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76 Cards in this Set
- Front
- Back
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A clumsy medical student is attempting to perform a "subclavian stick". If he goes too deep, what specific structure will be damaged?
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Cupula of the lungs
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As a nephrologist, which spinal levels would you palpate to find the RIGHT kidney?
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T12-L4
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As a nephrologist, which spinal levels would you palpate to find the LEFT kidney?
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T11-L3
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A patient with an infection in the right lung, may not have the infection spread to his left lungs because of what structural impediment?
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Mediastinum separates pulmonary cavities
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A man is stabbed at the sternal angle while standing. Where will the knife penetrate?
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The aortic arch
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A man is stabbed at the sternal angle while laying down. Where will the knife penetrate?
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The aorta and, if deep enough, the thoracic descending aorta
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As a surgeon, after performing a mastectomy you notice weakened adduction of the arm in your patient. What did you damage?
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Thoracodorsal nerve
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As a surgeon, after performing a mastectomy you notice a winged scapula in your patient. What did you damage?
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Long thoracic nerve
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A patient is stabbed in the anterior superior lateral chest. He can still breath normally, but has trouble with taking deep breaths and holding his breath. What has been damaged?
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Pec. Major and Minor assist with forceful respiration
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A patient is having trouble inhaling. Which intercostal muscle layer is likely damaged?
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External intercostal muscles are the main controllers of inhalation
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As a vascular surgeon, you notice ischemia in the medial mammary region. After examining the blood supply to the arm and hand, you conclude it is normal. Which artery will you likely be repairing?
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Internal thoracic artery (medial mammary branches/perforating branches)
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An hour after performing a thoracocentesis on a patient, you notice hemothorax. What was your mistake?
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Your needle hit an intercostal artery, blood enters the cavity
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A patient is stabbed in mid chest at the T8 level. What symptoms would we expect to see in this patient with regard to breathing?
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Paradoxical breathing. Only Right phrenic is likely damaged. (Pericardiophrenic artery is also damaged = ischemia of diaphragm)
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A patient is stabbed in mid chest. We see a dramatically increased heart rate. Why? What vertebral level was he stabbed?
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T10, Vagus nerve is likely damaged. Vagus nerve is the parasympathetic nerve for the heart (decreases heart rate)
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A patient has been stabbed in the right chest. He has trouble breathing. Even though his right lung is still intact, why can it not inflate? What was actually damaged by this stab wound?
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Plurae MUST be fully intact for lung to inflate. The parietal plurae was probably the only thing damaged
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A patient is unable to take deep breaths (forced respiration). When they try to take deep breaths, there is pain in the abdomen. What is likely occurring?
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Fluid is filling the costodiaphragmatic recess. Perform thoracocentesis
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Why would you ask a patient to hold their breath during thoracocentesis?
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We want the lungs to be as small as possible in the cavity so we are less likely to puncture them
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A med student walks into a patient's room. They tell them they are performing a thoracocentesis and ask them to lean over. The student hits a lung. What was else was he supposed to ask a patient to do to reduce the likelihood of hitting a lung?
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Hold their breath. this reduces the amount of small the lung occupies in the cavity
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A patient has abnormally low oxygen saturation in the blood. Even after breathing pure oxygen, it is unable to reach 99%. Everything related to the lungs are normal. What is a possible cause for this?
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In some people, the foramen ovale fails to close. Blood can easily enter the left atrium from the right atrium.
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An athlete who regularly inhales 100% oxygen complains when he sees his blood oxygen levels are 99%. Why is his argument invalid?
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We can never have 100% oxygen because the veins bronchi connect to the pulmonary vein in the lungs. There is a small mixing of pulmonary and systemic circuits.
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A patient is stabbed in the right anterior scalene muscle. He now has weak breathing and unilateral abdominal pressure. What nerve was damaged? Explain the unilateral abdominal pressure.
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right Phrenic nerve. Paradoxical breathing pushes the abdominal organs to the side that is not active during inhalation.
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Most doctors working in the intercostal space try to go straight through the middle of the intercostal muscles. Why might an anesthesiologist working in the area try to go higher or lower within the intercostal space?
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To numb the intercostal nerves. (intercostal nerve block)
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A patient is shot in the chest. Why would you expect to see pneuomothorax? Why would the lung immediately collapse?
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Air enters through the wound. Negative pressure system is lost when opened to outside air. Negative pressure keeps the lungs from collapsing
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A patient complains that it "feels like an elephant is sitting on my chest". What is your immediate suspicion?
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Heart attack
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A patient is stabbed superior to the heart and just anterior of the esophagus. What blood vessel is likely directly damaged?
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Brachiocephalic artery
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A patient is stabbed just lateral to the carotid artery. The jugular is still intact. What action might the patient have difficulty doing?
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Vagus nerve damage. difficulty swallowing. Vagus innervates esophagus
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A patient with tension in the left recurrent laryngeal nerve may be damaging which associated vessel?
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Aorta, left laryngeal recurrent nerve wraps under the aorta
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A patient is stabbed between the pericardial sac and the parietal plurae of the lung. What muscle will be weakened?
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Diaphragm. phrenic nerve was hit unilaterally. diaphragm still has unilateral function
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A CT surgeon is placing a ligature in the transverse pericardial sinus before a heart transplant. He runs a wire through the sinus, pulls the wire anteriorly and ties it. What 2 vessels are now ligated?
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Aorta and pulmonary trunk
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A CT surgeon is opening a chamber of the heart. There are only 2 papillary muscles in there. Which chamber of the heart is he in?
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Left Ventricle
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A patient has a weak mitral valve (not very tight). During systole, what will we auscultate?
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Regurgitation of blood into the left atrium
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After examining an EKG, a cardiologist and CT surgeon suspect ischemia in the now weakened right ventricle. They also notice minor arrhythmia. What vessels will they probably need to repair?
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Right coronary artery (SA node and marginal branches)
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After examining an EKG, a cardiologist and CT surgeon notice arrhythmia and have found a blood clot. Assuming there is no ischemia in the right ventricle, where is this clot located?
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SA node branch of right coronary artery
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Why would a patient with a bundle branch block frequently pass out?
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Conduction in the heart is unstable at anytime and blood cannot be pumped to the body. Passing out is the body's way of saving oxygen.
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A patient has a low heart rate and you notice fluid surrounding the heart. What is the diagnosis and treatment?
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Pericarditis/Cardiac Tamponade. Pericardiocentesis. Tamponade causes weaker pumping = lower heart rate
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A CT surgeon is placing a ligature in the transverse pericardial sinus before a heart transplant. He runs a wire through the sinus, pulls the wire posteriorly and ties it. What vessel is now ligated?
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Superior Vena Cava
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A patient with atherosclerosis and frequent blood clots has sudden arrhythmia and poor muscular coordination in the heart. What layer of cardiac tissue contains the cells responsible for this? Explain a possible pathogenesis of this problem for this patient?
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Subendocardium contains Purkinje fibers. They are sensitive to ischemia. In this patient ischemia may be caused by a blood clot
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What characteristic of cardiac cells explains the presence of lipofuschin?
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They are post-mitotic. Same cells since birth means more accumulation
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A patient recently suffered from a heart attack. Why is it likely that there will be angiogenesis in the affected region?
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Angiogenesis is supplying the newly synthesized/synthesizing scar tissue
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Assume you developed a drug that could promote controlled angiogenesis in myocardium. What would this drug be used for?
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Heart attacks. To prevent myocardial ischemia, we may be able to create new anastomoses.
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The heart is unable to move smoothly in the pericardial sac. What type of epithelium is damaged or weakened?
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Simple squamous, mesothelium
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You have a hypertensive patient with atherosclerosis. Why is his heart a weak pump?
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Ventricular hypertrophy. Ventricles must pump against increased resistance. Since we cannot make more myocardium, the current muscles must grow. This creates a less flexible heart.
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In a patient with Marfan's Syndrome, How would we expect their blood pressure to be affected?
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Defective fibrillin = Bad elastic fibers = poor recoil of blood vessels after systole = low diastolic pressure
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As a pathologist looking to differentiate between types of arteries, what stain would you likely use?
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Orecin or Resoucin-Fuschin. Arteries have differing amounts of elastic.
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As a cardiologist, you notice abnormally high levels of PDGF in a patient's blood and high levels of elastin in the vessel walls. If you believe they are at a high risk for developing atherosclerosis, which pathogenesis hypothesis are you likely to support?
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Monoclonal hypothesis suggest that smooth muscle proliferation is the initiating step to atherosclerosis. PDGF stimulates smooth muscle proliferation and smooth muscle creates elastic
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Data shows that atherosclerosis is significantly more likely in areas of vessel bifurcations. Which hypothesis of atherosclerosis pathogenesis does this support?
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"response to injury" hypothesis. bifurcations have RBCs constantly hitting the walls. this can damage the endothelium over time. "response to injury" hypothesis says endothelial damage initiates atherosclerosis
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What function of endothelial cells is likely damaged in patients with atherosclerosis?
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Anti-clotting function. Plaques form now
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As a pathologist, you notice a capillary with tight junctions, but notice no pinocytotic vesicles. What type of capillary is this? Where is this tissue from?
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continuous; CNS or PNS
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As a pathologist, you notice a capillary with continuous endothelium, but has small pores with no diaphragms. What type of capillary is this? Where is this tissue from?
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Fenestrated. renal glomeruli
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As a pathologist, you notice a capillary with broken basal lamina and macrophages. What type of capillary is this? Where is this tissue from?
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sinusoidal/discontinuous. liver, lymphoid tissues
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A diabetic patient shows you ulcerations on his fingers. Why does he have these?
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Diabetes causes increased collagen 4 and laminin production. Basal membranes thicken in endothelium. Lumen of blood vessel shrinks. Effects are more prominent in smaller capillaries that require thin basement membranes
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As a pathologist, you are examining a blood vessel with a thin tunica media. What can you tell about its function?
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It works with low pressure fluids (veins or lymphatic)
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Why would a calmodulin deficiency affect blood pressure?
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Smooth muscle cells in arteries and large veins (vena cava)
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A patient has been inhaling cold, dry air and has been having frequent respiratory infections. What "segment" of the nose is dysfunctional? What structures are likely deficient?
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Respiratory segment; conchae/turbinates. chonchae moisten and warm air, and create turbulence to trap particles in mucous
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A patient with rhinitis will have edema in the nasal cavity. Why is this?
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The nasal cavity lamina propria is very well vascularized. fluids can leave circulation and enter the tissue
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A patient has a lamina propria that is not producing lysozymes (antibacterials). What types of cells are dysfunctional?
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Demilunes
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A patient has lost his sense of smell. After 4 years it still has not returned. What type of cells of the olfactory segment are defective?
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Basal cells are responsible for creating new sensory olfactory cells.
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Why wouldn't Kartegener's Syndrome affect smell even though cilia are required for smell?
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The olfactory cilia are non-motile, purely sensory
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Why would damage to the trigeminal nerve lead to respiratory infection?
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Inability to sneeze = not able to get dust out of system
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A patient cannot smell. His olfactory cells are present and intact. His inability to smell may be attributed to what?
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Damage to the olfactory nerve (CN 1)
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A patient complains about losing their voice. Which muscles may be damaged?
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Vocalis muscle
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Why do smokers have a thickened trachea basal lamina?
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Due to chronic coughing
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A patient is unable to cough. After further examination, you realize they have a calmodulin deficiency. Explain their symptoms.
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Calmodulin is needed for smooth muscle contraction. Trachealis muscle (smooth muscle) makes us cough.
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A patient is unable to make proper clara cells. What will this dysfunction cause in the patient?
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No CC16 is made. Adjacent walls of the bronchioles can touch. Damage to the bronchioles can occur
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A patient is having difficulty breathing due to lung damage. What protein from bronchioles might we find in the blood?
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lipoprotein CC16 from clara cells in the blood indicates lung damage
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Assume that you had a patient with blockages at the end of all his terminal bronchioles. Would any gas exchange occur?
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No, terminal bronchioles only move air, no gas exchange
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A patient comes into your office with pneumonia. After performing a history, you learn he is an alcoholic. Why does this make sense?
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chronic alcohol can kill cilia.
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A patient who smokes wants to know why he has to cough so hard to cough up mucus. Explain this.
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Upper cilia in smokers is impaired. Goblet cell activity increases as a result of the crap inhaled. Because upper cilia are dead, crap gets further down and goblet cells follow it to trap it in mucus.
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A patient has an asthma attack. What medications would you give him and why?
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Epinephrine to relax the smooth muscle constricting bronchioles
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A patient has very thick mucus and trouble breathing. What is your diagnosis? How is this inherited?
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Cystic fibrosis, autosomal recessive
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A patient has difficulty breathing and becomes tired easily. His blood is well under 99% O2 saturation. The cells responsible for this problem later regenerate and the symptoms are gone. What alveolar cells would you blame for this?
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Type 2 pneumocytes. They were not making enough surfactant. So the gas exchange was not very efficient. Type 2 pneumocytes can divide, type 1 cannot divide.
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As an OB/GYN, you deliver a very premature baby. It has to be put on a ventilator immediately. Assuming the lungs were structurally fine, what was wrong?
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Respiratory distress syndrome. Unable to produce surfactant
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Assume you removed a patient's type 2 pneumocytes. What would happen as he exhaled?
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The lungs would collapse from the high surface tension without surfactant.
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A patient has damage to the basal lamina of alveolar septae. It is found to be an auto-immune disease. What is your diagnosis?
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Goodpasture's Syndrome- antibodies are made to collagen 4
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A patient is having trouble breathing. He is a coal miner and found to have narrow bronchioles. What is the diagnosis and a common treatment?
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COPD/Emphysema. Kill the alveoli that are dilated so others can expand
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A patient in the ER is coughing up blood. Lab tests show hemosiderin-filled macrophages in the pharynx. What is your diagnosis?
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Congestive heart failure
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