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Are most cases of uncomplicated pneumothorax dangerous?
no
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What happens if the opening of the pneumothorax in visceral pleura has a flap over it?
air can enter pleural cavity on nspiration but can't leave it during expiration
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If air can enter the pleural cavity on inspiration but can't leave during expiration, what happens to the amount of air in the pleural cavity?
increases (positive pressure pneumothorax)
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With positive pressure pneumothorax (increased air in pleural cavity), what does this cause?
pushes mediastinum to contralateral side, compressing opposite lung, and creating medical emegency
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How is air/fluid (blood, pus, and chyle) removed from pleural cavity?
w/ wide-bore needle
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How are large amounts of air/fluid removed from pleural cavity?
insert drainage tube through intercostal space
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Where is the other end of the drainage tube connected?
underwater seal in a bottle
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What is thoracotomy?
removal of large amount of air/fluid from pleural cavity by use of drainage tube through intercostal space
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Why might the costal pleura be injured during surgical removal of a kidney?
because costal pleura is in contact w/ 12th rib
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Why might the 11th rib be mistaken for the 12th rib?
when 12th rib is very short
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What is a bronchoscope?
instrument inserted via mouth for examining trachea and bronchi
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What is the name of the keel-like ridge between the orifices of the main bronchi?
carina
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What plane is the carina normally in?
nearly in a sagittal plane and has fairly definite edge
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What happens if tracheobronchial lymph nodes in angle between main bronchi enlarge?
carina becomes distored, widened posteriorly, and immobile
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The morphological chages in the carina are important diagnostic signs for:
the bronchoscopist in assisting w/ differnetial diagnosis of disease of rpiratory system
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What is one of the most sensitive areas of the tracheobronchial tree?
the mucous membrane at carina
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What part of the tracheobronchial tree is associated wth the cough reflex?
mucous membrane at carina
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Knowledge of normal anatomy of bronchopulmonary segments is essential for accurate interpretation of what?
chest radiographs and surgical resection of diseased segments
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Where do bronchial and pulmonary disorders often localize?
in bronchopulmonar segment
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Are each bronchopulmonary segment supplied by own nerve, artery and vein?
yes, but planes between thm crossed by tributaries of pulmonary veins and small branches of pulmonary arteries
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What do the connective tissue septa separating segments prevent?
air from passing between segments
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What causes segmental atelectasis?
air in bronchopulmonary segment whose segmental bronchus is obstructed and absorbed by bloodstream
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What is segmental atelectasis?
collapse of affected segment of lung tissue
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Knowledge of branching of bronchial tree is essential for determining what?
the appropriate posture for draining infected area of lung
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When patient w/ bronchiectasis (dilation of bronchi) is on left side, secretions from right lung/bronchi flow toward what?
carina of trachea
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Since the carina is very sensitive, the secretions flowing toward it stimulate what?
cough reflex, patient brings up purulent sputum, clearing R bronchial tree
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A person w/ bronchiectasis of lingula of supeiror lobe drains it by lying on which side?
right side
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Oropharyngeal and nasopharyngeal contents containing bacteria may be aspirated into what?
lungs
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Aspiration of bacterial contents from oropharyneal and nasopharyngeal into the lungs causes what?
- inflammation of lungs (pneumonitis or pneumonia
- lung abscess in one or more bronchopulmonary segments
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How does inflmmation of lungs or lung abcess in one or more bronchopulmoary segments relate to the position of very ill and unconscious patients?
- position changed frequently to promote good aeration of lungs
- usual supine position assumed in bed, is poor for lung drainage
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A tumor may block a segmental bronchus and cause what?
collapse of bronchopulmonary segment, owing to absorption of air in segment by blood circulating through it
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Pulmonary thromboembolism (PTE) is a common cause of what?
morbidity and mortality
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How does an embolus form?
- when thrombus (blood clot), fat globules, or air bubbles are carried from distant site
- thrombus passes through R side of heart and carried to lung via pulmonary artery
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What is the immediate result of PTE?
complete/partial obstruction of arterial blood flow to lung
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What does embolicobstruction of pulmonary artery produce?
sector of lung ventilated by not perfused w/ blood
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What might a very large embolus do?
occlude pulmonary trunk or one of main pulmonary arteries
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When large embolus occludes pulmonary trunk/pulmonary artery what happens to the patient?
suffers acute respiatory distress and may die in few minutes
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What might a medium-sized embolus do?
block artery to bronchopulmonary segment/produce infarct
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What is an infarct?
area of dead tissue
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In healthy people, collateral circulation often develops so what?
so that infarcton doesn't occur
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What is collateral circulation?
abundant anastomoses in region of teminal bronchioles
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What happens in ill people whom circulation in lung is impaired?
PTE commonly results in infarction of lung
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B/c area of pleura is deprived of blood, what happens?
becomes inflamed, which results in pain
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Where is pain from inflammed pleura referred to?
cutaneous distribution of intercostal nn (thoracic wall/anterior abdominal wall)
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What do lymph from lungs carry?
phagocytes
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What do phagocytes contain?
ingested carbon particles from inspired air
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In cigarette smokers/city dwellers, these particles give surface of lungs what kind of appearance?
mottled gray to black apearance
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Where are the carbon particles carried to?
lymph nodes in hilum of lungs and mediastinum, giving them similar appearance
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What happens if parietal and visceral layers of pleura adhere to one another?
lymphatics in lung and visceral pleura may drain into axillary lymph nodes
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Presence of carbon particles in axillary lymph nodes is presumptive evidence of what?
pleural adhesions
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