Test 2 Clinicals Flashcards
(23 cards)
Peau d’orange
orange peel texture appearance on surface of skin caused by subcutanous lymphatic obstruction and tumor growth on suspensory ligaments in breast
Cancer en cuirasse
further subcutanous spread than Peau d’orange; a hard woody texture to skin
simple mastectomy
remove breast to retromammary space
radical mastectomy
remove breast, pectoral muscles, all lymph nodes in axillary and pectoral region
Consequences of mastectomy (2)
significant lymph drainge distruption if mastectomy or surgical axillary node clearance has been performed;
damage to LONG THORACIC NERVE can result in paralysis of serratus anterior (winged scapula)
Radiotherapy can damage lymph nodes
may result in arm sweeling and pitting edema (lymphedema)
What is located at the sternal angle?
articulation of rib 2 with sternum
cervical ribs (6 parts)
- present in 1% of population
- an accessory rib articulates with C7; the anterior end attaches to superior border of anterior aspect of rib 1;
- appears as horn like structures on plain radiographs
- a fibrous band commonly extends from small cervical rib to rib 1 - produces cervical band
- structures that normally pass over rib 1 are elevated by and pass over cervical rib and band
- can cause thoracic outlet syndrome
thoracic outlet syndrome
results from abnormal compression of brachial plexus of nerves as it passes over first rib and through axillary inlet into upper limb; cervical band puts upward stress on brachial plexus
- sensory disturbance over medial aspect of forearm; wasting of intrinsic muscles of hand
3 diseases produced by cervical ribs
- arterial compression and embolization - distal embolization:
subclavian artery diameter is reduced - thoracic outlet syndrome
- compression of subclavian vein
collection of sternal bone marrow
the subcutanous position of the sternum makes it possible to put a needle through the cortex into the medullary (internal) cavity containing bone marrow to aspirate bone marrow
flail chest
can be produced when ribs are broken in 2 or more places; enough ribs are broken to produce a loose fragment
paradoxical breathing
surgical access to chest
dependent upon the organ which is operated upon and its relationshops to subdiaphragmatic structures and structures in the neck
the standard incision site of chest
a median sternotomy to obtain access to the heart, coronary arteries, and cardiac valves
minimally invasive thoracic surgery (video assisted thoracic surgery VATS)
making small incisions in the intercostal spaces, placing a small camera on a telescope, and involves other instruments
can perfom a lobectomy, lung biopsy, and esophagectomy in this manner
thoracostomy (chest) tube insertion
- relieve air or fluid trapped in thorax in pleural cavity; done for pneumothorax, hemothorax, hemopneumothorax, malignant pleural effusion empyema, hydrothorax, chylothorax, after thoracic surgery
- positioned determined by “safe triangle” formed by anterior border of latissimus doors, lateral border of pectoralis major, and apex below axilla
- position of ribs should be clearly marked
- anesthetic applied to superior border of the ribe and inferior aspect of interostal space
- neruvascular bundle runs in the groove that runs on the inferior surface of the rib, hencs the reason for inserting the tube on the superior surface of the rib
innervation of parietal pleura
somatic afferent fibers
innervation of costal pleura
branches from intercostal nerves
innervation of diaphragmatic pleura and mediastinal pleura
phrenic nerves (originating at spinal cord levels C3, C4, C5)
reffered pain
phrenic nerves (C3, C4, C5) refers to C3, C4, C5 dermatomes (lateral neck and supraclavicular region of shoulder)
innervation of visceral pleura
visceral afferent nerves that accompany bronchial vessels; pain is generally not eleicited form this tissue
why do foreign bodies tend to lodge more frequently on the right side?
the right main bronchus is wider and takes a more vertical course through the root and hilum than the left
bronchopulmonary segment
the smallest functionally independent region of alung and smallest area of lung that can be isolated and removed without affecting adjacent regions
