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38 Cards in this Set
- Front
- Back
Chest anatomy terms
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Manubrium, suprasternal notch, sternal angle (angle of Louis), 1st and 2nd ribs, xyphoid process.
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Pectus excavatum
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Depression in the lower sternum
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Pectus carinatum
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Anteriorly displaced sternum
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Traumatic flail chest
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Multiple rib fractures resulting in paradoxical movements of the thorax. On inspiration injured area caves inward and expiration outward
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Thoracic kyphoscoliosis
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Abnormal spine curve and vertebral rotation causing chest deformities.
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2nd rib
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From suprasternal notch move about 5 cm inferiorly to the sternal angle and then laterally (start counting interspaces)
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2nd intercostal space is location for...
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Tension pneumothorax needle insertion
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4th intercostal space is location for...
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Chest tube insertion
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Where ribs articulate...
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7th rib is last to articulate with sternum
8-10th ribs articulate with costal cartilage 11th and 12th ribs are free floating |
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12th rib
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Palpable posteriorly and can start counting ribs/interspaces
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Inferior tip of scapula
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Lies at the level of the 7th rib/interspace.
T7-T8 interspace is location for thoracentesis |
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C7
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With neck flexed the most protruding process is usually C7
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Describing location on the chest
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Use:
-Vertical axis – by noting rib level (counting ribs) -Circumference around the chest – using boney land marks and vertical lines |
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Vertical lines
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Midsternal line, Midclavicular line, Axillary lines, Anterior, Midaxillary, Posterior axillary, Vertebral line, Scapular line
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Lung apex
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Rises 2-4cm above clavicles
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Lung bases
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Extend
-6th rib midclavicular -8th rib midaxillary -T10 spinous process posteriorly |
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Oblique fissure
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Find spinous process of T3
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Horizontal fissure
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Near 4th rib to midaxillary line near 5th rib
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Tracheal bifurcation
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At sternal angle anteriorly and T4 posteriorly
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Common chest complaints
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-Chest pain
-Shortness of breath -Wheezing -Cough -Hemoptysis |
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Chest pain - general
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History gives you significant direction for cause, always ask questions that can include or exclude sources
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Chest pain - possible causes
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Cardiovascular, pulmonary, GI, musculoskeletal, skin, anxiety, and others
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Chest pain - questions to ask
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Location, quality, quantity, timing/onset, setting, associated manifestations, aggravating/alleviating factors
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Cardiovascular chest pain - location
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Substernal, shoulder, jaw, neck
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Cardiovascular chest pain - quality
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Pressure, ache, heavy, "crushing", "ripping or tearing", sharp
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Cardiovascular chest pain - quantity
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Mild to severe (typically more significant)
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Cardiovascular chest pain - timing
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1-20 min and intermittent (angina), constant (pericarditis and dissection)
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Cardiovascular chest pain - aggravating
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Exertion (angina/MI), breathing and position (pericarditis)
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Cardiovascular chest pain - alleviating
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Rest, sitting forward (pericarditis)
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Cardiovascular chest pain - associated symptoms
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Dyspnea, nausea, diaphoresis (angina/MI)
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Levine sign
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A clenched fist over the anterior chest typical in coronary syndrome.
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Tracheobronchitis
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Upper chest, burning, mild-moderate, aggravated by cough/deep breathing, alleviated by lying on involved side
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Pleuritic pain
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Any chest wall area, sharp/stabbing, mod-severe, constant, aggravated by cough/breathing/chest wall motion
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Bronchospasm
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Substernal, sharp to ache, mild-severe, episodic, aggravated by cough/breathing deep, associated with wheezing/dyspnea
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GERD
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Substernal and to back, burning/squeezing, mild-severe, worse after meals and lying down, alleviated with antacids (some)
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Esophageal spasm
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Substernal to jaw or back, squeezing, mild-severe, aggravated with swallowing, improved occasionally with belching and antacids
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Peptic ulcer
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Substernal to back/abdomen, ache to burn, mild-severe, initially may improve with food then worsen later
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Gallbladder
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Substernal to back/abdomen, ache to burn, mild-severe, initially may improve with food then worsen later, worse with greasy meals.
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