Chapter 23 Throat, Thorax, and Visceral Conditions

Question 1

What are the four abdominopelvic quadrants?

Answer 1

Lower left quadrant
Left upper quadrant
Right upper quadrant
Right lower quadrant

Question 2

What are the organs present in the Lower left quadrant?

Answer 2

descending colon, sigmoid, left ovary, left fallopian tube, left ureter

Question 3

What are the organs present in the left upper quadrant?

Answer 3

stomach, spleen, left lobe of liver, body of pancreas, left kidney, left adrenal gland, parts of transverse and descending colon

Question 4

What are the organs present in the right upper quadrant?

Answer 4

liver, gall bladder, duodenum, right kidney

Question 5

What are the organs present in the right lower quadrant?

Answer 5

cecum, appendix, ascending colon, right ovary and fallopian tube, right ureter

Question 6

What is the stomach?

Answer 6

Stomach – j-shaped bag positioned between the esophagus and small intestine  stores food for 4 hours during which HCL breaks it down into chyme  small intestine where it is absorbed
Water, electrolytes, aspirin and alcohol – absorbed into bloodstream across stomach lining without full digestion

Question 7

What is the small intestine?

Answer 7

most of digestion and absorption of food, propelled through by peristalsis (3-6 hours, several times per day to move feces into rectum)

Question 8

What can happen to the appendix?

Answer 8

accumulation of bacteria leads to appendicitis

Question 9

What does the liver do?

Answer 9

Liver  bile to break down fat, absorbs excess glucose from bloodstream and stores it as glycogen
Alcohol abuse – cirrhosis of liver
Hepatitis – inflammation of liver caused by a viral infection

Question 10

What does the gall bladder do?

Answer 10

accessory to liver, stores bile

Question 11

what does the spleen do?

Answer 11

(1) cleansing the blood of foreign matter, bacteria, viruses and toxins (2) storing excess RBCs for later reuse and releasing others into the blood for processing by the liver (3) producing RBCs in the fetus (4) storing blood platelets

Question 12

What does the pancreas do?

Answer 12

secretes most digestive enzymes that break down food in the small intestine, secretes insulin (lower blood sugar levels) and glucagon (elevate blood sugar levels)

Question 13

What do the kidneys do?

Answer 13

filter and cleanse blood, connected to bladder which stores urine

Question 14

What is appendicitis?

Answer 14

inflammation of the appendix resulting in constant pain; progresses in severity, begins in the outer umbilicus region; moves to the right lower quadrant; nausea, vomiting, loss of appetite; low-grade fever

Question 15

What is cholecystitis?

Answer 15

inflammation of the gall bladder, resulting in constant pain in the right upper quadrant; onset often follows a meal; nausea and vomiting; tenderness in RUQ and right shoulder; splinting on the right side

Question 16

What is a perforated peptic ulcer?

Answer 16

perforated stomach ulcer resulting in a sudden onset of pain in the midepigastric region that spreads and is aggravated by movement; individual is reluctant to move and appears acutely ill; rigid abdomen, grunting respiration; absent bowel sounds

Question 17

What is an ectopic pregnancy?

Answer 17

pregnancy in the fallopian tube, which results in a tubal rupture causing a sudden, severe and persistent pain, generally followed by a missed or abnormal period; typically epigastric, often associated with hypotension and tachycardia

Question 18

What is an ovarian cyst?

Answer 18

an abnormal cystic tumour of the ovary that usually is benign; constant pain with a sharp, sudden onset; usually in the ipsilateral lower area of the abdomen below the umbilicus; may have nausea and vomiting following pain

Question 19

What is pelvic inflammatory disease?

Answer 19

chronic inflammation of the pelvis caused by multiple infections, including chlamydia and gonorrhea, resulting in pain at the end of or shortly after a normal menstruation period, bilateral lower quadrant pain aggravated by manipulation of the cervix; rarely nausea and vomiting; possible cervical discharge, fever

Question 20

What is a urinary calculus?

Answer 20

pain location changes with movement of the urinary stone and may radiate to the testicle or groin of the involved site, pain is very severe individual cannot get comfortable

Question 21

What are crackles?

Answer 21

abnormalities of lungs (pneumonia, fibrosis) or airways (bronchitis, bronchiectasis)

Question 22

What are fine crackles?

Answer 22

soft, high-pitched, and very brief (5-10msec)

Question 23

What are coarse crackles?

Answer 23

louder than fine crackles, lower in pitch (20-30msec)

Question 24

What are wheezes?

Answer 24

high-pitches, hissing or shrill quality, suggests narrowing of airways (asthma, bronchitis, COPD)

Question 25

What are Rhonchi?

Answer 25

low pitched, rumbling/snoring quality, passage of air through bronchi obstructed by thick mucus

Question 26

What is stridor?

Answer 26

inspiratory wheeze, indicated partial obstruction of the larynx/trachea

Question 27

What is a pleural rub?

Answer 27

inflamed pleural surfaces grate each other, delayed by friction, producing creaking sounds

Question 28

What is a mediastinal crunch?

Answer 28

a series of precordial crackles synchronous with heartbeat, not with respiration, left lateral position (Hamman sign), mediastinal emphysema

Question 29

What causes an absence of breath sounds?

Answer 29

caused by pleural effusion, pneumothorax, tension pneumothorax, hemothorax, traumatic asphyxia

Question 30

What are abnormal findings during an auscultation of the heart?

Answer 30

murmur, produced by turbulent energy in the walls of the heart and blood vessels

Question 31

What are the four classic auscultation sites?

Answer 31

Aortic (second intercostal space, right sternal border) Pulmonic (second intercostal space, left sternal border) Tricuspid (left lower sternal border) Mitral (cardiac apex)

Question 32

What is indicated by an auscultation of the abdomen?

Answer 32

Bowel motility Normal – 5-34 per minute of clicks and gurgles Hyperperistalsis with rushes, cramps, and diarrhea suggests gastroenteritis

Question 33

What is dysesthesia?

Answer 33

underlying peritoneal irritation causes a light touch to be perceived as a disagreeable sensation

Question 34

What is McBurney's point?

Answer 34

one-third of the distance between the ASIS and umbilicus

Question 35

What is Lanzmann's point?

Answer 35

tender point in appendicitis situated in line between the two ASIS, 5-6cm from the right spine and 2cm below McBurney's point

Question 36

How do contusions and fractures occur to the trachea, larynx and hyoid bone?

Answer 36

To trachea, larynx, and hyoid bone – occurs during hyperextension of neck  thyroid cartilage becomes prominent and vulnerable to direct impact forces Rare  fatal due to extravasation of blood into the laryngeal tissues, leading to airway edema and asphyxia resulting from obstruction S/S – hoarseness, dyspnea, coughing, difficulty swallowing, laryngeal tenderness, inability to make a high pitched “e” sound, laryngospasm, severe pain, occlusion

Question 37

What is a stitch in the side?

Answer 37

Include trapped colonic gas bubbles, localized diaphragmatic hypoxia with spasm, liver congestion with stretching of the liver capsule, and poor conditioning S/S – refers to a sharp pain or spasm in the chest wall, usually on the lower right side, during exertion Management – forcibly exhaling through pursed lips, breathing deeply and regularly, leaning away from the affected side, stretching the arm on the affected side over the head as high as possible

Question 38

What is a contusion of the breast?

Answer 38

excessive breast motion or direct trauma can lead to hemorrhage and edema formation in the breast tissue

Question 39

What is nipple irritation?

Answer 39

seen in distance runners, Runner’s nipple – friction over the nipple, Cyclist’s nipple – combined effects of perspiration and wind chill

Question 40

What is gynecomastia?

Answer 40

excessive development of the male breast tissue, often accompanied by pain and sensitivity, nipple soreness

Question 41

What is the MOI for a pectoralis major strain?

Answer 41

MOI – eccentric muscle tension, results from direct trauma involving sudden deceleration Higher incidence seen with anabolic steroid abuse

Question 42

How do costochondral injuries occur and what are their S/S?

Answer 42

Costochondritis and costochondral sprains – occur during a collision with another object or as a result of a severe twisting motion of the thorax S/S – hear/feel pop, initial sharp pain followed by intermittent stabbing pain for several days

Question 43

What is the MOI and what are the S/S of sternal fractures?

Answer 43

MOI – rapid deceleration and high impact into an object or acute flexion that causes the upper fragment to displace anteriorly to lower fragment Most common – body of sternum S/S – immediate loss of breath, localized pain, with pressure over sternum

Question 44

What are rib fractures?

Answer 44

Stress fracture – indirect force such as violent muscle contraction Occurs at weak points – where it changes direction or has the smallest diameter Opposing contraction of scalene muscles and SA  1st rib fracture at its thinnest segment Anterolateral stress fractures at ribs 4 and 5  excessive contraction of SA External oblique  lower three ribs Most common t/s injury as a result of blunt trauma – force applied in anteroposterior plane leading to fractures at the posterior angles of the 5-9 ribs  nondisplaced more common Fracture lower ribs – damage to kidneys, liver and spleen

Question 45

What is hyperventilation?

Answer 45

Linked to pain, stress or trauma in sport Altitude, asthma, pulmonary embolus, left ventricular failure, aspirin, alcohol withdrawal, anxiety or panic, or CNS lesions Respiratory rate increases during activity – rapid, deep inhalations draw more oxygen into the lungs, long exhalations result in too much carbon dioxide being exhaled S/S – inability to catch ones’ breath, numbness in hands/lips, spasms of hands, dry mouth, dizziness Management – calm down athlete, paper bag ==> do not use. Encourage pursed lip breathing

Question 46

What is a non-penetrating chest trauma?

Answer 46

forces transmitted through thorax causing blood and protein to leak into the alveoli and interstitial space leading to pulmonary collapse

Question 47

What is a penetrating chest trauma?

Answer 47

fractured rib or penetrating would to the chest, result in laceration of lung tissue

Question 48

What are the S/S of chest traumas?

Answer 48

S/S – chest pain, rapid breathing, shortness of breath, rales, coughing, hypoxia 2-4 hours after trauma, coughs up blood

Question 49

What is a pneumothorax?

Answer 49

air is trapped in the pleural space, causing a portion of a lung to collapse

Question 50

What is a spontaneous pneumothorax?

Answer 50

Spontaneous – occurs unexpectedly, with or without an underlying disease Males, cigarette smoking, asthenic physiognomy, narrow chest, asthma, cystic fibrosis, emphysema, pneumonia S/S – pain can stop abruptly (delaying treatment), dyspnea, chest discomfort, difficulty breathing

Question 51

What is a non-spontaneous pneumothorax?

Answer 51

Non-spontaneous – trauma, air is allowed to escape into the pleural cavity with each inhalation preventing lungs from fully expanding S/S – dyspnea, cyanosis, severe chest pains, breath sounds affected, asymmetric chest expansion, confusion, fatigue, anxiety, decrease BP, referred pain to tip of shoulder

Question 52

What is a hemothorax?

Answer 52

Hemothorax – involves loss of blood rather than air into pleural cavity, fractured lungs may tear lung tissue and blood vessels in the chest or chest cavity S/S – severe pain, hypoxia, decreased breath sounds, cough up blood, as it gets worse  shock (hypotension, decreased venous return, cyanosis), tracheal deviation

Question 53

What is a tension pneumothorax?

Answer 53

wound present, air or blood progressively accumulates in the pleural space during inspiration and cannot escape on expiration, pleural space expands with each breath displacing the mediastinum to the opposite side  compresses the heart/uninjured lung/aorta/vena cava = decreasing cardiac output S/S – tracheal deviation away, hypotension, compromised circulation leading to death/cyanosis, asymmetric chest wall movement

Question 54

What is traumatic asphyxia?

Answer 54

direct, massive trauma to the thorax S/S - bluish tinge over the neck and facial regions, subconjunctival hemorrhage, ecchymosis, loss of vision due to retinal edema

Question 55

What is a heart contusion?

Answer 55

blunt chest trauma that compresses the heart between the sternum and the spine, right ventricle often injured, RBCs and fluid leak into the surrounding tissues  decrease circulation to the heart  cellular damage and necrosis of heart tissue

Question 56

What is cardiac tamponade?

Answer 56

massive blunt trauma ruptures the myocardium or lacerates a coronary artery  increase blood unto the pericardial sac  limit venous inflow and diastolic filling  CO diminished S/S – shortness of breath, chest and heart pain, weakness, fatigue, irregular heart beats, shock, Beck triad, collapse within seconds CT

Question 57

What is commotio cordis?

Answer 57

heart is struck at the beginning of the T wave in the cardiac cycle and disrupts the electrical impulses that control normal heart rhythm – patient collapses instantly due to ventricular tachycardia  defibrillator

Question 58

What is a heart murmur?

Answer 58

distinguished from normal heart sounds by their longer duration – turbulent blood flow and may be benign or diagnostic of valvular heart disease Narrow valve  obstructs BF  aortic stenosis Valve unable to close  aortic regurgitation Grade I - faint, Grade 6 – extremely loud

Question 59

What is a solar plexus contusion?

Answer 59

A blow to the abdomen with the muscle relaxed – solar plexus punched True cause of breathing difficulty unknown – diaphragmatic spasm and transient contusion to sympathetic celiac plexus S/S – inability to catch one’s breath (dyspnea) Management – airway analysis, deep breath and hold, whistle

Question 60

What is an abdominal hernia?

Answer 60

Protrusion of the abdominal viscera through a weakened portion of the abdominal wall Congenital – at birth or family history Acquired – direct blow, strain, or abnormal intra-abdominal pressure (heavy lifting) Indirect – young athletes most common, weakness in peritoneum around deep inguinal ring allows the abdominal viscera to protrude through the ring into the inguinal canal and extend into scrotum, may reduce spontaneously Direct – men 40+, result in weakness in an area of fascia bounded by the rectus abdominus muscle, inguinal ligament and epigastric vessels Femoral – women, abdominal viscera to protrude through the femoral ring into the femoral canal, compressing the lymph vessels, connective tissue, and femoral artery/vein, hernia presents as a mass that in inferolateral to the pubic tubercle S/S – visible, tender swelling and an aching feeling in groin, protrusion increases with coughing

Question 61

What is a splenic rupture?

Answer 61

Rare in sports, infectious mononucleosis can enlarge this organ making it vulnerable to injury Most commonly injured abdominal organ and most frequent cause of death from abdominal blunt trauma in sports Spleen can lose blood rapidly due to its high vascularity, but it can splint itself and stop hemorrhaging S/S – blunt trauma to the ULQ, persistent dull pain in ULQ, left lower chest, left shoulder  Kehr Sign, caused from irritation of diaphragm innervate by the phrenic nerve (C3-C5), free blood can irritate right diaphragm  right shoulder pain Management – no PA for at least 2 weeks, vigorous sport 2-3 months, surgery at least 3 months

Question 62

What is a liver contusion and rupture?

Answer 62

Direct blow to the URQ can contuse liver Systemic disease such as hepatitis can enlarge liver  more susceptible to injury S/S – pain, tenderness, hypotension, shock, pain referred to inferior angle of the right scapula

Question 63

What is appendicitis?

Answer 63

Vermiform appendix – pouch extending from the cecum Obstructed  impair venous circulation leading to increased bacterial growth and the formation of pus Inflammation of appendix  ischemia or gangrene Appendix ruptures  feces, bacteria sprayed over the abdominal contents causing peritonitis S/S – abdominal pain 2-7 days prior to actual representation, pain in RLQ, rebound pain at McBurney point, loss of appetite, nausea, vomiting, diarrhea, low-grade fever

Question 64

What is a kidney contusion?

Answer 64

direct blow or contrecoup injury from high-speed collision S/S – pain, tenderness, hematuria, pain referred posteriorly to low back, sides of buttocks and anteriorly to the lower abdomen

Question 65

What are kidney stones?

Answer 65

substances filtered by kidneys form crystals, other substances prevent crystal formation (citrate and magnesium) Calcium stones – most are formed by calcium, result from large amounts of vitamin D causing the body to absorb too much calcium, drugs (thyroid hormones/diuretics), cancers, overactive parathyroid glands, kidney conditions Uric acid stones – formed by uric acid a by-product of protein metabolism, diet high in meat, chemotherapy Struvite stones – women, chronic UTIs cause by bacteria that secret specific enzymes, increases ammonia in urine, large and have a stag’s horn shape, damage kidneys Cystine stones – 1% of kidney stones, hereditary disorders causing kidneys to excrete excessive amounts of amino acids S/S – asymptomatic until becomes large enough (> 7 mm) to cause blockage or infection, pain starts in back just below the edge of the ribs and moves anteriorly toward the groin as the stone moves down the ureter into the bladder, stops moving  pain may stop, blood/cloudy urine, nausea, vomiting, urge to urinate, fever/chills

Question 66

What are urinary tract infections?

Answer 66

Any condition that begins in the urinary system Painful and annoying, serious health problem if spreads to kidneys, most occur in lower tract Cystitis – inflammation of bladder Urethritis – inflammation of urethra Most cases caused by Escherichia coli – ascend the urinary tract from the opening in the urethra Sexually transmitted organisms such as Chlamydia trachomatis and Neisseria gonorrhoeae Women more likely

Question 67

What is hematuria?

Answer 67

Blood in urine Caused by direct kidney injury, bladder contusion, UTI, drug or medication use, infection, sickle cell disease, rhabdomyolysis Non-traumatic – decreased renal BF Pelvic fractures

Question 68

What is proteinuria?

Answer 68

Elevated levels of protein (albumin) occur in 70% of competitive athletes after exertion Dehydration, heat-related illness, fever, emotional stress, inflammatory conditions, acute illnesses, pregnancy Excessive protein in urine = renal disease S/S – swelling in hands, feet, abdomen, face

Question 69

What are penile injuries?

Answer 69

superficial wounds to penis, urethra can be damaged, cyclists – transient paresthesia of penis  pressure on pudendal nerve

Question 70

What are scrotal injuries?

Answer 70

contusion, hematoma, torsion, dislocation or rupture of testicle, tunica vaginalis ruptures – vascular and tubercle components can be ruptured S/S – nausea, pain, internal hemorrhage, effusion and muscle spasms, swelling in tunica vaginalis (traumatic hydrocele), plexus of veins on posterior testicle become engorged (varicocele), blood accumulate in scrotum (hematocele) Torsion of testicle – congenital or traumatic

Question 71

What are female genital injuries?

Answer 71

Injuries to vulva caused by trauma – hematoma can result from direct impact, injure pubic symphysis