocnemius may contain a sesamoid bone

408
Q

What does the fabella articulate with

A

Lateral femoral condyle

409
Q

What percent of people have a fabella

A

3-5%`

410
Q

Calcaneal tendinitis

A

Inflammation of the calcaneal tendon

411
Q

Calcaneal tendinitis constitutes what percent of running injuries

A

9-18%

412
Q

Microscopic tears of collagen fibers in the tendon, particularly just superior to its attachment to the calcaneus results in ___,

A

Tendinitis

413
Q

Pain of calcaneal tendinitis

A

Pain during walking especially when wearing rigid soled shoes

414
Q

Calcaneal tendinitis often occurs during ___ activities..especially what

A

Repetitive
People who take up running after prolonged inactivity or suddenly increasing training intensity
OR POOR FOOTWEAR

415
Q

Who gets rupture of the calcaneal tendon

A

Poorly conditioned people with a history of calcaneal tendinitis

416
Q

How is the rupture of calcaneal tendon experienced

A

An audible snap during a forceful push off (plantarflexion with the knee extended) followed immediately by sudden calf pain and sudden dorsiflexion of the plantarflexed foot

417
Q

In a completelyruptured calcaneal tendon, what is palpable

A

Gap 1-5 cm proximal to the calcaneal attachment

418
Q

What muscles are affected by a ruptured calcaneal tendon

A

Gastrocnemius, soleus, and plantaris

419
Q

Calcaneal tendon rupture is probably the most severe acute muscular problem of the leg. How are they effected

A

Can’t plantarflex against resistance and passive dorsiflexion is excessive

420
Q

Ambulatory is possible only when the limb is laterally rotated, rolling over the transversely placed foot during the stance phase without push off

A

Ok

421
Q

With rupture calcaneal tendon where is bruising and where is there a lump

A

In the malleolar region and a lump usually appears in the calf owing to shortening of the triceps surae

422
Q

The ankle jerk reflex/triceps surae reflex, is a — tendon reflex

A

Calcaneal

423
Q

The calcaneal reflex tests the _ and _ nerve roots

A

S1 s2

424
Q

What happens if s1 nerve root is injured or compressed

A

Ankle reflex is virtually absent

425
Q

If the muscles of the calf are paralyzed, the calcaneal tendon is ruptured, or normal push off can still be accomplished by the actions of what

A

The gluteus Maximus and hamstrings in extending the knee

426
Q

Bc the push off from the forefoot is not possible, those attempting to walk in the absence of plantarflexion often rotate the foot as far ____ as possible during the stance phase to disable passive dorsiflexion and allow a more effective push off through hip and knee extension exerted at the midfoot

A

Laterally

427
Q

What is the gastrocnemius strain from

A

Partial tearing of the medial belly of the gastrocnemius at or neat its musculotendinous junction

428
Q

Who gets gastrocnemius strain

A

People over 40

429
Q

What causes gastrocnemius strain

A

Overstretching the muscle by concomitant full extension of the knee and dorsiflexion of the ankle joint.

430
Q

How do patients present with gastrocnemius strain

A

Abrupt onset of stabbing pain is followed by edema and spasm of the gastrocnemius

431
Q

Calcaneal bursitis (retro-achilles bursitis) results from what

A

Inflammation of the deep bursa of the calcaneal tendon located between the calcaneal tendon and the superior part of the posterior surface of the calcaneus

432
Q

Presentation of calcaneal bursitis

A

Causes pain posterior to the heel and occurs commonly during long-distance running , basketball, and tennis
Caused by excessive friction on the bursa as the tendon continuously slides over it

433
Q

How does blood return from the leg

A

A venous plexus deep to the triceps surae is involved in the return of blood from the lef

434
Q

When a person is standing, what does venous return from the leg depend on

A

Muscular activity of the triceps surae

435
Q

How does muscle move superiorly when standing

A

Musculovenous pump Contraction of the calf muscles pumps blood superiorly in the deep veins

436
Q

The musculovenous pump is improved by what

A

The deep fascia that invests the muscles like an elastic stocking

437
Q

What percent of people have an accessory soleus

A

3%

438
Q

Where is an accessory soleus

A

As a distal belly medial to the calcaneal tendon

439
Q

Clinical problem of accessory soleus

A

Associated with pain and edema (swelling) during prolonged exercise

440
Q

Where do you palpate the posterior tibial pulse

A

Between the posterior surface of the medial malleolus and the medial border of the calcaneal tendon

441
Q

Why is it important to have the patient invert their foot what taking a posterior tibial pulse

A

The posterior tibial artery passes deep to the flexor retinaculum

442
Q

If don’t invert the foot and try to take the posterior tibial pulse

A

May think its absent!

443
Q

Why are both posterior tibial arteries palpated for pulse at the same time

A

Idk

444
Q

Occlusive peripheral artery disease

A

Should measure posterior tibial pulse
Sign is absence of posterior tibial pulse in people over 60

445
Q

In the normal population how many people don’t have a posterior tibial pulse

A

15%

446
Q

Intermittent claudation

A

Leg pain and cramps, develops during walking and siappears after rest
May result in ischemia of the leg msucles caused by narrowing or occlusion of the leg arteries

Anatomy Examen 1 (7 decks)

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