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Exam 2 > Thorax Clinical Supplement > Flashcards

Thorax Clinical Supplement Flashcards

1
Q

What is pectus excavatum

A

depression of the sternum, associated with exercise intolerance, dyspnea, chest pain

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2
Q

What is pectus carinatum

A

pigeon chest, anterior protrusion of the sternum

dyspnea, frequent respiratory tract infections, scoliosis

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3
Q

What is sternal angle (angle of Louis)

A

union of the manubrium and body of the sternum, associated with sternal end of the 2nd rib

projects posteriorly to TV4

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4
Q

What structures are approximated at the sternal angle

A

superior border of the middle mediastinum, arch of aorta, bifurcation of trachea

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5
Q

What kind of tissue can the sternum be used for

A

red bone marrow sample

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6
Q

What happens if the sternum is biopsied

A

result in sternal fracture
pneumomediastinum
pneumothorax
cardiac tamponade

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7
Q

What are three types of causes of thoracic outlet syndrome

A

bony issues: cervical rib or hypo plastic first rib

soft tissue changes: hypertrophic/spastic muscles

others: trauma and tumors

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8
Q

What are signs and symptoms of thoracic outlet syndrome

A

compression of C8-T1 roots of brachial plexus: upper limb sensation and motor

vascular compression of subclavian: cold fingers, color changes in hands, claudication, pain

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9
Q

What are 5 consequences of rib fractures

A 
flail chest
pneumo or hemothorax
spleen injury or liver injury
lacerations of the aorta/great vessels
diaphragmatic hernia if diaphragm is pierced
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10
Q

fracture of which ribs may rupture spleen

A

9-12

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11
Q

Which ribs if fractured may rupture aorta

A

ribs 1+2

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12
Q

What is the dermatome of the male nipple

A

T4

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13
Q

What is the dermatome of the xiphoid process

A

T6

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14
Q

How does herpes zoster present

A

rash that follow dermatomal patterns

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15
Q

At which levels do we tend to find 66% of all herpes zoster eruptions

A

T5-T10

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16
Q

What is intercostal nerve block

A

injection of anesthesia into the intercostal space

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17
Q

Between which layers should the anesthesia for an intercostal nerve block be placed

A

internal intercostals

innermost intercostals

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18
Q

Which nerves are most at risk of iatrogenic injury in an intercostal nerve block and why

A

intercostal nerve and collateral branch

neurovascular bundle protects vein and artery while leaving nerve most exposed

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19
Q

In which direction does lymphatic drainage of organs in the body cavities generally follow

which three are exceptions

A

backwards to lymph nodes around main arterial branches

lungs, parts of liver, oral cavity and tongue

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20
Q

Three mechanisms of cancer cell metastasis

A 
local spread and invasion (seeding of pleura and peritoneum)
lymphatic channels
blood vessels (vein, arteries, then capillary beds)
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21
Q

Lymph drainage of breast

A

majority to axillary
medial to parasternal
inferior to inferior phrenic (route to liver metastasis)

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22
Q

Where do 60% of malignant breast tumors arise from

A

superior lateral quadrant

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23
Q

How can breast cancer metastasize to liver

A

inferior phrenic nodes

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24
Q

Signs and symptoms of breast cancer

A 
peau de orange-edema
breast mass
axillary lump
skin dimpling
impaired lymphatic drainage
nipple inversion
metastasis
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25
Where does lymph from the skin of the breast drain to
axillary, parasternal inferior deep cervical infraclavicular
26
Metastasis from the breast via what venous channels
azygos | intercostals
27
What does the pleural space do
maintain a vacuum for breathing, if disrupted cannot function properly
28
What is pleural effusion
accumulation of fluid in pleural cavity
29
What is pneumothorax
accumulation of air in the pleural cavity
30
What is spontaneous pneumothorax
rupture of visceral pleura, air from lung enters pleural cavity
31
What are predisposes to spontaneous pneumothorax
Marfan or EDS, tall thin stature, young, smoker
32
What is the signs and symptoms of spontaneous pneumothorax
acute onset, chest and shoulder pain that is worse with inspire, SOB, decreased breath sounds
33
What is tension pneumothorax
rupture of visceral pleura, lung tissue forms a 1 way valve so with each breath, more air is drawn into pleural cavity
34
What are signs and symptoms of tension pneumothorax
sudden onset of chest pain, dyspnea, reduced breath sounds, hypotension, hypoxia, JV distention, tachycardia
35
What is treatment for tension pneumothorax
immediate decompression via thoracotomy at 2nd intercostal space, midclavicular, then chest tube
36
What is hydropneumothorax
air and fluid in the pleural space
37
What is hemopneumothorax
blood and air in the pleural space
38
What is chylothorax
lymphatic fluid in pleural space
39
What is pyopneumothorax
pus and air in pleural space
40
What is empyema
pus in pleural cavity from an infection or abscess
41
What is pleurisy
inflammation of pleura
42
What are the levels of lung fissures: oblique | scapular, midaxillary, midclavicular
Scapular: 4th rib Midaxillary: 5th rib Midcalvicular 6th rib
43
What are the levels of lung fissure: horizontal
4th rib
44
Where should the stethoscope be placed to hear the superior lobes
anterior chest wall R: above 3rd rib L: above 5th rib
45
Where should the stethoscope be placed to hear the middle lobe
Anterior chest wall | below 4th rib
46
Where should stethoscope be placed to hear the inferior lobes
posterior wall | below 5th rib
47
What is thoracocentesis
used to sample pleura fluid or for removing pleural effusions or empyemas done at 8th or 9th intercostal space midaxillary line
48
what are chest tubes placed for
drain large amounts of air or fluid from the pleural space
49
Where are chest tubes inserted
4th or 5th intercostal space midaxillary line
50
What is the innervation of parietal pleura
GSA Intercostal nerves (costal and peripheral diaphragmatic) Phrenic nerve (mediastinal and central diaphragmatic)
51
What is the innervation of visceral pleura
GVA--no pain innervation
52
Venous drainage of the lungs: 4 common sites of metastasis
CNS, cerebellum, brainstem Bone Liver Adrenal Gland
53
What is the significance of an enlarged inferior tracheobronchial/carinal node seen in bronchoscopy
can displace carina
54
Where can aspirated foreign objects most likely end up stuck and why
right main bronchus | shorter, wider, and more vertical than the left with opening
55
What is sensory of cough reflex
vagus nerve
56
What is motor of cough reflex
vagus nerve, phrenic, intercostals
57
What is atelectasis
collapse of lung or lobe due to blockage of the airway
58
What lobe of lung is most susceptible to atelectasis and why
right middle lobe, smallest and most narrow
59
What is pan coast tumor
tumor of lung apex
60
What are 2 effects of pan coast tumor
Klumpke palsy= lower trunk of brachial plexus | Horner syndrome=cervical sympathetic chain
61
What is pulmonary embolism
blockage of a branch of the pulmonary artery with a blood clot, fat droplet or an air bubble
62
Signs and symptoms of pulmonary embolism
edema, leg pain, tenderness, chest pain, dyspnea, tachypnea, tachycardia, fever, cyanosis
63
Risk factors for pulmonary embolism
``` poor venous flow long travel immobility hyper coagulable states recent surgery COPD pregnancy oral contraceptives estrogen therapy smoking ```
64
What is hemoptysis
coughing up blood, bleeding form the airway from bronchial artery/pulmonary arteries
65
Signs and symptoms caused by presence of thymic tumors
compression of trachea or recurrent laryngeal nerve: hoarsness esophagus compression: dysphagia compression of great veins: cyanosis Thymomas seen in myasthenia gravis
66
Transverse sinus used for what procedure
CABG
67
What is pericarditis
inflammation of pericardium
68
What is pericardial effusion
accumulation of fluid in the pericardial space
69
What is innervation of the pericardium
vagus phrenic sympathetics
70
Where is needle placed for pericardiocentesis. Where else can we place it. Which vessel and branched do we want to avoid
left xiphisternal junction 5th intercostal space must avoid internal thoracic artery
71
What is cardiac tamponade
compression of the heart from accumulated fluid in the pericardial sac
72
What is Beck's triad of cardiac tamponade
rapid heartbeat/muffled sounds distended neck veins hypotension/weak pulses
73
Which artery is dominant in 7-75% of hearts. which specific artery determines dominance
right coronary PDA
74
Which artery provides the majority of arterial supply to SA and AV nodes
right coronary artery
75
What artery supplies anterior 2/3 of IV septum, including the AV bundle and L/R bundle branches
LAD
76
Which coronary artery supplies the posterior-inferior third
RCA
77
3 sites of occlusion in heart
LAD-50% RCA- 30% Left circumflex-20%
78
Significance of the internal thoracic artery in surgery
can be used for CABG
79
What is angina pectoris
chest pain from the heart resulting from insufficient supply of oxygen to cardiac muscle
80
What condition occurs when heart conduction system damage occurs
arrhythmias
81
Consequences of complete bundle block
dissociation between atrial and ventricular contractions
82
Where is AV bundle and what are consequences of surgical repair
courses in the margin of a VSD repair can cause damage and result in bundle branch block
83
What is Ortner syndrome
compression of left recurrent laryngeal nerve from a cardiovascular etiology enlarged left atrium, aneurysm of the arch S/S: hoarseness, dysphagia,, dyspnea
84
3 points where aorta is fixed and susceptible to deceleration trauma
aortic valve ligamentum arteriosum aortic hiatus
85
where do a majority of non-penetrating aortic injuries occur
aortic isthmus between the left subclavian artery and ligaments arteriosum
86
In which patient population is coarctation of the aorta most common
females with Turner syndrome 50% of patients have a bicuspid aortic valve
87
What does coarctation of the aorta in infants cause
cyanosis in lower extremity | requires surgery
88
What does coarctation of the aorta in adults cause
HTN in upper extremity, weak pulses in lower develop enlarged collateral circulation with the internal thoracic and intercostal arteries causing rib notching and LVH
89
What is aortic dissection
creation of space within the wall of the aorta: accumulates a lot of blood resulting in strokes or infarcts
90
S/S of aortic dissection
hypotension, exsanguination severe blood loss, stroke, ischemia, claudication, compression
91
Risk factors for aortic dissection
``` marfan syndrome EDS Turner syndrome osteogenesis imperfecta syphilis trauma cocaine use ```
92
Between the head and tubercle of which ribs can impinge or lacerate the descending aorta and cause massive blood loss
ribs6-9
93
Obstruction of the SVC (SVC syndrome)
most times caused by malignancy of the mediastinum, like lung cancer and lymphoma cyanosis, dyspnea, facial and arm swelling, distention of neck, thoracic wall veins, cough, hoarseness, chest pain, dysphagia
94
4 caval to caval anastomoses important in SVC syndrome
thoracoepigastric internal thoracic vertebral plexus azygos system
95
What 4 structures must be avoided in subclavian venipuncture done inferior to clavicle
first rib phrenic nerve subclavian artery cupola of the lung
96
Where do GVE distribute
viscera in the skin and deep organs
97
What is raynaud syndrome and how to treat it
Idiopathic sympathetic dysregulation of UL vasculature characterized by pain and numbness and ischemia of digits relieved by surgical destruction of the sympathetic chain at the root of the neck
98
Effect of spinal anesthesia on sympathetic innervation
impart sympathetic relay and produce temporary vasodialtion
99
What nerve innervates esophagus
vagus nerve
100
4 places esophagus can be constricted
junction with pharynx aortic arch left main bronchus diaphragm at esophageal hiatus
101
3 ways esophageal cancer can spread and what structures involved
local: vagus nerve, recurrent laryngeal, trachea, pleura, pericardium lymph veins: lungs, liver, vertebra
102
Sympathetic innervation of the lungs and UE
T2-T7

Exam 2 (14 decks)

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