Thorax Clinical Supplement Flashcards
“a depression of the sternum; ““funnel chest”” associated with exercise intolerance, dyspnea, chest pain”
“Pectus Excavatum<div><br></br></div><div><img></img></div>”
“an anterior protrusion of the sternum; ““pigeon chest”” associated with dyspnea, frequent respiratory tract infections; commonly found with scoliosis”
“pectus carinatum<div><br></br></div><div><img></img></div>”
the union of the manubrium and body of the sternum; <br></br>–associated with the sternal end of the 2nd rib<br></br>–arch of the aorta <br></br>–bifurcation of the trachea <br></br>–projects posteriorly to TV4 and approximates the superior border of the middle mediastinum
“sternal angle (of louis)<div><br></br></div><div><img></img></div>”
an important site of red bone marrow, but a biopsy can result in a sternal fracture, pneumonediastinum, pneumothorax, or cardiac tamponade
“sternal biopsy (risks and purpose)<div><br></br></div><div><img></img></div>”
causes: <br></br>–bony issues: cervical rib, hypoplastic first rib; <br></br>–soft tissue changes: hypertrophic/spastic muscles (ant/mid scalene), fibrous CT band; <br></br>–other: trauma, tumors<br></br><br></br>signs and symptoms: compression of C8-T1 roots of brachial plexus, vascular compression of subclavian a. (cold fingers, color changes in hands, claudication, pain)
“thoracic outlet syndrome<div><br></br></div><div><img></img></div>”
rib fractures can lead to:
flail chest, pneumo or hemothorax, spleen/liver injury, lacerations to the aorta/great vessels
intercostal nerve block should be administered where?
between internal and innermost intercostal muscles
whats at risk for iatrogenic injury with intercostal nerve block?
intercostal n.
metastasis of cancer cells from a primary tumor can occur by 3 mechanisms:
local spread, lymphatic channels, blood vessels (usually veins)
the majority of the lymph from the breasts is directed towards the _________ nodes
“axillary<div><br></br></div><div><img></img></div>”
secondary lymph drainage for the breast is directed to the _______________ nodes (medial quadrants)or ___________ nodes (lower quadrants) (provides a route for spread to the liver)
parasternal, inferior phrenic
60% of malignant breast tumors arise from the ___________ ________ quadrant
superior lateral
“signs and symptoms of _______________:<br></br>-breast mass<br></br>-axillary lump<br></br>-skin dimpling <br></br>-impaired lymphatic drainage (peau d’orange)<br></br>-nipple inversion, retraction, or bloody discharge<br></br>-skin ulceration <br></br>-metastasis”
“breast cancer<div><br></br></div><div><img></img></div>”
metastasis from the breast can get to the brain and intervertebral column through ____________ __________
“batson’s plexus<div><br></br></div><div><img></img></div>”
accumulation of fluid in the pleural sac
pleural effusion
______________________<br></br><b>rupture of visceral pleura</b>, air enters the pleural cavity<br></br> <br></br>risk factors: <b>Marfan or Ehlers-Danlos syndrome</b>, tall, thin stature, young (20-30s), smoking <br></br><br></br>S/S: acute onset chest/shoulder pain (worse with inspiration), shortness of breath<br></br> <br></br>Chest x-rays: line of visceral pleura (collapsed lung), <b>mediastinal shift away from affected lung</b>, reduces size of pulmonary cavity on contralateral side, impaired pulmonary function, venous return, diniminishes atrial filling and <b>reduces CO</b>
spontaneous pneumothorax (Traumatic Pneumothorax would result in (at least) the same S/S and imagining)
_____________ <br></br><b>rupture of visceral pleura</b>, air enters the pleural cavity through a <b>flap like tear</b><br></br>- more air enters with each successive breath<br></br>-increased interpleural pressure can lead to <b>compression of SVC</b><br></br>—-hypotension, hypoxia, jugulovenous distention, tachycardia, anxiety, fatigue<br></br>—-need thoractomy @ 2nd intercostal space and then chest tube
tension pneumothorax
air and fluid in the interplural space
hydropneumothorax
blood in the interplural space
hemopneumothorax
lymph in the interplural space (injury to the thoracic duct)
chylothorax
pus and air in the interplural space
pyopneumothorax
pus <b>without</b> air in the interplural space (from infection, bacterial pneumonia or abscess)
empyma
inflammation of the pleura
“pleurisy<div><br></br></div><div><img></img></div>”
which ribs does the oblique fissure run along (scapular line, midaxillary line, midclavicular line)?
“4, 5, 6<div><br></br></div><div><img></img></div>”
bone (vertebrae),
liver,
adrenal gland,
most common to occur in the ___ __________ lobe, because its entrance is the most narrow
LAD - PDA (within IV septum)
Pain from MI is perceived on these dermatomes on the left
this phenomenon is known as ___________
Acronym to remember placement _______
-hypertension in UL
-weak pulses in LL
-rib notching due to enlarged collateral circulation
-defect is opposite ductus arteriosus, distal to great arteries
can compress the left recurrent laryngeal nerve and cause: hoarseness > dysphagia > dyspnea
-creation of space within the wall of the aorta due to the tearing of the tunica intima and subsequent accumulation of blood volume in the wall of the vessel
-can result in strokes and/or infarcts
- can be fixed by surgical destruction of the ___________ _________ at the root of the neck which would result in vasodilation of arterioles in the ipsilateral upper extremity
