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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
Q

Where does lymph from the skin of the breast drain to

A

axillary, parasternal
inferior deep cervical
infraclavicular

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26
Q

Metastasis from the breast via what venous channels

A

azygos

intercostals

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27
Q

What does the pleural space do

A

maintain a vacuum for breathing, if disrupted cannot function properly

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28
Q

What is pleural effusion

A

accumulation of fluid in pleural cavity

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29
Q

What is pneumothorax

A

accumulation of air in the pleural cavity

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30
Q

What is spontaneous pneumothorax

A

rupture of visceral pleura, air from lung enters pleural cavity

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31
Q

What are predisposes to spontaneous pneumothorax

A

Marfan or EDS, tall thin stature, young, smoker

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32
Q

What is the signs and symptoms of spontaneous pneumothorax

A

acute onset, chest and shoulder pain that is worse with inspire, SOB, decreased breath sounds

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33
Q

What is tension pneumothorax

A

rupture of visceral pleura, lung tissue forms a 1 way valve so with each breath, more air is drawn into pleural cavity

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34
Q

What are signs and symptoms of tension pneumothorax

A

sudden onset of chest pain, dyspnea, reduced breath sounds, hypotension, hypoxia, JV distention, tachycardia

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35
Q

What is treatment for tension pneumothorax

A

immediate decompression via thoracotomy at 2nd intercostal space, midclavicular, then chest tube

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36
Q

What is hydropneumothorax

A

air and fluid in the pleural space

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37
Q

What is hemopneumothorax

A

blood and air in the pleural space

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38
Q

What is chylothorax

A

lymphatic fluid in pleural space

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39
Q

What is pyopneumothorax

A

pus and air in pleural space

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40
Q

What is empyema

A

pus in pleural cavity from an infection or abscess

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41
Q

What is pleurisy

A

inflammation of pleura

42
Q

What are the levels of lung fissures: oblique

scapular, midaxillary, midclavicular

A

Scapular: 4th rib
Midaxillary: 5th rib
Midcalvicular 6th rib

43
Q

What are the levels of lung fissure: horizontal

A

4th rib

44
Q

Where should the stethoscope be placed to hear the superior lobes

A

anterior chest wall
R: above 3rd rib
L: above 5th rib

45
Q

Where should the stethoscope be placed to hear the middle lobe

A

Anterior chest wall

below 4th rib

46
Q

Where should stethoscope be placed to hear the inferior lobes

A

posterior wall

below 5th rib

47
Q

What is thoracocentesis

A

used to sample pleura fluid or for removing pleural effusions or empyemas

done at 8th or 9th intercostal space midaxillary line

48
Q

what are chest tubes placed for

A

drain large amounts of air or fluid from the pleural space

49
Q

Where are chest tubes inserted

A

4th or 5th intercostal space midaxillary line

50
Q

What is the innervation of parietal pleura

A

GSA

Intercostal nerves (costal and peripheral diaphragmatic)

Phrenic nerve (mediastinal and central diaphragmatic)

51
Q

What is the innervation of visceral pleura

A

GVA–no pain innervation

52
Q

Venous drainage of the lungs: 4 common sites of metastasis

A

CNS, cerebellum, brainstem
Bone
Liver
Adrenal Gland

53
Q

What is the significance of an enlarged inferior tracheobronchial/carinal node seen in bronchoscopy

A

can displace carina

54
Q

Where can aspirated foreign objects most likely end up stuck and why

A

right main bronchus

shorter, wider, and more vertical than the left with opening

55
Q

What is sensory of cough reflex

A

vagus nerve

56
Q

What is motor of cough reflex

A

vagus nerve, phrenic, intercostals

57
Q

What is atelectasis

A

collapse of lung or lobe due to blockage of the airway

58
Q

What lobe of lung is most susceptible to atelectasis and why

A

right middle lobe, smallest and most narrow

59
Q

What is pan coast tumor

A

tumor of lung apex

60
Q

What are 2 effects of pan coast tumor

A

Klumpke palsy= lower trunk of brachial plexus

Horner syndrome=cervical sympathetic chain

61
Q

What is pulmonary embolism

A

blockage of a branch of the pulmonary artery with a blood clot, fat droplet or an air bubble

62
Q

Signs and symptoms of pulmonary embolism

A

edema, leg pain, tenderness, chest pain, dyspnea, tachypnea, tachycardia, fever, cyanosis

63
Q

Risk factors for pulmonary embolism

A 
poor venous flow
long travel
immobility
hyper coagulable states
recent surgery
COPD
pregnancy
oral contraceptives
estrogen therapy
smoking
64
Q

What is hemoptysis

A

coughing up blood, bleeding form the airway from bronchial artery/pulmonary arteries

65
Q

Signs and symptoms caused by presence of thymic tumors

A

compression of trachea or recurrent laryngeal nerve: hoarsness

esophagus compression: dysphagia

compression of great veins: cyanosis

Thymomas seen in myasthenia gravis

66
Q

Transverse sinus used for what procedure

A

CABG

67
Q

What is pericarditis

A

inflammation of pericardium

68
Q

What is pericardial effusion

A

accumulation of fluid in the pericardial space

69
Q

What is innervation of the pericardium

A

vagus
phrenic
sympathetics

70
Q

Where is needle placed for pericardiocentesis. Where else can we place it. Which vessel and branched do we want to avoid

A

left xiphisternal junction
5th intercostal space
must avoid internal thoracic artery

71
Q

What is cardiac tamponade

A

compression of the heart from accumulated fluid in the pericardial sac

72
Q

What is Beck’s triad of cardiac tamponade

A

rapid heartbeat/muffled sounds
distended neck veins
hypotension/weak pulses

73
Q

Which artery is dominant in 7-75% of hearts. which specific artery determines dominance

A

right coronary

PDA

74
Q

Which artery provides the majority of arterial supply to SA and AV nodes

A

right coronary artery

75
Q

What artery supplies anterior 2/3 of IV septum, including the AV bundle and L/R bundle branches

A

LAD

76
Q

Which coronary artery supplies the posterior-inferior third

A

RCA

77
Q

3 sites of occlusion in heart

A

LAD-50%
RCA- 30%
Left circumflex-20%

78
Q

Significance of the internal thoracic artery in surgery

A

can be used for CABG

79
Q

What is angina pectoris

A

chest pain from the heart resulting from insufficient supply of oxygen to cardiac muscle

80
Q

What condition occurs when heart conduction system damage occurs

A

arrhythmias

81
Q

Consequences of complete bundle block

A

dissociation between atrial and ventricular contractions

82
Q

Where is AV bundle and what are consequences of surgical repair

A

courses in the margin of a VSD

repair can cause damage and result in bundle branch block

83
Q

What is Ortner syndrome

A

compression of left recurrent laryngeal nerve from a cardiovascular etiology

enlarged left atrium, aneurysm of the arch

S/S: hoarseness, dysphagia,, dyspnea

84
Q

3 points where aorta is fixed and susceptible to deceleration trauma

A

aortic valve
ligamentum arteriosum
aortic hiatus

85
Q

where do a majority of non-penetrating aortic injuries occur

A

aortic isthmus between the left subclavian artery and ligaments arteriosum

86
Q

In which patient population is coarctation of the aorta most common

A

females with Turner syndrome 50% of patients have a bicuspid aortic valve

87
Q

What does coarctation of the aorta in infants cause

A

cyanosis in lower extremity

requires surgery

88
Q

What does coarctation of the aorta in adults cause

A

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
Q

What is aortic dissection

A

creation of space within the wall of the aorta: accumulates a lot of blood resulting in strokes or infarcts

90
Q

S/S of aortic dissection

A

hypotension, exsanguination severe blood loss, stroke, ischemia, claudication, compression

91
Q

Risk factors for aortic dissection

A 
marfan syndrome
EDS
Turner syndrome
osteogenesis imperfecta
syphilis 
trauma
cocaine use
92
Q

Between the head and tubercle of which ribs can impinge or lacerate the descending aorta and cause massive blood loss

A

ribs6-9

93
Q

Obstruction of the SVC (SVC syndrome)

A

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
Q

4 caval to caval anastomoses important in SVC syndrome

A

thoracoepigastric
internal thoracic
vertebral plexus
azygos system

95
Q

What 4 structures must be avoided in subclavian venipuncture done inferior to clavicle

A

first rib
phrenic nerve
subclavian artery
cupola of the lung

96
Q

Where do GVE distribute

A

viscera in the skin and deep organs

97
Q

What is raynaud syndrome and how to treat it

A

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
Q

Effect of spinal anesthesia on sympathetic innervation

A

impart sympathetic relay and produce temporary vasodialtion

99
Q

What nerve innervates esophagus

A

vagus nerve

100
Q

4 places esophagus can be constricted

A

junction with pharynx
aortic arch
left main bronchus
diaphragm at esophageal hiatus

101
Q

3 ways esophageal cancer can spread and what structures involved

A

local: vagus nerve, recurrent laryngeal, trachea, pleura, pericardium

lymph

veins: lungs, liver, vertebra

102
Q

Sympathetic innervation of the lungs and UE

A

T2-T7

Exam 2 (14 decks)

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