Quiz 3 powerpoints

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seanoz28
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Quiz 3 powerpoints
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2011-11-14 13:40:58
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NSG 211
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chapters 17-23 excluding 18 & 20
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  1. Tail of Spence
    • superior lateral corner, most common site of cancer and tumors, projects
    • up and laterally into the axilla
  2. Montgomery glands
    • = small elevated sebaceous glands, secrete protective lipid material
    • during lactation to protect nipple
  3. Areola
    contains smooth muscle allowing for erection
  4. Breast
    • contains glandular tissue, fibrous tissue, and suspensory
    • tissue, and adipose tissue
  5. Glandular tissue
    • contains 15-20 lobes radiating from nipple and are composed
    • of lobules containing clusters of alveoli that produce milk. Each lobe empties
    • into lactiferous duct. Reservoirs located behind nipple store milk
  6. Coopers ligaments
    • suspensory ligaments or fibrous bands extending vertically
    • from surface to attach on chest wall muscles. Support the breast tissue. They
    • become contracted with breast cancer producing pits or dimples in overlying
    • skin
  7. Adipose tissue
    provide most of the bulk of breast
  8. Central auxillary nodes=
    • high up in auxilla over ribs and serratus muscle. Receives
    • lymph from other three lobes. Lymph drainage flows up to the infraclavicular
    • and supraclavicular nodes
  9. Pectoral nodes
    along lateral edge of the pectoralis major muscle
  10. Lateral nodes
    along humerous inside upper arm.
  11. Supernumerary nipple
    extra nipple
  12. Tanner staging
    stages used to identify sexual maturity rating
  13. Menarche
    period
  14. Colostrum
    • thick yellowish fluid which is the precursor to milk,
    • contains the same amount of protein and lactose as milk but practically no fat
  15. Mastalgia
    • occurs with trauma, inflammation, infection, and benign
    • breast disease
  16. Inframammary ridge
    • firm transverse ridge of compressed tissue in lower
    • quadrants of breasts
  17. Premature thelarche
    • early breast development with no other hormone dependent
    • signs ie: pubic hair, menses
  18. Signs of retraction of nipple
    dimpling, edema, fixation, deviation in nipple pointing
  19. Breast lump
    benign breast disease, cancer, fibroadenoma
  20. Abnormal nipple discharge
    carcinoma, pagets disease
  21. Disorders during lactations
    = plugged duct, breast abscess, mastitis
  22. Abnormalities in male breast
    = gynecomastia, carcinoma
  23. Cardiovascular system=
    consists of heart and blood vessels
  24. Precordium
    • area on the anterior chest directly overlying heart and great vessels
    • (major arteries and veins connected to the heart) between the lungs in the
    • middle third of the thoracic cage
  25. Mediastinum
    between the lungs in the middle third of the thoracic cage
  26. Pericardium
    • tough fibrous, double walled sac that surrounds and protects
    • the heart. Has two layers that contain a few millimeters of serous pericardial
    • fluid ensuring smooth friction free movement of heart muscle. Adherent to the
    • great vessels, esophagus, sternum, and pleurae anchored to the diaphragm
  27. Myocardium
    the muscular wall of the heart, it does the pumping
  28. Endocardium
    • the thin layer of endothelial tissues that lines the inner surface of
    • the heart chambers and valves
  29. Chambers
    • right side pumps blood into lungs, and left side pumps blood
    • into body simultaneously. Two pumps separated by an impermeable wall called the
    • septum.
  30. Atrium
    thin walled reservoir for holding blood
  31. Ventricles= muscular pumping chamber
    muscular pumping chamber
  32. Heart valves
    • main purpose is to prevent backflow of blood. The valves
    • open passively in response to pressure gradients in the moving blood
  33. Atrioventricular valves
    separate the atria and ventricles
  34. Tricuspid valve
    right atria valve
  35. Mitral valve
    left atria valve
  36. Chordae tendinae
    • anchors thin leaflet of valve, collagenous fibers anchored to papillary
    • muscles embedded in the ventricle floor
  37. AV valves
    • open during heart filling phase “diastole” allowing
    • ventricles to fill with blood. Close during heart pumping stage “systole” av
    • valves close to prevent regurgitation of blood. Papillary muscles contract at
    • this time, so that leaflets meet and unite to form a perfect seal withouth
    • turning inside out
  38. Semilunar valves
    • separate the ventricles and the arteries. Open during the
    • pumping phase “systole” to allow blood to be ejected from heart
  39. Pulmonic valve
    right side of heart
  40. Aortic valve
    left side of heart
  41. No valves exist between vena cava and atrium or between pulmonary veins
    • No valves exist between vena cava and atrium or between
    • pulmonary veins and left atrium. Abnormally high pressure in left side of heart
    • gives person symptoms of pulmonary congestion. Abnormally high pressure in the
    • right side of heart shows in neck veins and abdomin
  42. Blood flow through heart:
    Blood flow through heart: Liver->inferior vena cava->



    Head and upper extremities->superior vena cava->



    • ->right atrium->tricuspid valve->right
    • ventricle->pulmonic valve->pulmonary



    • artery->lungs->pulmonary veins-> left
    • atrium->mitral valve-> left ventricle-> aortic



    valve-> aorta-> body
  43. cardiac cycle
    rhythmic movement of blood flow through the heart
  44. Diastole
    • ventricles relax and fill with blood, this takes up 2/3 of
    • cycle. AV valves open (Acoustically silent), pressure in atria is higher then
    • in ventricles so blood pours rapidly into ventricles.
  45. first passive filling phase is called early or protodiastolic filling.
    • *first passive filling phase is called early or
    • protodiastolic filling. Toward the end of diastole the atria contract and push
    • the last amount of blood (25% of
    • stroke volume), into ventricles. This active filling phase is called presystole
    • or atrial systole
  46. protodiastolic filling
    protodiastolic filling=first passive filling phase of atria

    • presystole or atrial systole aka “Atrial kick”=Toward the
    • end of diastole the atria contract and push the last amount of blood (25% of stroke volume), into
    • ventricles.
  47. Systole
    • hearts contraction, blood is pumped from ventricles and
    • fills the pulmonary and systemic arteries 1/3 of cycle. Ventricular pressure is
    • finally higher then than in the atria causing mitral and tricuspid valves
    • closure.
  48. All four valves closed for a brief moment
    • All four valves closed for a brief moment until ventricles
    • contract against the closed system causing a surge of pressure opening the
    • aortic valve to the body ejecting blood. Some blood flows backward into the
    • ventricle causing the semilunar valve to close producing the second heart sound
    • S2.
  49. Isometric contraction
    • All four valves closed for a brief moment until ventricles
    • contract against the closed system causing a surge of pressure
  50. S1
    • closure of the AV valve produces the first heart sound S1
    • and signals the beginning of systole. Audible or precordium and loudest at the
    • apex of heart
  51. S2
    • after the ventricle ejects its contents the pressure in the
    • ventricle decreases causing blood to flow backward into the ventricle causing
    • the aortic valve to close producing the second heart sound. S2 signals the end
    • of systole. Audible over precordium and loudest at the base.
  52. S3
    • occurs when the ventricles are resistant to filling with
    • blood during the early rapid filling phase of the ventricles from the
    • protodiastole (atria contracting to push the remaining 25% of stroke volume
    • into ventricle). Occurs immediately after S2 when the AV valve opens and atrial
    • blood first pours into the ventricles.
  53. S4
    • occurs at the end of diastole at presystole when the
    • ventricle is resistant to filling. The atria contract pushing blood into a
    • noncompliant ventricle causing audible vibrations. Occurs just before S1.
  54. Events in right and left sides of heart
    • pressure in right side of heart much lower then the left because the
    • less energy is needed to pump blood to the lungs vs the entire body. Cardiac
    • cycle of right side occurs later then left side due to the route of the
    • myocardial depolarization. This occurrence causes heart sounds S1 and S2 to
    • each have two distinct components. In S1, the mitral component M1 closes just
    • before the tricuspid component T1. With S2, the aortic closure A2 occurs
    • slightly before pulmonic closure P2. These sounds aren’t usually distinguishable
    • and sound like lub dub as in S1 and then S2.
  55. Effects of respiration on Right side of heart
    • = inthrathoracic pressure decreases during inspiration,
    • pushing more blood into the vena cava, increasing venous return to right side
    • of heart, increasing right ventricular stroke volume. The increased stroke
    • volume prolongs right ventricular systole and delays pulmonic valve closure.
  56. Effects of respiration on left side of heart
    • greater amount of blood is sequestered in lungs during
    • inspiration which momentarily decreases the amount of blood returned to the
    • left side of the heart decreasing left ventricular stroke volume. The decreased
    • volume shortens left ventricular systole and allows the aortic valve valve to
    • close a bit earlier. Early closure of the aortic valve before the pulmonic
    • valve allows the two components of S2 “A2 and P2” to be audible called an S2
    • split.
  57. Murmurs
    • occur when the velocity of blood flow increases (flow
    • murmur), viscosity of blood decreases (anemia), and in structural defects in
    • valves or unusual openings occur in the chambers (dilated chamber, wall defect)
  58. Characteristics of heart sounds
    frequency, intensity, duration, timing
  59. SA node
    “pacemaker” of the heart. Intrinsic rythm
  60. Heart’s path of conduction
    • atria->av node low in the atrial septum where it is
    • slightly delayed so the atria have time to contract before the ventricles
    • contract-> bundle of his-> right and left bundle branches-> ventricles
  61. P wave
    depolarization of the atrial
  62. PR interval-
    • from beginning of the P wave to the beginning of the QRS complex, (the
    • time necessary for atrial depolarization plus time for the impulse to
    • travelthrough the AV node to the ventricles)
  63. QRS complex
    depolarization of the ventricles
  64. T wave
    repolarization of the ventricles
  65. Hearts pumping ability
    • 4-6 liters of
    • blood per minute through body
  66. Cardiac output
    • the volume of blood in each systole aka “stroke volume”
    • multiplied by the number of beats per minute. CO= SV x R
  67. Heart preload
    • venous return that builds during systole. The length to which
    • the ventricle muscle is stretched at the end of diastole just before
    • contraction. Volume of blood returned to the ventricle ie: “exercise
    • stimulating skeletal muscle to contract and force more blood back to the heart
    • because of systemic pressure”, the muscle bundles are stretched beyond their
    • normal resting state to accommodate. The force of this switch is the preload.
    • Frank –Starling law: the greater the stretch , the stronger the heart’s
    • contraction. The increased contractility results in an increased volume of
    • blood ejected (increased stroke volume)
  68. Heart’s afterload
    • the opposing pressure that the ventricle must generate to
    • open the aortic valve against the higher aortic pressure. The resistance
    • against which the ventricle must pump its blood. Once the ventricle is filled
    • with blood, the ventricular end diastolic pressure is 5 to 10mm hg, whereas
    • that in the aorta is 70-80mm hg. To overcome this difference, the ventricular
    • muscle tenses (isovolumic contraction). After the aortic valve opens, rapid
    • ejection occurs.
  69. Carotid artery
    • = located in the groove between the trachea and the
    • sternomastoid muscle, medial to and along side that muscle. Characteristics of
    • its waveform is a smooth rapid upstroke, a summit that is rounded and smooth,
    • and a downstroke that is more gradual and that has a dicrotic notch caused by
    • closure of the aortic valve.
  70. Jugular veins
    • internal and external jugular veins exist on both sides of the neck.
    • They empty unoxygemnated blood directly into the superior vena cava. The
    • jugular veins give information about the function of the right side of the
    • heart function because there is no valve between the superior vena cava and the
    • right atrium. Reflects filling pressure and volume changes, because volume and
    • pressure increase when the right side of the heart fails to pump efficiently which
    • is visualized by inspecting the jugular veins.
  71. Internal Jugular vein
    • = lies deep and medial to the the sternomastoid muscle. Usually not
    • visible. May be seen when when person is supine
  72. External jugular vein
    • = more superficial, lies lateral to the sternomastoid
    • muscle, lies lateral to the sternomastoid muscle, above clavicle
  73. Venous pulse and pressure
    • results from a backwash, a waveform moving backward caused
    • by events upstream.
  74. Jugular pulse 5 components
    • A wave =results
    • from atrial contaction because some blood flows backward to the vena cava
    • during right atrial contaction.



    • C wave =
    • ventricular contraction, is backflow from the bulging upward of the tricuspid
    • valve when it closes at the beginning of ventricular systole



    • X decent= shows
    • atrial relaxation when the right ventricle conracts during systole and pulls
    • the bottom of the atria downward.



    • V wave= occurs
    • with passive atrial filling because of the increasing volume in the right atria
    • and increased pressure



    • Y decent=
    • reflects passive ventrical filling when tricuspid valve opens and blood flows
    • from RA to RV
  75. Dyspnea
    shortness of breath
  76. Orthopnea
    • how many pillows
    • do you use when sleeping or lying down?
  77. Nocturia
    • recumbency at
    • night promotes fluid reabsorbtion and excretion, this occurs with heart failure
    • in the person who is ambulatory during the day,
  78. Thrill
    a palpable vibration
  79. Sinus arrhythmia
    • usually occurs in
    • young adults and varies with person’s breathing, increasing at the peak of inspiration and slowing with
    • expiration
  80. Pulse deficit
    • ausciltate apical
    • beat while simuletaneously palpating radial pulse, signals a weak contraction
    • of the ventricles and occurs with atrial fibrillation, premature beats, and
    • heart failure
  81. Aortic prosthetic valve sound
    • opening of
    • mechanical aortic ball-in-cage prosthesis produces an early systolic sound.
  82. Midsystolic click
    • associated with
    • mitral valve prolapse, in wich the mitral valve leaflets not only close but
    • ballon back up into the left atrium. During ballooning, the sudden tensing of
    • the valve leaflets and the chordae tendineae creates a click. Occurs mid-to
    • late systole and is short and high pitched with click quality
  83. Mitral prosthetic valve sound
    • an iatrogenic
    • sound, the opening of the ball-in-a-cage mitral prosthesis gives an early
    • diastolic sound, an opening click just after S2. It is loud heard over the
    • whole precordeum , and is loudest over the apex and left lower sternal border
  84. Pericardial friction rub
    • inflammation of
    • the precardium gives rise to a friction rub. High pitched and scratchy, like
    • sandpaper, best heard with the diaphragm, with person sitting up and leaning
    • fwd, and with breath held in expiration, heard best at apex and left lower
    • sternal border where precordium comes in close contact with chest wall,
    • friction rub of pericarditis common during 1st week after myocardial
    • infarction and may only last a few hours
  85. Thrill at base of heart
    • occuring in
    • second and third right interspaces with severe aortic stenosis and systematic
    • hypertesnion. Occurrence in the second and third left interspaces with pulmonic
    • stenosis and pulmonic hypertension
  86. Lift (heave) at the sternal border
    • occurs with right
    • ventricular hypertrophy, as found in pulmonic valve disease, pulmonic
    • hypertension, and chronic lung disease. Will feel a diffuse lifting impulse
    • during systole at the left lower sternal border, may be associated with
    • retraction of apex because left ventricle is rotated posteriorly by enlarged
    • right ventricle
  87. Patent ductus arteriosus (PDA)=
    • persistence of
    • the left channel joining the left pulmonary artery to aorta. Normal in the
    • fetus and usually closes spontaneously within hours of birth
  88. Arterial septal defect (ASD)=
    • abnormal opening
    • in the atrial septum, resulting usually in left-to-right shunt and causing
    • large increase in pulmonary blood flow
  89. Ventricular septal defect (VSD)=
    • abnormal opening
    • in septum between the ventricles, usually subaortic area. The size and position
    • vary considerably
  90. Tetralogy of fallot
    • four components:
    • (1) right ventricular outflow stenosis (2)VSD (3)right ventricular hypertrophy
    • (4)overriding aorta. Result shunts a lot of venous blood directly into aorta
    • away from pulmonary system, so blood never gets oxygenated
  91. Coarctation of the aorta
    • severe narrowing
    • of descending aorta, usually at the junction of the ductus arteriosus and the
    • aortic arch, just distal to the origon of the left subclavian artery. Results
    • in an increased workload on left ventricle. Assosciated with defects of aortic
    • valve in most cases, as well associated patent ductus arteriosis , and
    • associated ventricular septal defect
  92. Midsystolic ejection murmurs
    • due to fwd flow
    • through semilunar valves



    • Aortic stenosis= calcifiction of
    • aortic valve cusps restricts forward flow of blood during systole, LV
    • hypertrophy develops



    • Pulmonic stenosis= calcification of
    • pulmonic valve restricts fwd flow of blood
  93. Pansystolic reguritant murmurs
    • due to backflow of blood from area of higher pressure to one of lower
    • pressure
  94. Mitral regurgitation
    • stream of blood regurgitates back
    • into LA during systole through incompetent mitral valve. In diastole, blood
    • passes back into LV again along with new flows, results in LV dilation and
    • hypertrophy
  95. Tricuspid regurgitation
    • backflow of blood through
    • incompetent tricuspud valve into RA

    • Diastolic rumbles of AV valves=
    • filling murmurs at low pressures, best heard with bell lightly touching skin



    • Mitral stenosis=calcified mitral
    • valve will not open properly, impeded fwd flow of blood into LV during
    • diastole. Results in LA pressure increased



    • Tricuspid stenosis=calcification
    • of tricuspid valve impedes fwd flow into RV durig diastole
  96. Early diastolic murmurs
    due to SL valve incompetence
  97. Aortic regurgitation
    • stream of blood regurgitates back
    • through incompetent aortic valve into LV during diastole. LV dilation and
    • hypertrophy due to increased LV stroke volume. Rapid ejection of large stroke
    • volume into poorly filled aorta, then rapid runoff in diastole as part of blood
    • pushed back into LV.
  98. Pulmonic regurgitation
    • backflow of blood through incompetent pulmonic valve, from pulmonary
    • artery to RV
  99. Viscera
    • all organs inside the abdominal
    • cavity
  100. Solid viscera
    • organs which maintain a characteristic shape: stomach, gallbladder,
    • small intestine, colon, bladder.
  101. Hollow viscera
    • = the shape of the stomach,
    • gallbladder, small intestine, colon, and bladder depend on their contents.
    • Usually not palpable.
  102. Organs in RUQ
    • liver,gallbladder,duodenum, head of
    • pancreas, right kidney and adrenal, hepatic flexure of colon, part of ascending
    • transvers colon
  103. Organs in LUQ
    • stomach, spleen, left lobe of
    • liver, body of pancrease, left kidney and adrenal, splenic flecture of colon,
    • part of transverse and descending colon
  104. Organs in RLQ
    • cecum, appendix, right ovary and
    • tube, right ureter, right spermatic cord
  105. Organs in LLQ
    • part of descending colon, sigmoid colon, left ovary and tube, left
    • ureter, left spermatic cord
  106. Organs midline
    aorta, uterus,bladder
  107. What to look for during abdomen physical
    • contour, symmetry, umbilicus, skin, pulsations or movement, hair
    • distribution, demeanor
  108. Percussing abdomen
    • general tympany, liver span,
    • splenic dullness (between 9-11 intercostal space just behind left midaxillary
    • line, usually not more then 7cm in adult),
  109. costrovetebral angle tenderness “CVA”=
    • 12th rib at CV and thump
    • with fist,pain indicates kidney infection
  110. fluid wave
    • stand over persons right side,ulnar
    • edge right flank while striking left flank. Tests for acites which occurs with
    • heart failure, portal hypertension, cirrhosis, hepatitis, pancreatitis, and
    • cancer
  111. Obesity
    normal bowel sounds, tympany
  112. umbilical hernia
    • soft, skin covered mass, protrudes
    • through weakening in the umbilical ring, common in premature infants, most
    • resolve by themselves after 1 year, occurs in adults during pregnancy, chronic
    • ascites, chronic intrathoracic pressure e.g. asthma,chronic bronchitis
  113. diagastric recti=
    • midline longitudin al ridge,
    • separation of abdominal muscles, congenital, result of pregnancy, or marked
    • obesity, not clinically significant
  114. enlarged liver
    • occurs with fatty infiltration,
    • portal obstruction or cirrhosis, high obstruction of inferior vena cava, and
    • lymphocyctic leukemia, tender to palpation with early heart failure, acute
    • hepatitis, or hepatic abscess
  115. enlarged gallbladder
    • suggests acute cholecycstitis, difficult to palpate, area is exquisitely
    • painful to percussion and inspiratory arrest is present, feels like a smooth
    • sausage like mass. Occurs when gallbladder is filled with stones, as with
    • common bile duct obstruction
  116. enlarged spleen
    • enlarges down to the midline
    • because superiorly blocked by diaphragm, usually not tender to palpation unless
    • peritoneum is also inflamed. Usually occurs with acute infection
    • (mononucleosis)
  117. enlarged kidney
    • en;larged with hydronephrosis,
    • cyst, or neoplasm, percussion over spleen is dull, wheras over kidney it is tympanic
    • because of overriding bowel
  118. Nonsynovial joints
    • bones are united by nonfibrous tissue or cartilage and are
    • immovable
  119. Synovial joints
    • freely moveable because they have bones that are separated
    • from each other and are enclosed in a joint cavity filled with lubricant.
    • Synovial fluid allows for sliding of opposing surfaces. Layer of resilent
    • cartilage covers bone of opposing joint.
  120. Cartilage
    • avascular,
    • receives nourishment from synovial fluid that circulates during joint
    • movement, very stable connective tissue with a slow cell turnover rate.
  121. Ligament
    • fibrous bands running directly from one bone to another that
    • strengthen the joint and help prevent movement in undesireable direction.
  122. Bursa
    • enclosed sac filled with viscous synovial fluid, much like a joint.
    • Located in areas of potential friction e.g. subacromial bursa of shoulder,
    • prepatellar bursa of knee, and easily help muscles and tendons glide smoothly
    • over bone
  123. Fasciculi
    bundles of muscle fibers
  124. Tendon
    strong fibrous chord attaching muscle to bone
  125. Flexion
    bending a limb at joint
  126. Extension
    straightening a limb
  127. Abduction
    moving a limb away from midline of body
  128. Adduction
    moving a limb towards the midline of body
  129. Pronation
    turning the forearm so the palm is down
  130. Supination
    turning the forearm so that the palm is up
  131. Circumduction
    moving the arm in a circle around the shoulder
  132. Inversion
    moving the sole of the foot inward at the ankle
  133. Eversion
    moving the sole of the ankle outward at the ankle
  134. Rotation
    moving the head around a central axis
  135. Protraction
    moving a body part forward and parallel to the ground
  136. Retraction
    moving a body part backward and parallel to the grtound
  137. Elevation
    raising a body part
  138. Depression
    lowering a body part
  139. Temporalmandibular joint
    • articulation of the mandible and the temporal bone, palpable
    • in the depression anterior to the tragus of the ear, permits jaw function for
    • speaking or chewing, allows 3 motions: 1)hinge action to open and close jaws
    • 2)gliding action for protrusion and retraction 3)gliding action for side to
    • side movement of lower jaw
  140. Spine
    • 33 vertebrae connecting bones stacked in a vertical column,
    • 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 3-4 coccygeal vertebrae
  141. Landmarks of the spine
    • spinous process of of C7 and T1 are prominent at base of
    • neck, inferior angle of scapula usually present at the level of the interspace
    • between T7 and T8, an imaginary line connecting the highest points on each
    • iliac crest crosses L4, imaginary line joining two symmetric dimples that
    • overlie the posterior superior iliac spines crosses the sacrum
  142. Invertebral disks
    • elastic fibrocartilagous plates that constitute one fourth of the length
    • of the coloumn. Each disk has a nucleus pulpose made of soft, semifluid, mucoid
    • material that has the consistency of toothpaste in the young adult, the disks
    • cushion the spine like a shock absorber
  143. Shoulder glenohumeral joint
    • articulation of the humerous with the glenoid fossa of the
    • scapula, its ball and socket action allows great mobility of the arm on many
    • axises
  144. Rotator cuff
    • the glenohumeral joint enclosed by four different muscles and tendons
    • comprise the rotator cuff
  145. Subacromial bursa
    • located superior to rotator cuff, helps during abduction of
    • the arm
  146. Acromion process
    bump of scapula located on the very top of the shoulder
  147. Greater tubercle of the humerus
    • the next bump outward and downward from acromion process a few
    • centimeters downward
  148. Coracoid process
    • bump located a few cm medially to greater turbicle of
    • humerus
  149. Elbow medial and lateral epicondyles
    • palpable landmarks are the medial and lateral epicondyles of
    • the humerus and the large olecran process of the ulna in between them.
  150. Radiocarpal joint
    • articulation of the radius on the thumb side, and a row of carpal bones.
    • Its condyloid action permits movement into two planes at right angles: flexion
    • and extension, and side to side deviation
  151. Midcarpal joint
    • articulation between two parallel rows of carpal bones, allows flexion,
    • extension, and same rotation
  152. Metacarpophalageal and
    interphalangeal joint
    • Metacarpophalageal
    • and interphalangeal joint permit finger flexion and extension. The
    • flexor tendons of the wrist and hand are enclosed in synovial sheaths
  153. Hip
    • acetabulum and head of femur, anterior superior iliac spine,
    • ischial tuberosity, greater trochanter of femur
  154. Knee
    • femur, tibia, and patella, suprapatellar pouch, medial and
    • lateral menisci, cruciate ligaments, prepatellar bursa, quadriceps muscle
  155. Ankle and foot
    tibiotalar joint, medial and lateral malleous, metatarsals
  156. Order of operation for musculoskeletal muscle exam=
    = inspection, palpation, range of motion, muscle testing
  157. Inflammatory condition (rheumatoid arthritis)=
    • chronic, systemic inflammatory disease of joints and
    • surrounding tissue. Inflammation in the synovial membrane leads to thickening
    • then to fibrosis which limits motion and finally into bony ankylosis
  158. Osteoarthritis
    • nonimflammatory, localized, progressive disorder involving deterioration
    • of articular cartilages and subchondral bone and formation of new bone
    • (osteophytes) at joint surfaces
  159. Osteoporosis
    • decrease in skeletal bone mass occurring when rate of bone reabsorption
    • is greater then that of bone formation. Increasd risk for stress fractures
    • especially at wrist, hip, and vertebrae
  160. Atrophy
    loss of muscle mass
  161. Joint effusion
    swelling from excess fluid in the joint capsule
  162. Frozen shoulder
    • adhesive capsulitis= fibrous tissue form in the joint
    • capsule, causing stiffness, progressive limitation of motion, and pain
  163. Subacromial bursitis
    • inflammation and swelling of subacromial bursa over the
    • shoulder casuing limited range of motion
  164. Olecran bursitis
    • large soft knob or “goose egg”and redness from inflammation
    • of olecran bursa
  165. Gouty anthritis
    • joint effusion or synovial thickening, seen first as a bulge
    • or fullness in grooves on either side of olecran process.redness and heat can
    • extend beyond area of synovial membrane
  166. Epicondylitis (tennis elbow)=
    • chronic disabling pain at lateral epicondyle of humerus,
    • radiates down extensor surface of forearm. Occurs with activites combining
    • excessive pronation and supination of forearm with an extended wrist
  167. Ganglion cyst
    • round, cystic, nontender nodule overlying a tendon sheath or
    • joint capsule, usually on dorsum wrist. Flexion makes it more prominent. A
    • common benign tumor which does not become malignant
  168. Colle’s fracture
    • nonarticular fracture of distal radius, with or without
    • fracture of ulna at syloid process, usually from a fall on an outstretched
    • hand, occurs more often in elderly woman, characteristic hump when viewd from
    • the side
  169. Carpal tunnel syndrome
    • atrophy occurs from interferance with motor function from
    • compression of the median nerve inside the carpal tunnel. Caused by chronic repetitive
    • motion, symptoms include burning, pain, numbness
  170. Degenerative joint disease or osteoarthritis
    • characterized by hard, nontender, nodules 2 to 3 mm or more,
    • bony overgrowths of the distal interphalangeal joints arte called “herberden
    • nodes
  171. Acute rheumatoid arthritis
    • painful swelling and stiffness of joints, with fusiform or
    • spindle-shaped swelling of the soft tissue of proximal interphalageal joints,
    • limited range of motion of effected joints
  172. Prepatellar bursitis
    • localized swelling of the anterior knee between patella and
    • skin, tender fluctuant mass indicates swelling, infection may spread through
    • surrounding tissues, condition limited to bursa, and the knee joint itself is
    • not involved, overlying skin may be red, shiny, atrophic, or coarse and thickened
  173. Osgood-schlatter disease
    • painful swelling of the tibial tubercle just below the knee,
    • probably from stress on the patellar tendon, occurs most often during pubery
    • during rapid growth and most often in males, symptoms may resolve with rest
  174. Achilles tenosynovitis
    • inflammation of the tendon sheath near the ankle, produces a
    • superficial lining swelling and a localized tenderness along the route of the
    • sheath, movement causes pain
  175. Chronic/acute gout
    • usually involves first the metatarsophalageal joint,
    • consists of redness, swelling, heat, and extreme tenderness, a metabolic
    • disorder of disturbed purine metabolism, associated with skeletal serum uric
    • acid, occurs primarily in men older then 40 yrs
  176. Hallux vagus
    • hallux vagus is a common deformity from rheumatoid arthritis, lateral or
    • outward deviation of the greater toe with medial prominence of the head of the
    • first metatarsal
  177. bunion
    • inflamed bursa that forms at the pressure point. The great toe loses
    • power to push off while walking which stresses the second and third metatarsal
    • heads, they develop calluses and pain
  178. hammer toes
    • deformities in the 2,3,4,5 toes, associated with hallux valgus, includes
    • hyperextension of the metatarsophalangeal joint and flexion of the proximal
    • interphalangeal joint
  179. Callus
    • hypertrophy of the epithelium develops because of prolonged pressure,
    • commonly on the plantar surface of the first metatarsal head in the hallux
    • valgus deformity, condition is not painful
  180. plantar wart
    • vascular papillomatous growth due to a virus and occurs on
    • the sole of the foot, commonly on the ball, extremely painful
  181. Scoliosis
    • lateral curvature of thoracic and lumbar segments of the
    • spine, usually with some rotation of involved vertebral bodies, functional
    • scoliosis is flexible and is apparent with standing and dissappers when bending
    • over, structural scoliosis is fixed and the curvature is apparent when standing
    • or bending over
  182. spina bifida
    • = incomplete closure of posterior part of vertebrae results in a neural
    • tube defect, seriousness ranges from skin defect along the spine to protrusion
    • of the sac containing meninges, spinal fluid, or malformed spinal cord, most
    • serious type is mylemeningocele in which the meninges and neural tissue
    • protrude whivh usually paralyse below the level of the lesion
  183. central nervous system
    includes brain and spinal cord
  184. peripheral nervous system
    • includes all nerve fibers outside the brain and spinal cord,
    • 12 pairs of cranial nerves, 31 pairs of spinal nerves, and all their branches,
    • carries sensory (afferent) messages to the CNS from sensory receptors, motor
    • (efferent) messages from CNS out to muscles and glands, as well as autonomic
    • messages that govern the internal organs and blood vessels
  185. cerebral cortex
    • the center for human’s highest functions governing thought,
    • memory, reasoning, sensation, and voluntary movement, each half of the cerebrum
    • is a hemisphere with the left hemisphere being more dominant in 95% of people, each
    • hemisphere is divided into 4 lobes: frontal, parietal, temporal, and occipital,
    • each lobe has certain areas to mediate specific functions, the cerebrums outer
    • layer consists of nerve cell bodies, which looks like gray matter because it
    • lacks myelin which is the white insulation on the axon that increases the
    • conduction velocity of nerve impuls
  186. frontal lobe
    • controls personality, behavior , emotion, and intellectual
    • function, precentral gyrus of the frontal lobe initiates voluntary movement
  187. frontal lobe
    • controls personality, behavior , emotion, and intellectual
    • function, precentral gyrus of the frontal lobe initiates voluntary movement
  188. parietal lobe
    postcentral gyrus is the primary center for sensation
  189. occipital
    primary visual receptor center
  190. Temporal
    • behind ear, has primary auditory reception center with
    • functions of hearing, tasts, and smell
  191. wernicke’s area
    • = in temporal lobe, associated with language comprehension,
    • when damage occurs, receptive aphasia results, person hears sounds,but it has
    • no meaning like hearing a foreign language
  192. basal ganglia
    • large bands of gray matter buried deep within the two
    • cerebral hemispheres that form the subcortical associated motor system (the
    • extrapyramidal system), they help initiate and coordinate movements of the body
    • (e.g. the arm swing alternating with legs during walking)
  193. Thalamus
    • main relay station where the sensory pathways of the spinal
    • cord, cerebellum, and brainstem from synapses (sites of contact between two neurons)
    • on there way to the cerebral cortex
  194. Hypothalamus
    • major respiratory center with basic vital functions:
    • temperature, appetite, sex drive, heart rate, and blood pressure control, sleep
    • center, anterior and posterior pituitary gland regulators, and coordinator of
    • autonomic nervous system activity and stress response
  195. Cerebellum
    • a coiled structure located under the occipital lobe tht is
    • concerned with moptor coordination of voluntary movements, equilibrium, and
    • muscle tone, does not initiate movements,but helps quick and complex
    • coordination of many different muscles needed for playing piano, swimming, or
    • juggling
  196. Brainstem
    • consists of 3 areas: midbrain, pons, medulla, the central
    • core of the brain consisting of mostly nerve fibers, CN 3-11 originater from
    • the nuclei in the brainstem
  197. Midbrain
    • most anterior part of brainstem that still has the basic tubular
    • structure of the spinal cord, it merges into the thalamus and hypothalamus,
    • contains many motor neurons and tracts
  198. Pons
    • = enlarged area containing ascending motor tracts , has two
    • respiratory centers (pneumotaxic and apneustic) that coordinate with the main
    • respiratory center in the medulla
  199. Medulla
    • continuation of the spinal cord in the brain that contains all ascending
    • and descending fiber tracts, contains vital autonomic centers (respiration,
    • heart, gastrointestinal function) as well as nuclei for CN 7-12, pyramidal
    • decussation (crossing of the motor fibers) occurs here
  200. Spinal cord
    • a long, cylindric structure of nervous tissue as big around
    • as the little finger, occupys upper two thirds of the vertebral canal from the
    • medulla to the lumbar bertebrae L1-L2, its white matter is bundles of
    • myelinated axons that form the main highway for ascending and descending fiber
    • tracts that connect the brain to the spinal nerves, mediates reflexes of
    • posture control, urination, and pain response, its nerve cell bodies or gray
    • matter are arranged in a butterfly shape with anterior and posterior horns
  201. Pathways of the CNS:
    • crossed representaion: left cerebral cortex receives sensory
    • information from and controls right side of the body whereas the right cerebral
    • cortex likewise interacts with the left side of the body
  202. Sensory pathways
    • millions of sensory receptors are embroided into the skin,
    • mucous membranes, muscles, tendons, and viscera, monitor conscious sensation,
    • internal organ functioning, body position, sensation travels in the afferent
    • fibers in the peripheral nerve then through the posterior (dorsal) root and
    • then into the spinal cord where it may take the spinothalamic tract or the
    • posterior (dorsal) columns
  203. Spinothalamic tract
    • contains sensory fibers that transmit the sensations of
    • pain, temperaure, and crude or light touch (i.e not precisely localized),
    • fibers enter the dorsal root of the spinal cordand synapse with a second
    • neuron, the second-order neuron fibers cross to the opposite side and ascend up
    • the spinalthalamic tract to the thalamus, fibers carrying pain and temperature
    • sensations ascend the lateral spinothalamic tract, crude touch sensations form
    • from the anterior spinothalamic tract, at the thalamus the fibers synapse with
    • a third sensory neuron which carries the message to the sensory cortex for full
    • interpretation
  204. Posterior dorsal column
    • these fibers conduct the sensation of position, vibration,
    • and localized touch, position: without looking you know where your body parts
    • are in space in relation to each other, feeling vibrating objects,
    • (stereognosis) without looking, you can identify familiar objects by touch,
    • these fibers enter the dorsal root and proceed immediately up the same side of
    • the spinal cord to the brainstem
  205. Motor pathways (corticospinal or pyramidal tract)=
    • mediate voluntary movement particularly the very skilled
    • discrete and purposeful movements such as writing, named the pyramidal because
    • it originates from the pyramidal shaped cells in the motor cortex, motor nerve
    • fibers originate in the motor cortex and travel to the brainstem where they
    • cross to the opposite or contrlateral side and then pass down in the lateral column
    • of the spinal cord, at each cord level they synapse with a lower motor neuron
    • contained in the horn of the spinal cord,
  206. Extrapyramidal tracts
    • include all the motor nerve fibers originating in the motor
    • cortex, basal ganglia, brainstem, and spinal cord that are outside the
    • pyramidal tract, an older lower more primitive motor system which maintain
    • muscle tone and control gross autonomic movements, body movements such as
    • walking
  207. Cerebellar system
    • complex motor system that controls system coordinates movements,
    • maintains equilibrium, and helps maintain posture, cerebellum receives in
    • formation about the position of muscles and joints, the body’s equilibrium, and
    • what kind of motor messages are being sent from the cortex to the muscles, info
    • is integrated and the cerebellum uses feedback pathways to exert its control
    • back on the cortex or down to a lower motor neurons in the spinal cord, entire
    • process is on the subconscious level
  208. Upper motor neurons
    • complex of all descending motor fibers that can influence or
    • modify lower motor neurons, located completely within the CNS, convey impulses
    • from motor areas of the cerebral cortex to the lower motor neurons in the
    • anterior horn cells of the spinal cord, disease of upper motor neuron consist
    • of cerebrovascular accident, cerebral palsy, and multiple sclerosis
  209. Lower motor neurons
    • located mostly in the peripheral nervous system, cell body
    • located in the anterior gray column of the spinal cord, but the nerve extends
    • from here to the muscle, the final common pathway because it funnels many
    • neural signals here and it provides the final direct contact with the muscles,
    • any action into movement must be translated into action by lower motor neuron
    • fibers, examples: CN and spinal nerves of the peripheral nervouse system,
    • disease: spinal cord lesions, poliomyelitis, and amyotrophic lateral sclerosis
  210. Peripheral nervous system
    • = a nerve bundle is a bundle of nerves outside the CNS, peripheral nerve
    • carries input to the CNS via their sensory afferent fibers and deliver output
    • from the CNS via the efferent fibers
  211. Spinal nerves
    • arise from the length of the spinal cord and supply the rest of the
    • body, named for the region of the spine from which they eit: 8 cervical, 12
    • thoracic, 5 lumbar, 5 sacral, 1 coccygeal, they are mixed nerves because they
    • carry both sensory and motor fibers, the nerves enter and exit the cord through
    • roots, sensory afferent fibers enter and exit through posterior or dorsal roots
    • and motor efferent fibers through the anterior or ventral roots
  212. Autonomic nervous system
    • overall fuction is to maintain body homeostasis, the
    • peripheral nervous system is composed of CN and spinal nerves, the nerves carry
    • fibers that can be divided into two functioning parts: somatic and autonomic,
    • somatic fibers innervate the skeletal (voluntary) muscles, the autonomic fibers
    • innervate smooth (involuntary) muscle e.g. cardiac muscle and glads, also
    • mediates unconscious activity
  213. Reflex arch
    • 4 types of reflexes: (deep tendon reflex aka myotic)e.g.
    • knee reflex, (superficial) e.g.abdominal reflex, (visceral aka organic) e.g.
    • papillary response to light accommodation, (pathologic aka abnormal) e.g. babinski,
  214. Romberg test
    • ask person to stand up with feet together and arms at the
    • side, close eyes and hold position, should be able to hold position for 20
    • seconds, positive Romberg when pt loses balance when closing eyes, occurs with
    • cerebellar ataxia, multiple sclerosis, alcohol intoxication, loss of
    • proprioception and loss of vestibular function
  215. Stereognosis
    • abiltuy to identify objects by holding in hands with eyes
    • closed
  216. Graphesthesia
    ability to read a number that is traced on your hand
  217. Extinction
    • simultaneously touch both sides of the body at the same
    • point, ask person what they feel, should feel both points
  218. Glascow coma scale
    • divided into 3 areas: eye opening, verbal response, and motor response,
    • >7 reflects coma, 15 is normal
  219. Paralysis
    • decrease or loss of motor control due to problem with motor
    • nerve or muscle fiber
  220. Fasciculations
    • rapid continuous twitching of resting muscle without
    • movement of limb, 2 types: fine-occurs with lower motor neuron disease, and
    • coarse-occurs with cold exposure or fatigue that is not significant
  221. Tic
    • involuntary compulsive repetitive twitching due to a neurological cause,
    • e.g. tardive dyskinesias, tourette syndrome
  222. Myoclonus
    • rapid sudden jerk or a short series of jerks at fairly
    • regular intervals, e.g. hicupp is a myclonus of the diaphragm, normal when
    • falling asleep
  223. Tremor
    • invouluntary contraction of opposing muscle groups resulting
    • in rhythmic back and forth movement of one or more joints, may be slow or rapid
  224. Rest tremor
    • occurs when muscles are quiet and supported against gravity,
    • coarse and slow
  225. Intention tremor
    • rate varies, worse with voluntary movement as in reaching towards a
    • visually guided target
  226. Spastic hemiparesis
    • = arm is immobile against body, with flexion of the
    • shoulder, elbow, wrist, and fingers and adduction of shoulder, does not swing
    • freely, leg is stiff and extended and circumducts with each step (drags toe in
    • a semicircle)
  227. Cerebellar ataxia
    • staggering, wide-based gait, difficulty with turns, uncoordinated
    • movement with posistive Romberg sign
  228. Parkinsonian (festinating)=
    • posture is stooped, trunck pitched fwd, elbows, knees are
    • flexed, steps are short and shuffling, hesistation while walking and difficult
    • to stop suddenly, body rigid, walks and turns whole body as one unit,
    • difficulty with cjange in direction
  229. Steppage and foot drop
    • slapping quality, looks as if walking up stairs and finds no
    • stair there, lift knee and foot high and slaps it down hard on flat to
    • compensate for footdrop
  230. Peripheral neuropathy
    • loss of sensation involves all modalties, loss is most
    • severe distally (feet and hands),
  231. Spinal cord hemisection (brown sequard syndrome)=
    • loss of pain and temperature, contralateral side, staring
    • one to two segments below the level of the lesion, loss of vibration position
    • discrimination on the ipsilateral side, below the level of the lesion
  232. Complete transection of spinal cord
    • = complete loss of all sensory modalities below the level of
    • the lesion, associated with motor paralysis and loss of sphincter control
  233. Thalamus
    • loss of all sensory modalities on the face, arm, and leg on the side
    • contalateral to the lesion
  234. Decorticate rigidity
    • upper extremities flexion of the arm, wrist, and fingers,
    • adduction of arm, lower extremities extension, internal rotation, plantar
    • flexion, indicates hemispheric lesion of cerebral cortex
  235. Decebrate rigidity
    • upper extremities stiffly extended, adducted, internal
    • rotation, palms pronated, lower extremities stiffly extended, plantar flexion,
    • teeth clenched, hyperextended back, more ominous then decorticate rigidity,
    • idicates lesion in brainstem at midbrain or upper pons
  236. Flaccid quadriplegia
    • complete loss of muscle tone and paralysis of all four extremities,
    • indicating completely nonfunctional brainstem
  237. thoracic cage
    bony structure with a conical shape witch is narrower at the top, defined by the vertebre, 12 pairs of ribs, and 12 thoracic vertebre, floor consists of the diaphragm
  238. ribs
    first 7 ribs attach directly to sternum via coastal cartilidge

    ribs 8-10 attach via cartilage above sternum

    11-12 free floating with free palpable tips
  239. costochondral junctions
    points at which the ribs connect to their cartilge

    not palpable
  240. suprasternal notch
    u shaped depression just above the sternum in between clavicles
  241. sternum "breast bone"
    3 parts:

    manubrian

    body

    xiphoid process
  242. sternal angle
    "angle of louis", articulation of the manubrium and body of sternum

    useful place to start counting ribs

    marks the site of tracheal bifurification into the right and left bronchi
  243. costal angle
    right and left costal margins form an angle where they meet at the xiphoid process

    usually 90 degrees

    angle increases when the rib cage is overly extended like with emphysema
  244. vertebra prominens
    flex head and feel the most prominent bony spur at the base of the neck

    spinous process of C7
  245. spinous processes
    angle downward from their vertebral body and overly the vertebral body and rib below

    used as reference points
  246. inferior border of scapula
    dorsal

    lower tip usually located at the 7th or 8th rib
  247. mediastinum
    • middle section of the thoracic cavity
    • contains:esophagus,trachea, heart, and great vessels
  248. pleural cavities
    on both sides of mediastium containing the lungs
  249. lung apex and base
    • highest point
    • 3-4 cm above inner third of the clavicles

    base lies on top of the diaphragm
  250. lobes of lungs
    • left lung narrower because of buldging heart
    • right lung has 3 lobes and left 2
    • may only auscultate right middle lung from anterior
    • lower lobes auscultated from posterior
  251. pleurae
    • thin, slippery serous membranes
    • form an envelope between the lungs and the chest wall
  252. visceral pleurae
    • line the outside of the lungs
    • dipping down into fissures
    • continuos with the parietal pleurae lining the inside of the chest wall and diaphragm
  253. parietal pleurae
    • lines inside of chest wall and diphragm
    • filled with a few ml of lubricant
    • normally has vacum/negative pressure which holds lungs tightly against chest wall
    • extend 3 cm below the costodiphragmatic recess
  254. costodiaphragmatic recess
    • potential space
    • may abnormally fill with air or fluid compromising lung expansion
  255. trachea and bronchial tree
    • transports gases between the environment and the lung parenchyma
    • constitues dead space (150 ml)
  256. acinus
    • functional respiratory unit that consists of the bronchioles, alveolar ducts, alveolar sacs, and the alveoli
    • gaseous exchange occurs across the respiratory membrane in the alveolar duct and in the millions of alveoli which are clustered like grapes wich maximizes surface area for gas exchange
  257. 4 major functions of respiration
    • 1)supplying oxygen to the body for energy production
    • 2)removing co2
    • 3)maintaining homeostasis (acid base balance)
    • 4)maintaining heat exchange (less important in humans)
  258. control of respiration
    • mediated by respiratory center located in the pons and medulla
    • major feedback loop=humoral regulation: co2/o2 levels
    • hypercapnia=increase of co2 in blood causes body to breathe
    • hypoxia= low level of o2 in blood, causes body to breathe, but not as much as excess co2
  259. hypercapnia
    excess levels of co2 in blood
  260. orthopnea
    difficulty breathing when supine
  261. paroxysmal nocturnal dyspnea
    awakening from sleep with shortness of breath (SOB)
  262. tactile fremitus
    • palpable vibration
    • pt says "99"
    • palpable vibration
  263. bronchial sounds
    high, loud
  264. bronchovesicular sounds
    moderate, moderate
  265. vesicular sounds
    low,soft
  266. forced expiratory time
    number of seconds it takes a person to exhale from total lung capacity to residual volume
  267. bronchophony
    • person repeats "99" while you listen
    • normal=soft muffled, indisticnt
    • abnormal=distinct, clear
  268. egophony
    • listen to chest while pt says "eeeeeee"
    • normal= "eeeeeeeee"
    • abnormal= "aaaaaaa"
  269. whispered pectoriloquy
    • ask person to whisper phrase "1-2-3" as you auscultate
    • normal=faint, muffled, almost inaudible
    • abnormal=very clear, distinct, still faint
  270. 6 minute distance walk (6MD)
    • patient in pulmonary rehab
    • person who walks >300 meters is more likely to engage in daily activites
  271. pectus excavatum
    sunken chest
  272. pectus carnatum
    pigeon chest
  273. scoliosis
    lateral s shaped spine
  274. kyphosis
    hump back
  275. cheyne-stokes respiration
    • a breathing cycle in which the pattern will wax and wane
    • increasing in rate and depth and then decreasing
    • 30-45 seconds cycles
    • periods of apnea (20 seconds)
    • common cause is heart failure, meningitis, drug OD,
  276. chronic obstructive breathing
    normal inspiration and prolonged expiration to overcome increased airway resistance
  277. increased tactile fremitus
    occurs with conditions that increase density of lung tissue allowing for better conduction of vibrations and sound

    eg pneumonia, consolidation
  278. decreased tactile fremitus
    • occurs when anything obstructs transmission of vibration
    • e.g. obstructed bronchus, emphysema
  279. rhonchial fremitus
    vibration felt when inhaled air passes through thick secretions in the larger bronchi, may decrease by coughing
  280. crackles fine
    • inhaled air collides with previously deflated airways, airways suddenly pop open
    • pneumonia,heart failure, interstitial fibrosis,
  281. crackles (coarse)
    • inhaled air collides with secretions in the trachea and large bronchi
    • pulmonary edema, pneumonia....
  282. atelectatic crackles
    sounds like fine cracklesbut do not last and are not pathologic

    sections of alveoli are not fully areated, they deflate and accumulate secretions
  283. stridor
    high pitched, originating in larynx or trachea, upper airway obstruction from swollen, inflamed tissues or lodged foreign body
  284. atelectasis
    • collapsed shrunken section of alveoli or entire lung
    • as a result of airway obstruction, compression of the lung
    • cough, lag of expansion from effected side
    • percussion dull over area
    • breath sounds decreased
  285. lobar pneumonia
    infection of lung parenchyma leaves alveolar membrane edematous and porous allowing blood to pass into alveoli
  286. emphysema
    • caused by destruction of pulmonary connective tissue
    • permanent enlargement of air sacs distal to terminal bronchioles
    • decreased tactile fremitus and chest expansion
    • shortness of breath
  287. pneumocystis carinii pneumonia
    • virulent form of pneumonia is a protozoal infection associated with aids
    • cysts containing the organism and macrophages form in the alveolar spaces causing them to thicken
  288. tuberculosis
    • accute inflammatory, macrophages engulf bacilli but do not kill them
    • tubercle forms around bacilli, scar tissue forms, lesions calcify, extensive erosion as lesion erodes into bronchus
    • initially asymtomatic
    • normal or decreased breath sounds
  289. pulmonary embolism
    undissolved material originating in legs or pelvis detach and travel through venous system returning blood to right heart and lodge to occlude pulmonary vessels
  290. acute respiratory distress syndrome
    • acute pulmomary insult (trauma, gastric acid aspiration,shock,sepsis) damages alveolar capillary membrane leading to an increased permeability of pulmonary capillaries and alveolar epithelium and to pulmonary edema,
    • acute onset of dyspnea
    • hypotension
    • tachycardia
    • crackles
  291. temporal artery
    palpated in front of the ear
  292. carotid artery
    palpated in groove between the sternomastoid muscle and trachea
  293. brachial artery
    • major artery supplying the arm
    • runs in the bicepts-tricepts furrow of the upper arm and surfaces at the antecubical fossa in the elbow medial to the bicepts tendon
    • bifuricates immediately below elbow into the ulnar and radial arteries
  294. ulnar arteries
    run distally and form two arches supplying the hands

    called superficial and deep palmar arches

    pulse located at wrist closest to pinky
  295. radial artery
    pulse located at wrist closest to thumb
  296. femoral artery
    • passes under the inguinal ligament
    • travels down thigh and then is known as popliteal artery
    • pulse located posterior knee medially
  297. popliteal artery
    • located posterior knee medially
    • bifuricates directly below knee
    • turns into anterior tibial artery traveling down to anterior foot to become dorsalis pedis
    • back of leg called posterior tibial artery travels down behind medious malleus and forms plantar arteries
  298. dorsalis pedis artery
    pulse located on top of foot medially, closer to big toe side
  299. posterior tibial artery
    pulse located on interior achilles tendon below joint
  300. veins in the arm
    • each arm has two sets of veins
    • superficial and deep
    • superficial in subcutaneous and responisble for most of the venous return
  301. veins in leg
    • leg contains 3 types of veins
    • 1)deep veins
    • 2)superficial veins
    • 3)perforators
  302. deep veins
    • run alongside the deep arteries and conduct most of venous return for legs
    • these are the femoral and popliteal veins
  303. superficial veins of legs
    these are the great and small saphenous veins
  304. perforator veins of legs
    connective veins that join the superficial and great and small saphenous veins

    contain one way valves that route blood from the superficial into the deep veins
  305. venous flow
    • drain deoxygenated blood and its waste products to the heart
    • low pressure system unlike arteries
    • because veins do not have a pump allowing circulation, they depend on body movement for circulation
  306. venous method of circulation
    • 1)contracting skeletal muscles
    • 2)pressure gradient caused by breathing causing thoracic pressure to increase while abdomainl pressure increases
    • 3)intraluminal valves ensuring one way directional flow
  307. right lymphatic duct
    • empties into right subclavian vein
    • drains right side of head, neck,right arm,right side thorax, right lung and pleura, right side of heart, upper right section of liver
  308. thoracic duct
    • drains everything that the right lymphatic duct doesnt
    • drians into left subclavian vein
  309. functions of lymphatic system
    • 1)conserve fluid and plasma proteins that leak out of capillaries
    • 2)form major part of immune system
    • 3)absorb lipids from intestinal tract
  310. lymph nodes
    • small oval clumps of lymphatic tissue located at intervals along the vessels
    • most nodes located at intervals alongside vessels
    • filter fluid before it is returned to the blood stream
    • expose pathogens to b and t lymphocytes
  311. related organs to lymphatic system
    • spleen-4 functions 1)destroy old blood cells
    • 2)produce antibodies 3)store red blood cells 4)filter microoragnisms from blood
    • tonsils-respond to local inflammation
    • thymus-located insuperior mediastynum, develops t lymphocites in children
    • b lymphocites originate in bone marrow
  312. pulse rating
    • 1+ =weak or thready
    • 3+ - 4+ =full, bounding
  313. pulses paradoxus
    • beats have weaker amplitude with inspiration
    • stronger amplitude with expiration
  314. raynaud's syndrome
    • abrupt, progressive tricolor change in fingers in response to cold, vibration, or stress
    • may expierience cold, numbness, or pain along with pallor or cyanosis
  315. lymphedema
    • high protein swelling of limb
    • most commonly due to breast cancer treatment
    • surgical removal of lymph nodes and vessels with radiation therapy impedes drainage of lymph
  316. arteriosclerosis-ischemic ulcer
    • buildup of fatty plaques on intima
    • hardening and calcification or arterial wall
    • deep muscle pain in calf or foot
    • coolness, pallor, diminished pulse
    • ulcers occur at toes, metatarsal heads, heals, lateral ankle,
    • ulcers characterized by pale ischemic base, well defined edges, and no bleeding
  317. venous (stasis) ulcer
    occurs after acute deep vein thrombosis or chronic incompetant valves in deep veins

    often occurs at medial malleous and characterized by bleeding and uneven edges
  318. deep vein thrombosis
    • deep vein occluded by thrombus, causing inflammation and blocked venous return, cyanosis and edema,
    • 3 factors promoting disorder:stasis, hypercoagulbality, and endothelial dysfunction
    • caused by prolonged bedrest
  319. occlusions
    caused by athersclerosis
  320. aneurysms
    sac formed by dilation of artery wall

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