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27 Cards in this Set
- Front
- Back
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chest pain |
most important sx of cardiac disease but can occur for a multitude of reasons
during PE, discriminate between major/minor causes of pain
e.g. MI can be crushing, sub-sternal, not alleviated c rest |
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rib fracture |
R1 rarely fractured if so, the subclavian vessels & brachial plexus (which run superiorly over it) may be damaged
middle ribs most commonly fractured
weakest part: just anterior to angle
broken end may puncture viscera or cause diaphragmatic hernia |
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flail chest |
multiple rib fractures allow large segment of anterior/lateral thoracic wall to move freely
movement is paradoxical
extremely painful
impairs ventilation
must be fixed by hooks/wires to limit mvmt |
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thoracotomy |
surgical opening through thoracic wall to enter pleural cavity
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supernumerary ribs |
may have extra in lumbar or cervical region may have fewer, usually missing R12
cervical ribs may interfere c neurovascular structures |
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fx of costal cartilage |
provide resilience to thoracic cage ↓ elasticity c ↑age
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xiphoid process |
may ossify in 40s palpated as hard lump in epigastric fossa
commonly perforated in elderly d/t age-related ∆ |
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sternal fracture |
uncommon traumatic compression, surgical fracture
usually comminuted
manubriosternal joint fracture is most common sternal fracture in elderly |
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median sternotomy |
splitting the sternum in median plane, then retracting it to provide access for surgery
removal of tumors in superior lung nodes, CABG, etc. |
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bone marrow needle biopsy |
often the sternum d/t breadth & superficiality
used to dx mets, blood dyscrasias, or obtain marrow specimen |
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sternal bands/bars |
precartilaginous tissue that provides framework for sternal development |
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complete sternal cleft |
uncommon heart protrudes into sternum |
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sternal formamen |
perforation of sternum d/t incomplete fusion |
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pectus excavatum/cavinatum |
receding (funnel) chest / projecting (pigeon breast) chest |
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thoracic outlet syndrome |
thoracic inlet: allows entry of non-circulating substances
outlet: arteries & T1 nerves that emerge from thorax to enter lower neck & upper limbs
various syndromes exist, depending on the impacted emerging structure |
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rib dislocation |
displacement of costal cartilage from sternum aka dislocation of sternocostal joint
common in body contact sports
displacement of interchondral joints usually unilateral, involving R8-R10 generally requires enough trauma that underlying structures are damaged |
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rib separation |
dislocation of costochondral junction between rib & costal cartilage
If R3-R10, often the perichondrium & periosteum are torn |
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diaphragm paralysis |
d/t injury to motor supply
each R/L half served by an independent branch of phrenic nerve
on inspiration, dome ascends d/t superior push as contralateral dome compresses viscera |
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dyspnea |
dysfxl breathing
pts often use accessory respiratory muscles to assist thoracic cavity expansion
lean forward on knees to fix pectoral girdle to allow muscle to act on rib attachments to expand thorax |
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extrapleural intrathoracic surgical access |
provides natural cleavage plane, enabling surgeon to separate costal parietal pleura from thoracic wall |
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herpes zoster of spinal ganglia |
produces sharp, burning pain in dermatome supplied by involved nerve
erythema, vesicles |
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intercostal nerve block |
local anesthesia of intercostal space by injecting anesthetic around the intercostal nerves between the paravertebral line & area requiring anesthesia
blocks sensory impulses from reaching CNS |
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space of Bogros |
potential space between transversalis fascia & parietal peritoneum
can be used to place prosthetic to repair inguinal hernia |
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abdominal protruberance |
common in infants/children d/t air in GI, liver size
other causes food, fluid, fat, feces, flatus, fetus
umbilicus may evert |
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abdominal hernias |
umbilical common in neonates d/t anterior abdominal wall weakness
acquired umbilical mostly in women/obese
epigastric occurs in midline between xiphoid process & umbilicus
Spigelian along semilunar lines 40+/obese |
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palpation of anterolateral abdominal wall |
warm hands, to avoid muscle tensing/guarding
guarding occurs c acute abdomen
pt supine, thighs & knees semi-flexed |
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superficial abdominal reflexes |
elicited by quickly stroking horizontally, from lateral to medial, toward the umbilicus
may be missing if obese |
