Clinical Notes Flashcards
(94 cards)
1
Q
What rib is rarely fractured?
A
1st rib
- When it is broken structures crossing its superior aspect (brachial plexus, subclavian vessels) may be injured
2
Q
The ___ ribs are most commonly fractured
A
Middle Ribs
3
Q
Rib fractures usually result from:
A
Blows or crushing injuries
4
Q
The weakest part of the rib:
A
Anterior to its angle
5
Q
What might happen if the bottom ribs are fractured?
A
They might tear the diaphragm and result in a diaphragmatic hernia
6
Q
Supernumerary Ribs
A
The number of ribs someone has might be >12 if they have cervical and/or lumbar ribs
7
Q
What pair of ribs might fail to form?
A
12th Pair
8
Q
Rib Dislocation (Slipping Rib Syndrome)
A
Displacement of a costal cartilage from the sternum - dislocation of a sternocostal joint or displacement of the interchondral joints
9
Q
Displacement of interchondral joints usually occurs ____ and involved ribs __, __ and ___
A
- Unilaterally
- Ribs 8-10
10
Q
Complications/Sxs of Rib Dislocation – Interchondral Joints
A
- Injury to diaphragm and/or liver causing severe pain especially with deep inspiration
- Injury produces a lump like deformity at the displacement site
11
Q
Rib Separation
A
Dislocation of the costochondral junction between the rib and its costal cartilage
12
Q
In separations of the 3rd-10th ribs, tearing of the ____ and ___ usually occurs
A
Perichondrium and Periosteum
13
Q
Thoracentesis
A
Hypodermic needle inserted through intercostal space into pleural cavity to obtain sample of fluid and/or remove blood or pus
14
Q
Where is the needle inserted in thoracentesis?
A
Superior to rib high enough to avoid collateral branches of intercostal nerve and vessels
15
Q
When a patient is upright, intrapleural fluid accumulates in the:
A
Costodiaphragmatic Recess
16
Q
During thoracentesis, how do you avoid the inferior border of the lung?
A
- Insert needle into 9th intercostal space in mid-axillary line during expiration
- Needle angled upward to avoid deep side of recess
17
Q
Chest Tube
A
Used to remove air/blood/fluid/pus from pleural cavity
18
Q
Chest Tube: Insertion
A
- Incision in 5th or 6th intercostal space in mid-axillary line
- Tube directed superiorly or inferiorly
19
Q
Chest Tube: Extracorporeal End of the Tube
A
Connect to underwater drainage system with controlled suction to prevent air from being sucked back into pleural cavity
20
Q
Removal of air from pleural cavity allows:
A
Re-inflation of collapsed lung
21
Q
Failure to remove fluid from pleural cavity may cause:
A
Lung to develop resistant fibrous covering that inhibits expansion unless peeled off
22
Q
Thoracoscopy
A
Diagnostic and sometimes therapeutic procedure in which the pleural cavity is examined with a thoracoscope
23
Q
Thoracoscopy: Procedure
A
Small incision are made into the pleural cavity via 1-3 intercostal spaces
24
Q
Insertion of Chest Tube: Pneumothorax or Hydrothorax Drainage
A
Direct tube inferiorly
25
Insertion of Chest Tube: Pneumothorax Drainage
Direct tube superiorly
26
Diaphragm
(1) Attachments:
(2) Motor Innervation:
(3) Sensory Innervation:
(4) Vascular Supply:
(1) Inferior thoracic aperture
(2) Phrenic N
(3) Phrenic N, Intercostal Ns, Subcostal N
(4) Branches of Internal Thoracic A and Thoracic Aorta
27
When foreign bodies are aspirated, they usually enter:
Right Main Bronchus
- It is wider, shorted and runs more vertically than the Left Main Bronchus
28
Lung Resections: Importance of Bronchopulmonary Segments
- These segments are the region of the lung supplied by each segmental bronchus and segmental artery; separated from adjacent segments via connective tissue septa; smallest functionally independent region of lung; each lung has 10 segments
- Segments can be surgically resected without compromising the reminder of the lung
29
Pneumonectomy
Surgical removal of whole lung
30
Lobectomy
Surgical removal of lobe of lung
31
Segmentectomy
Surgical removal of Bronchopulmonary Segment
32
Most lung cancers arise in the:
Mucosa of the Large Bronchi
33
Hemoptysis
Spitting up blood
34
The primary tumor in lung cancer metastasizes early to the ___ and then subsequently to the __
(1) Bronchopulmonary Lymph Nodes
(2) Thoracic Lymph Nodes
35
Common sites of hematogenous metastases with lung cancer:
- Brain
- Bones
- Lungs
- Suprarenal Glands
36
Which lymph nodes are commonly enlarged when bronchogenic carcinoma develops?
Supraclavicular Lymph Nodes
37
Sentinel Lymph Nodes
Node(s) that first receive lymph draining from cancer-containing area
38
Atelectasis
Collapsed lung
39
Secondary Atelectasis
Collapse of previously inflated lung
40
Primary Atelectasis
Failure of lung to inflate at birth
41
When does the pleural cavity become a real space?
When a lung collapses
42
Steps of Lung Collapse
(1) Penetrating wound opens through thoracic wall or surface of the lungs
(2) Air is sucked into the pleural cavity because of the negative pressure
(3) Surface tension adhering visceral to parietal pleura (lung to thoracic wall) is broken
(4) Lung collapses and expels most of its air because of its inherent elasticity (elastic recoil)
43
Pneumothorax
Air in the pleural cavity
44
Bronchopulmonary Fistula
- Rupture of a pulmonary lesion into the pleural cavity
- Typically causes a pneumothorax and collapse of lung
45
Hydrothorax
Fluid in the pleural cavity
46
Pleural Effusion
Escape of fluid into the pleural cavity; often causes a hydrothorax
47
Hemothorax
Blood in the pleural cavity
48
Common causes of Hemothorax
Injury to intercostal or internal thoracic vessels
49
Bronchoscope
Endoscope for inspecting the interior of the tracheobronchial tree
50
What can cause the carina to appear distorted?
Enlarged tracheobronchial lymph nodes (typically occurs because cancer cells have metastasized from a bronchogenic carcinoma)
51
Morphological changes in the carina are:
Important diagnostic signs to bronchoscopists
52
Bronchial Asthma
Respiratory disorder characterized by reversible narrowing of the bronchial passages
53
Clinical Relevance of Transverse Pericardial Sinus
Important during cardiac surgery to allow clamping/ligating of large vessels for coronary bypass machine to stop/divert blood circulation
54
Myocardial Infarction
Area of myocardium that has undergone necrosis
55
What is the most common cause of ischemic heart disease?
Coronary Artery Insufficiency due to Atherosclerosis
55
Infarcted
"Bloodless"
56
3 most common sites of Coronary Artery occulusion:
- Anterior IV (LAD) Branch of LCA
- RCA
- Circumflex branch of LCA
57
Angina Pectoris
Pain that originates in the heart; transient but moderately severe constricting pain
58
What causes Angina Pectoris?
Ischemia of myocardium that falls short of inducing cellular necrosis
59
Common cause of Angina Pectoris
Narrowed coronary arteries -> less oxygen to cardiac muscle cells -> accumulation of lactic acid and pH reduced -> stimulates pain receptors
60
Sublingual Nitroglycerin
- Medication placed or sprayed under the tongue for absorption through oral mucosa
- Dilates coronary arteries to increase blood flow to the heart and decrease workload
61
Angina Pectoris is a warning that indicates:
Coronary arteries are compromised
62
Primordial atrium is represented in the adult as the:
Right Auricle
63
Definitve atrium is enlarged by incorporation of most of the:
Sinus Venosus
64
What do the crista terminalis and sulucs terminalis indicate?
Line of fusion of the primordial atrium and sinus venarum
65
Rudimentary IVC Valve
Semilunar crescent of tissue that has no function after birth
66
Atrial Septal Defect (ASD)
Congenital anomaly of the interatrial septum, usually incomplete closure of the oval foramen
67
Large ASDs allow oxygenated blood from the lungs to be shunted from the left atrium through the ASD into the ___ ____, causing enlargement of the ___ atrium and ventricle, and dilation of the ___ ____.
- Right atrium
- Right
- Pulmonary Trunk
68
The Left-to-Right shunt created by ASDs overloads the ___ vascular system, resulting in ____ of the right atrium and ventricle, and pulmonary arteries
- Pulmonary
- Hypertrophy
69
Where is the common site of Ventricular Septal Defects?
Membranous part of the IVS
70
Cardiac Catheterization
Procedure where a radiopaque catheter is inserted into the peripheral vein and passed into the RA, RV, pulmonary trunk and pulmonary arteries
71
Goals of Cardiac Catheterization
- Record intracardiac pressures
- Remove blood samples
72
Fibrillation
Multiple, rapid, circuitous contractions/twitchings of muscular fibers
73
Atrial Fibrillation
- Rapid, irregular and uncoordinated twitchings of different parts of the atrial walls
- Ventricles respond at irregular intervals to dysrhythmic pulses from atria, but circulation remains satisfactory
74
Ventricular Fibrillation
- Rapid, irregular, twitching movements that do not pump (do not maintain the systemic and coronary circulation)
- Most disorganized of all dysrhythmias
- No effective cardiac output occurs
- Condition is fatal if allowed to persist
75
Artificial Cardiac Pacemaker
Produces electrical impulses that initiate ventricular contractions at a predetermined rate
76
Placement of Artificial Cardiac Pacemaker
Electrode with a catheter is inserted into a vein and passes to the SVC -> right atrium -> right ventricle -> electrode is firmly fixed to the trabeculae carnea in the right ventricular wall, making sure it is in contact with the endocardium
77
Pericarditis
- Inflammation of the pericardium
- Typically causes chest pain
- When listening with a stethoscope you can hear the friction of the roughened surfaces of the serous pericardium (known as Pericardial Friction Rub)
78
A chronically inflamed and thickened pericardium may ___, seriously hampering ___ ____.
- Calcify
- Cardiac efficiency
79
Pericardial Effusion
- Passage of fluid from pericardial capillaries into the pericardial cavity, or accumulation of pus
- Results in the heart becoming compressed (unable to expand and fill fully) and ineffective
80
Noninflammatory pericardial effusions often occur with:
Congestive Heart Failure
81
Congestive Heart Failure
- Condition where venous blood returns to the heart at a rate that exceeds cardiac output
- Produces right cardiac hypertension (elevated pressure in the R side of the heart)
82
Another name for Cardiac Tamponade:
Heart Compression
83
Cardiac Tamponade
Potentially lethal condition where heart volume is increasingly compromised by the fluid outside the heart but inside the pericardial cavity
84
Hemopericardium
- Blood in pericardial cavity
- Produces cardiac tamponade
- Can result from perforation of a weakened area of heart muscle (typically from a previous MI), bleeding into the pericardial cavity after cardiac operations, and/or stab wounds
85
Pneumopericardium
Condition that occurs when air from a pneumothorax dissects along connective tissue planes and enters the pericardial sac
86
Pericardiocentesis
- Drainage of fluid from pericardial cavity
- Necessary to relieve cardiac tamponade
87
Coronary Bypass Graft
- Used on patients with obstruction of their coronary circulation and severe angina
- Segment of an artery or vein is connected to the ascending aorta or to the proximal part of a coronary artery and then to the coronary artery distal to the stenosis
88
Vein that is commonly harvested for Coronary Bypass Surgery:
Great Saphenous Vein
89
Percutaneous Transluminal Coronary Angioplasty
Procedure where they pass a catheter with a small inflatable balloon attach to its tip into the obstructed coronary artery -> when reach obstruction the balloon is inflated which flattens the atherosclerotic plaque against the vessel wall -> vessel is stretched to increase size of the lumen which improves blood flow
90
Thrombokinase
Can be injected thru catheter to dissolve a blood clot
91
Pulmonary Embolism
- Clot that blocks Pulmonary A or other branch
- Causes partial/complete obstruction of blood flow to the lung
- Lung is still ventilated with air but not perfused with blood
92
Acute Respiratory Distress
- Major decrease in oxygenation of blood
- Often occurs when a large embolus occludes a pulmonary artery
93
Pulmonary Infarct
Area of necrotic (dead) lung tissue
