Exam 3: The Thorax Handout Part 1
Card Set Information
Exam 3: The Thorax Handout Part 1
review of thorax handout for exam 3
What does a rib dislocation commonly refer to?
displacement of cartilage, usually 2nd-7th, from sternum (dislocation of synovial joint)
What does a rib dislocation cause?
severe pain at time of injury and during respiratory movements
What does a rib dislocation produce?
a lump like deformity at dislocation site
Does dislocation of costovertebral joints occur?
yes, but less common
Why are dislocation of costovertebral joints less common?
owing to strong articular capsules ligaments
When are rib dislocations common?
in body contact sports
What are possible complications with rib dislocation?
pressure on or damage to nearby nerves, blood vessels, and muscles
What does a rib separation usually refer to?
dislocation of costochondral junction between rib and costal cartilage
no lack of continuity in shaft of rib that may be detected in radiograph of fractured rib
What happens in conjunction with separation of 3rd to 10th rib?
trearing of perichondrium and/or periostium
one of costal cartilages (usually 10th) separates from inferior border of costal cartilage superior to it
Since the perichondrium tears w/ rib separation, what usually happens?
cartilage of "slipping rib" can move superiorly and override one superior to it, causing pain
Why would one need to count the ribs?
to determine which rib is diseased/injured
How does one count the ribs?
sternal angle located/palpating digit passed directly laterally from it to second costal cartilage
ribs counted inferolaterally from this point to avid confusion w/ fused intercostal cartilages
Can the sternal angle occur at level of 3rd costal cartilage?
yes but uncommon
When should one check for the sternal angle to be at 3rd costal cartilage?
if manubrium is longer than usual and sternal angle is move than 5 cm (2in) inferior to jugular notch
Where does the subclavian artery pass on its way to the upper extremity?
crosses 1st rib
What does the subclavian artery produce when the subclavian artery passes the 1st rib?
Could the subclavian artery be compressed where it passes over the 1st rib?
If the subclavian artery is compressed when passing the 1st rib, what happens?
produces vasular symptoms
(pallor, coldness, and cyanosis of hands)
What happens with pressure on inferior trunk of brachial plexus?
nerve compression symptoms (numbness/tingling) in digits
What is it called when the subclavian artery and inferior trunk of brachial plexus are compressed?
neurovascular compresssion syndrome
(but also has many other names)
What is another name for herpes zoster?
What is herpes zoster?
viral disease of spinal dorsal root ganglia
: creeping, girdle-shaped cutaneous eruption)
What happens when herpes zoster invades spinal ganglia?
sharp buring pain produced in area of skin supplied by nerves involved
few days later, involved dermatomes become red/vesicular eruptions appear on skin
Where can a hypdermic needle be inserted to obtain a sample of pleural fluid or to remove blood/pus from pleural cavity?
through an intercostal space
Where can a tube be inserted to drain fluid/air from pleural cavity?
What is aspiration?
removal by suction
What site is chosen for aspiration of the pleural cavity?
depends on where abnormal fluid is located
tube usually passed through intercostal space just lateral to angles of ribs
During aspiration, how does one avoid damage to main intercostal vessles/nerve?
needle inserte superor to rib, just high enough to avoid collateral branches
How is local anesthesia of intercostal space produced?
inject anesthetic agent around origin of intercostal N, just lateral to vertebra concerned
What is intercostal nerve block?
inflitration of local anesthetic agent around intercostal N trunk and collateral branch
What does the term block indicate?
that nerve endings (pain receptors) in skin and transmission of impulses insensory nn carrying information about pain are interrupted (blocked) before reach spinal cord/brain
Because of considerable overlapping of adjacent dermatomes, what must be done for complete anesthesia to result?
two or more consecutive intercostal nn are anesthetized
Do the moist, smooth pleurae make sound during inspiration/expiration?
What is auscultaion?
listening to sounds made by thoracic viscera
What happens when there is inflammation of pleurae?
makes surfaces of lungs rough
What is the result of rough lungs?
friction rub (pleural rub)
heart w/ stethoscope
What does irritation of parietal pleura cause?
pain referred to thoracoabdominal wall (innervated by intercostal nerves) or to shoulder
What may cause pleural adhesions to form between parietal and visceral layers of pleura?
What is hydrothorax?
accumulation of significant amounts of fluid in pleural cavity
Is there one main cause of hydrothorax?
no, results from variety of causes
What happens in advanced cases of pleuritis?
serum from inflamed pleurae may exude/effuse from blood vessels of pleurae into pleural cavity
Whe forms pleural exudate?
serum from inflamed pleurae exuding/effusing from blood vessels of pleurae into pleural cavity (in pleuritis)
As fluid accumulates, the negative or subatmospheric pressure is lessened, what does this allow the lung to do?
What happens when lung is completely retracted?
additional fluid will displace the heart and mediastinum toward opposite side
What happens with a chest wound?
blood may enter pleural cavity (hemothorax)
What is chyle?
lymph and emulsified fat
Why may chyle pass into pleural cavity?
ruptured thoracic duct
What is chylothorax?
when chyle passes into pleural cavity from ruptured thoracic duct
What is pneumothorax?
air in pleural cavity
What causes pneumothorax?
penetrating wound or rupture of lung
What is the result of pneumothorax?
partial collapse of lung
What is the most common type of pneumothorax?
What happens in an open pneumothorax?
communication between atmosphere and pleural cavity
What is open pneumothorax sometimes referred to as?