Mf2 Iii Blue Boxes

Front 1

Dislocation of ribs (2 types)

Back 1

Dislocation of sternocostal joint
Displacement of interchondral joints in ribs 8-10

Front 2

Separation of ribs

Back 2

Dislocaton of costochondral junction between rib and its costal cartilage
In separations of rib 3-10, preichondrium/periosteum can occur moving rib superiorly causing pain

Front 3

Intercostal nerve block

Back 3

Inject local anesthetic around intercostal nerves between paravertebral line and area of anesthesia

Front 4

Pulmonary collapse

Back 4

Penetrating wound in thorax or lungs will suck air into pleural cavity, disrupting surface tension -> lung collapse
Pleural cavity becomes a real space for hemorrhage and air
Results in elevation of diaphragm on radiography and displacement of mediastinum

Front 5

Pneumothorax

Back 5

Entry of air into pleural cavity form penetrating wound -> collapsed lung
Pleural effusion (escape of fluid into pleural cavity) -> hydrothorax
Chest wound -> hemothorax

Front 6

Thoracentesis

Back 6

Insert needle into 9th intercostal space in midaxillary line during expiration
Reaches costadiaphragmatic space
Insert superior to rib to avoid intercostal nerves and vessels

Front 7

Insertion of chest tube

Back 7

To remove air, blood, serous fluid, pus.
Insert tube in 5th or 6th IC space in midaxillary line

Front 8

Bronchoscopy

Back 8

Proceeds down trachea to enter a main bronchus
Carina is cartilaginous projection between orifices of main bronchi
Bronchogenic carcinoma - carina is distorted by tracheobronchial lymph nodes

Front 9

Level of arch of aorta (supine vs standing)

Back 9

Supine: Superior to transverse thoracic plane (T4-T5 IV disc to sternal angle
Standing: transected by transverse thoracic plane

Front 10

Level of bifurcation of trachea (supine vs standing)

Back 10

Supine: Transected by transverse thoracic plane
Standing: Inferior to transverse thoracic plane

Front 11

Level of inferior extent of heart (supine vs standing)

Back 11

Supine: xiphisternal junction and T9
Standing: middle of xiphoid process and T9-10 IV disc

Front 12

Widening of mediastinum (3 causes)

Back 12

After trauma -> hemmorhage into mediastinum from lacerated great vessel
Malignant lymphoma -> massive enlargement of lymph nodes
Enlargement of heart (w/ CHF) causes inferior mediastinum widening

Front 13

Pericarditis (3)

Back 13

Inflammation of pericardium causes chest pain
-> pericarditis friction where roughened serous pericardium rub against each other
Chronic inflammation can lead to calcification

Front 14

Pericardial effusion (from two main types)

Back 14

Inflammatory: Passage of fluid from pericardial capillaries into pericardial cavity
-> compressed and ineffective heart
Non-inflammatory: effusions from CHF

Front 15

Cardiac tamponade (3 causes)

Back 15

Heart compression
Pericardial effusion does not allow for full expansion of heart, reducing cardiac output
Hemopericardium from perforation of weakened area of heart -> lethal due to high pressure
Pneumothorax -> air my enter pericardial sac -> pneumopericardium

Front 16

Pericardiocentesis

Back 16

To relieve cardiac tamponade
Needle into 5th or 6th left intercostal space (cardiac notch) or infrasternal angle superiorposteriorly (careful of internal thoracic artery)

Front 17

Valvular heart disease

Back 17

Stenosis and insufficiency cause increased workload for the heart
Produce turbulence -> murmurs

Front 18

Valvular stenosis

Back 18

Failure of valve to open fully
Usually chronic

Front 19

Valvular insufficiency/regurgitation

Back 19

Failure of valve to close completely, so blood flows back from whence it came
Chronic or acute

Front 20

Mitral valve insuffiency/regurgitation (prolapse)

Back 20

Blood regurgitates into left atrium when LV contracts
Soft S1
Holosystolic, high pitched, blowing

Front 21

Pulmonary valve stenosis

Back 21

Restrict RV outflow
Soft S2 and wide split
S4 if RV hypertrophy
Mid-systolic, harsh

Front 22

Pulmonary valve incompetence

Back 22

Backrush of blood under high pressure into RV

Front 23

Aortic valve stenosis

Back 23

Most frequent abnormailty
Due to calcification
S2: soft, paradoxically split
S4: if LV hypertrophy
Mid-systolic harsh, med pitch, crescendo-decrescendo murmur

Front 24

Aortic valve insufficiency

Back 24

S2: single
S3: may be present, LV failure
Diastolic, high pitched blowing crescendo

Front 25

Coronary artery (heart) disease (etiology, common sites, why its slowly progressive)

Back 25

atherosclerosis -> embolic occlusion -> infarction -> necrosis
Most common sites: LAD, RCA, Circumflex of LCA
Can be slowly progressive due to compensatory collateral circulation

Front 26

Angina pectoris

Back 26

Ischemia that falls short of infarction -> low O2 to myocytes -> lactic acid accumulation -> pain
Relieved by rest or sublingual nitroglycerin to dilate coronary and systemic arteries

Front 27

Angina pectoris vs MI pain presentation

Back 27

Angina pectoris - short pain relieved by rest, follows exercise or eating, relieved by nitroglycerol
MI pain - more severe, does not disappear after a few minutes, may also follow exercise

Front 28

Coronary bypass graft (which vessels are used?)

Back 28

For obstruction of coronary circulation and severe angina
Graft is usually radial artery or great saphenous vein
Attach to ascending aorta and to coronary a. distal to stenosis

Front 29

Coronary angioplasty (3 options)

Back 29

Catheter w/ balloon is passed into coronary a.
Expand balloon to flatten plaque or inject thrombokinase to dissolve clot or introduce stent to keep vessel open

Front 30

Cardiac referred pain

Back 30

Usually referred to substernal, left pectoral, medial upper limb on left
Due to afferent pain fibers running w/ middle and inferior cervical branches and thoracic cardiac branches of sympathetic trunk
Enter spinal cord segments at T1-T4/5
Visceral afferent terminations for coronary arteries are common to cutaneous nerves of medial cutaneous nerve of arm and intercostal cutaneous nerves

Front 31

Aneurysm of ascending aorta (presentation?)

Back 31

Distal aorta is not reinforced by fibrous pericardium and also receives strong thrust of blood during LV contraction
Aneurysm (localized dilation) can occur here, visible on xray
Presentation as chest pain that radiates to back

Front 32

Coarctation of aorta

Back 32

Abnormal narrowing in descending aorta
If post ductus (ligamentum) arteriosus, collateral circulation develops between proximal and distal aorta via intercostal and internal thoracic arteries
Visible as pulsation in IC spaces on radiograph

Front 33

Variations in great vessels (4)

Back 33

Common variations in branching from arch of aorta (often no brachiocephalic trunk)
Retroesophagel right subclavian a. crossing posterior to esophagus causing dysphagia
Double arch of aorta can compress trachea
Right arch of aorta

Front 34

Laceration of thoracic duct

Back 34

During surgery since it is hard to identify, thin-walled and colorless
Laceration results in lymph escaping into thoracic cavity

Front 35

Atrial septal defects (ASDs, end result of clin. sign.)

Back 35

Can occur due to incomplete closure of foramen ovale
Clinically significant ASDs allow O2 blood from lungs into RA -> overloads pulmonary vascular system -> hypertrophy of RA and RV and PA

Front 36

Ventricular septal defects (end result)

Back 36

Membranous defects are most common
Cause left to right shunt
-> Increases pulmonary blood flow -> hypertension -> cardiac failure