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Exam Review 3 - Thorax (1)

Exam Review 3 - Thorax (1)

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Published by: ketsianicholas1stboy on Dec 26, 2012
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06/23/2013

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 A 35-year-old man was in a head on motor vehicle accident and the airbag hit his chestwall. He is in the ER with shortness of breath, chest pain on the right side, and fatigue. Onadmission he is anxious and is in severe respiratory distress. The patient has tachycardia,his blood pressure is 90/60, and he is cyanosed. The cyanosis is not improved with 100%oxygen. On examination you find that his right chest wall is hyperexpanded and has a jugular venous distension. You also find that the breath sounds are decreased on the rightside. What injury will need the most emergent care?
 
A
Openpneumothorax
 
B
Closedpneumothorax 
C
Tensionpneumothorax
 
D
Fracturedrib
 
E
One sidedphrenicusparesis
 
 
C
Tension pneumothoraxRib fractures are clinically important because they can impair respiration, can causepain, and can damage other structures in the area like heart, lung, or liver, for example.They are quite common and represent about 70% of all injuries to the thorax. Afractured rib, if at all, will most likely cause a closed pneumothorax. A closed pneumothorax causes a slow influx of air and usually seals itself. An openpneumothorax is a little more dangerous because it causes the effected side of the lungto collapse, and a shift of the mediastinum to the opposite side might occur. In addition,there is a risk of the wound causing an infection.Damage to one phrenic nerve will cause this side of the diaphragm to relax andtherefore stand higher in the thorax during inspiration, which can be seen onradiographs.Most important is that in all those cases described above, only one side of the lung isseriously affected, while the opposite side, although impaired, is still functioning. This isvery different in case of a tension pneumothorax. A one-way valve causes air to enter the pleural cavity during inspiration, which can not escape during expiration. This leadsto an increase in pressure on the affected side, and the lung will collapse. In addition,the other side of the thorax is compressed and can kill the victim because now bothsides of the lung are impaired to an extent where life can no longer be sustained.
Copyright © EXAM MASTER Corporation 2012
 
 A 50-year-old woman comes to the PCD (primary care doctor) for her annual examination.During the breast exam, it is noticed that when she puts her arms up, there is a retractionon the skin at the right upper external quadrant. What anatomical structure is retracting theskin?
 
A
 Clavipectoralfascia
 
B
 Costocoracoidligament 
C
 Ligamentasuspensoria(Cooper)
 
D
Pectoralfascia
 
E
 Suspensoryligament of the axilla
 
C
Ligamenta suspensoria (Cooper)The
ligamenta suspensoria (Cooper)
is part of the superficial fascia of the anterior thoracic region. These are fibrous processes that come from the fascia that covers themamma and passes forward to the integument and papilla. Sir A. Cooper called thosethe ligamenta suspensoria. This is the structure that retracts the breast skin in breastcancer patients.The
clavipectoral fascia
is located between the Pectoralis minor and Subclavius, alsocalled Coracoclavicular Fascia. It protects the axillary vessels and nerves.The
costocoracoid ligament
is a portion of the coracoclavicular fascia. It goes fromthe first rib to the coracoid process.The
pectoral fascia
covers the surface of the Pectoralis major.The
suspensory ligament of the axilla
is the name that the pectoralis fascia receivesin the axillary region.References:

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