Disorders of the chest wall

Question 1

Increased fat in this area is more likely to influence mechanical effects of breating?

Answer 1

Increased abdominal fat and in the thoracic region

Question 2

Obese individuals also have these pulmonary problems?

Answer 2

Increased proinflammatory cytokines (increased asthma and bronchoconstriction), orthopnea, chronic hypoxia, and hypercapnia

Question 3

Common effects on respiratory function from obesity?

Answer 3

Basic reduction in lung volume. Decreased expiratory reserve volume, reduced functional residual capicity (amount of air remained in lungs after normal tidal volume expiration),

Question 4

In kyphoscoliosis, this lung disease is common and can be quite severe?

Answer 4

Restrictive lung disease. Obstructive lung diseases are less common

Question 5

This test is used to measure severity of kyphoscholiosis? What results indicate respiratory impairment?

Answer 5

Cobb Angle, > 50-60 lung function is generally impaired, >90 respiratory failure, deformity above T10 associated with greater impairment

Question 6

More severe kyphoscoliosis causes what?

Answer 6

Decreased lung volume and total lung capacity

Question 7

Problems from pectus excavatum?

Answer 7

Left heart displacement, rotation, compression of heart, mild restrictive lung impairment with reduced TLC and FVC

Question 8

What is flail chest?

Answer 8

Fracture of 3 or more ribs in 2 places that causes the flail segment to move paradoxically (opposite) to the rest of the chest wall

Question 9

Due to independent segment movement, there is not enough________ to maintain adequate perfussion?

Answer 9

intrathoracic pressure

Question 10

Treatment of flail chest?

Answer 10

Pain control is important, severe respiratory compromise need ventilation, surgical rib fixation necessary in some cases

Question 11

What is in the anterior mediastinum and what associated lesions can be found?

Answer 11

Thymus & lymph nodes. Thymoma, Teratoma, Terrible lymphoma, thyroid tissue

Question 12

What is found in the middle mediastinum and what lesions can be found?

Answer 12

Heart, bronchi, hila, lymph nodes, trachae. Lymphadenopathy from lymphoma, sarcoidosis, metastasis

Question 13

What is in the posterior mediastinum and what lesions can be found?

Answer 13

Esophagus, lymph nodes, descending aorta. Neurogenic tumors

Question 14

Symptoms of mediastinum masses?

Answer 14

Cough, dyspnea, dysphagia, hoarseness, cardiac tamponade. Patients with lymphoma may have weight loss, fever, night sweats.

Question 15

What is mediastinitis?

Answer 15

Infection of the mediastinum that usually occurs post CABG or cardiovascular procedure.

Question 16

Clinical presentation of mediastinitis?

Answer 16

Fever, tachycardia, chest pain, sternal wound drainage from infection

Question 17

What is Hammans sign?

Answer 17

Crunching or air bubbles heard when auscultating. synchronous with heart beat.

Question 18

Treatment of mediastinitis?

Answer 18

Surgical debridment or sternal wound, closure or left open with vaccum assisted closure (VAC) device, IV vanco + either 3rd gen cephalo, cipro, or aminoglycoside

Question 19

What is pneumomediastinum? Causes?

Answer 19

Air in the medistinum from chest trauma, esophageal rupture, ventilator, severe cough from asthma, severe vomitting or defication strain, barotrauma, hyperpnea

Question 20

What is eventration of the diaphragm

Answer 20

Diaphragmatic weakness, usually unilateral, caused by disorder that affects phrenic nerve, spinal cord, muscle or neuromuscular junction

Question 21

What must you be sure to exclude on patients with diaphragmatic paralysis?

Answer 21

Mestastatic tumor