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What does a rib dislocation commonly refer to?
displacement of cartilage, usually 2nd-7th, from sternum (dislocation of synovial joint)
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What does a rib dislocation cause?
severe pain at time of injury and during respiratory movements
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What does a rib dislocation produce?
a lump like deformity at dislocation site
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Does dislocation of costovertebral joints occur?
yes, but less common
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Why are dislocation of costovertebral joints less common?
owing to strong articular capsules ligaments
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When are rib dislocations common?
in body contact sports
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What are possible complications with rib dislocation?
pressure on or damage to nearby nerves, blood vessels, and muscles
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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
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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
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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
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Why would one need to count the ribs?
to determine which rib is diseased/injured
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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
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Can the sternal angle occur at level of 3rd costal cartilage?
yes but uncommon
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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
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Where does the subclavian artery pass on its way to the upper extremity?
crosses 1st rib
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What does the subclavian artery produce when the subclavian artery passes the 1st rib?
distinct groove
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Could the subclavian artery be compressed where it passes over the 1st rib?
yes
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If the subclavian artery is compressed when passing the 1st rib, what happens?
- produces vasular symptoms
- (pallor, coldness, and cyanosis of hands)
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What happens with pressure on inferior trunk of brachial plexus?
nerve compression symptoms (numbness/tingling) in digits
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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)
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What is another name for herpes zoster?
shingles
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What is herpes zoster?
- viral disease of spinal dorsal root ganglia
- (literally: creeping, girdle-shaped cutaneous eruption)
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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
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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
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Where can a tube be inserted to drain fluid/air from pleural cavity?
intercostal space
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What is aspiration?
removal by suction
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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
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During aspiration, how does one avoid damage to main intercostal vessles/nerve?
needle inserte superor to rib, just high enough to avoid collateral branches
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How is local anesthesia of intercostal space produced?
inject anesthetic agent around origin of intercostal N, just lateral to vertebra concerned
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What is intercostal nerve block?
inflitration of local anesthetic agent around intercostal N trunk and collateral branch
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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
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Because of considerable overlapping of adjacent dermatomes, what must be done for complete anesthesia to result?
two or more consecutive intercostal nn are anesthetized
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Do the moist, smooth pleurae make sound during inspiration/expiration?
no
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What is auscultaion?
listening to sounds made by thoracic viscera
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What happens when there is inflammation of pleurae?
- pleuritis
- makes surfaces of lungs rough
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What is the result of rough lungs?
- friction rub (pleural rub)
- heart w/ stethoscope
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What does irritation of parietal pleura cause?
pain referred to thoracoabdominal wall (innervated by intercostal nerves) or to shoulder
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What may cause pleural adhesions to form between parietal and visceral layers of pleura?
pleuritis
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What is hydrothorax?
accumulation of significant amounts of fluid in pleural cavity
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Is there one main cause of hydrothorax?
no, results from variety of causes
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What happens in advanced cases of pleuritis?
serum from inflamed pleurae may exude/effuse from blood vessels of pleurae into pleural cavity
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Whe forms pleural exudate?
serum from inflamed pleurae exuding/effusing from blood vessels of pleurae into pleural cavity (in pleuritis)
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As fluid accumulates, the negative or subatmospheric pressure is lessened, what does this allow the lung to do?
retract
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What happens when lung is completely retracted?
additional fluid will displace the heart and mediastinum toward opposite side
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What happens with a chest wound?
blood may enter pleural cavity (hemothorax)
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What is chyle?
lymph and emulsified fat
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Why may chyle pass into pleural cavity?
ruptured thoracic duct
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What is chylothorax?
when chyle passes into pleural cavity from ruptured thoracic duct
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What is pneumothorax?
air in pleural cavity
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What causes pneumothorax?
- penetrating wound or rupture of lung
- fractured ribs
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What is the result of pneumothorax?
partial collapse of lung
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What is the most common type of pneumothorax?
spntaneous pneumothorax
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What happens in an open pneumothorax?
communication between atmosphere and pleural cavity
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What is open pneumothorax sometimes referred to as?
- blowing wound
- sucking pneumothorax
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